Adrenal Function In Infants Research Articles

Особливості перебігу гострих респіраторно-вірусних інфекцій у дітей раннього віку з тимомегалією

Вступ. Особливості перебігу гострої респіраторної вірусної інфекції (ГРВІ) у дітей із збільшеною загрудинною залозою пов’язані з наявністю у хворих більш чи менш значного імунодефіцитного стану та дисгормонозу з проявами наднирникової недостатності. Мета — вивчити особливості перебігу гострих респіраторних вірусних інфекцій та дослідити функцію наднирникових залоз у дітей раннього віку з тимомегалією. Матеріал та методи. У клінічні дослідження було залучено 41 дитину з тимомегалією, хвору на ускладнені форми ГРВІ, віком від 1 місяця до 3 років. Етіологічна розшифровка ГРВІ проводилася методом парних сироваток. Вміст кортизолу в плазмі крові визначався імуноферментним методом. Групу порівняння становили 36 дітей із тимомегалією без проявів ГРВІ впродовж не менше 3 місяців. Результати. Аналіз анамнестичних даних хворих із тимомегалією показав, що більшість із них зазнали впливу несприятливих умов на різних етапах антенатального, інтранатального та постнатального розвитку. Аналіз даних про розміри загрудинної залози вказав на те, що 3–4-й ступінь тимомегалії частіше спостерігався в дітей з ознаками стенозуючого ларинготрахеїту (75,0 %). У 23,5 % хворих на обструктивний бронхіт тимомегалія була 1-го ступеня, у решти — 3-го та 4-го. При необструктивному варіанті ураження бронхів відмічена протилежна тенденція: найменший ступінь збільшення загрудинної залози діагностовано в 62,5 %, а 3-й та 4-й — у 37,5 % хворих (р < 0,05). Найменша забезпеченість кортизолом спостерігалася в гострому періоді стенозуючого ларинготрахеїту (409,4 ± 10,2 нмоль/мл проти 537,7 ± 11,5 нмоль/мл у групі порівняння; р < 0,05). У гострому періоді ГРВІ, що ускладнилася бронхітом, рівень кортизолу не підвищувався і становив 432,3 ± 32,3 нмоль/мл). У групі хворих на пневмонію зареєстровано вірогідне, можливо, компенсаторне підвищення рівня кортизолу (787,3 ± 2,0 нмоль/мл, р < 0,05). При обструктивному бронхіті в гострому періоді відзначена тільки тенденція до збільшення концентрації кортизолу в крові (562,9 ± 18,9 нмоль/мл). Неоднорідним було й відновлення функції кори наднирникових залоз під час одужання дітей раннього віку з тимомегалією. Найбільш значно до фізіологічних показників наблизилися діти, які одужували від гострого бронхіту. Забезпеченість кортизолом хворих на пневмонію на момент одужання практично не відрізнялася від вихідного рівня дітей із ти­момегалією. Найбільш швидко кількість кортизолу збільшувалася в динаміці стенозуючого ларинготрахеїту (до 528,5 ± 22,6 нмоль/мл). Висновок. Діти з тимомегалією становлять групу ризику за розвитком бронхолегеневих ускладнень гострих респіраторно-вірусних інфекцій.

Adrenal Suppression in Infants Treated with Topical Ocular Glucocorticoids

To analyze the incidence of adrenal suppression and the glucocorticoid (GC) dose per kilogram body weight given in infants treated with standard protocol for topical ophthalmic GCs after congenital cataract surgery. Retrospective, consecutive case series. All children younger than 2 years of age who underwent operation for congenital cataract between January 2011 and May 2015 in 1 center. Patient charts were reviewed to collect data on results and timing of a standard corticotropin (adrenocorticotropic hormone [ACTH]) stimulation test and GC dose per kilogram body weight. Incidence of adrenal suppression in children tested on GC treatment. Glucocorticoid dose per kilogram body weight. Among 26 consecutive infants, 15 (58%) were tested while they were still on GC treatment. Ten of these 15 infants (67%) had adrenal suppression, 2 of whom had obvious clinical signs of Cushing's syndrome and 1 of whom had signs of Addisonian crises during general anesthesia. Eleven of the 26 infants (42%) were tested at a median time of 21 days (range, 6-89) after treatment cessation, and they all had normal test results. Children with suppressed adrenal function had received cumulative GC doses per body weight that were significantly higher the last 5 days before testing compared with children with normal test results. Infants with adrenal suppression were treated with hydrocortisone replacement therapy. Adrenal function recovered after a median of 3.1 months (range, 2.3 months to 2.3 years). Two thirds of the infants tested during treatment with a standard GC protocol after congenital cataract surgery showed adrenal suppression. There was a significant association between the cumulative daily dose of GCs and the test result. Because adrenal suppression is a serious but treatable condition, we recommend a systematic assessment of adrenal function in infants treated with doses of topical ocular GCs comparable to our regimen and careful evaluations of other treatment regimens.

Growth, Bone Mineral Accretion, and Adrenal Function in Glucocorticoid‐Treated Infants with Hemangiomas – A Retrospective Study

Hemangiomas, common proliferative vascular tumors, can grow rapidly in the first months of life. Although therapy with high-dose oral glucocorticoids is standard for lesions that threaten vital functions or are disfiguring, little is known about the endocrine consequences of this treatment. Using retrospective data, we examined growth velocity, changes in bone mineral density, and adrenal function in infants with hemangiomas treated with systemic glucocorticoids. Treatment consisted of oral prednisolone 2 to 4 mg/kg/day or dexamethasone 1 mg/kg/day. Mean growth velocity Z score on glucocorticoid therapy was -1.41 standard deviations in 13 patients. In four infants with adequate follow-up, growth velocity increased to +1.90 standard deviations after glucocorticoid treatment (Delta growth velocity +3.31 standard deviations). Mean lumbar spine bone mineral density Z score was -2.46 standard deviations before glucocorticoid treatment and -1.08 standard deviations at the end of treatment in six infants. Adrenal function after glucocorticoid therapy was assessed by low-dose adrenocorticotropic hormone stimulation test in 10 infants. Eight had a normal cortisol response, and one had a borderline response. One infant, who had been treated with dexamethasone, had an abnormal test result. In conclusion, systemic glucocorticoid treatment in infants with hemangiomas slowed linear growth, but "catch-up" growth was observed after treatment ceased. Glucocorticoids did not affect bone mineralization adversely. Only 1 of 10 glucocorticoid-treated infants had clear evidence of adrenal insufficiency after therapy was stopped.

Effect of Dose on Response to Adrenocorticotropin in Extremely Low Birth Weight Infants

Various cosyntropin doses are used to test adrenal function in premature infants, without consensus on appropriate dose or adequate response. The objective of this study was to test the cortisol response of extremely low birth weight infants to different cosyntropin doses and evaluate whether these doses differentiate between groups of infants with clinical conditions previously associated with differential response to cosyntropin. The design was a prospective, nested study conducted within a randomized clinical trial of low-dose hydrocortisone from November 1, 2001, to April 30, 2003. The setting was nine newborn intensive care units. The patients included infants with 500-999 g birth weight. The drug used was cosyntropin, at 1.0 or 0.1 microg/kg, given between 18 and 28 d of birth. We measured the cortisol response to cosyntropin. Two hundred seventy-six infants were tested. Previous hydrocortisone treatment did not suppress basal or stimulated cortisol values. Cosyntropin, at 1.0 vs. 0.1 microg/kg, yielded higher cortisol values (P < 0.001) and fewer negative responses (2 vs. 21%). The higher dose, but not the lower dose, showed different responses for girls vs. boys (P = 0.02), infants receiving enteral nutrition vs. not (P < 0.001), infants exposed to chorioamnionitis vs. not (P = 0.04), and those receiving mechanical ventilation vs. not (P = 0.02), as well as a positive correlation with fetal growth (P = 0.03). A response curve for the 1.0-microg/kg dose for infants receiving enteral nutrition (proxy for clinically well infants) showed a 10th percentile of 16.96 microg/dl. Infants with responses less than the 10th percentile had more bronchopulmonary dysplasia and longer length of stay. A cosyntropin dose of 0.1 microg/kg did not differentiate between groups of infants with clinical conditions that affect response. We recommend 1.0 microg/kg cosyntropin to test adrenal function in these infants.

Salivary Cortisol Levels in Very Low Birth Weight Infants with Bronchopulmonary Dysplasia Treated with Dexamethasone and Nebulized Budesonide 20

The administration of systemic and nebulized corticosteroids to VLBW infants is beneficial in the treatment of bronchopulmonary dysplasia (BPD). Side effects and complications are frequent and sometimes serious. The aim of the study was to investigate the effect of systemic dexamethasone and nebulized budesonide on adrenal function in infants with BPD using salivary samples. Methods: We measured salivary cortisol levels by RIA in saliva in four groups: (1) ten full-term neonates; (2) ten healthy preterm infants (GA 28-31 wks); (3) ten infants with BPD after 16 days of systemic dexamethasone treatment (24-28 wks); and (4) 10 infants with BPD after 5 days of nebulized budesonide (26-35 wks). Saliva samples were collected in each infant on three consecutive days at 8.00, 12.00, 18.00, 24.00 hours. Results: Our results show suppression of the adrenal function in infants treated with systemic dexamethasone and less pronounced with nebulized budesonide. The results are mean ± SEM (ng/ml).Table

Salivary Cortisol Levels throughout Childhood and Adolescence: Relation with Age, Pubertal Stage, and Weight

The measurement of cortisol in saliva has become a reliable tool for both the scientist and the clinician for studying adrenal cortical function in the adult. We have measured salivary cortisol in samples from 138 healthy infants, children, and adolescents, and from 14 adults. Saliva samples were obtained at home using a cotton swab and a saliva-collecting tube at 800, 1300, and 1800 h before meals. Cortisol was measured using a time-resolved fluorescent immunoassay. Cortisol levels in saliva ranged from less than 2 nmol/L up to more than 100 nmol/L. Cortisol levels were age-dependent. Interestingly, after the age of 6 y, cortisol levels correlated significantly with pubertal stages (analysis of variance). No sex difference was found. In addition, cortisol morning levels and daily cortisol levels (area under the curve from three measurements) increased with body weight and body mass index. The highest cortisol levels were measured in saliva of children younger than 1 y. No circadian variation was evident before the age of 9 mo. After 1 y of age, salivary cortisol levels varied in a circadian fashion. The measurement of salivary cortisol levels is an attractive way of testing adrenal function in infants and children. It provides a reliable tool for the determination of the physiology and developmental characteristics of cortisol metabolism.

159. Adrenal function in infants of diabetic mothers

159. Adrenal function in infants of diabetic mothers

Adrenal Function in Infants and Children: A Symposium.

The purpose of this concise treatise was to bring together as much information as possible on the subject matter, so that those attending the conference would be fully informed of research under way in the field and might profit from the comments and criticisms of their colleagues and peers. The book itself is nicely published on good paper with fine quality of photographs and tables. It is a credit to the editor that so much material could be compiled in so few pages that bear upon a topic which is undergoing rapid change at the present time. In my opinion this is a very complete synopsis, that forms a good background from which clinicians and investigators may draw valuable aid in the present and future. The material compiled in this book forms a staging point for the next steps in this field, namely, elucidation of enzymatic mechanisms involved and further

Adrenal Function in Infants and Children: A Symposium

Medical Journal of AustraliaVolume 1, Issue 23 p. 796-796 Review Adrenal Function in Infants and Children: A Symposium First published: 01 June 1957 https://doi.org/10.5694/j.1326-5377.1957.tb59870.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume1, Issue23June 1957Pages 796-796 RelatedInformation

Adrenal Function in Infants and Children

Adrenal Function in Infants and Children

Adrenal Function in Infants and Children

Adrenal Function in Infants and Children

Adrenal Function in Infants and Children

Adrenal Function in Infants and Children

Adrenal Function in Infants and Children: 13th M &amp;amp; R Pediatric Research Conference.

Adrenal Function in Infants and Children: 13th M &amp;amp; R Pediatric Research Conference.

Book Review: A Symposium on Adrenal Function in Infants and Children

Book Review: A Symposium on Adrenal Function in Infants and Children

SYMPOSIUM ON ADRENAL FUNCTION IN INFANTS AND CHILDREN

Journal Article SYMPOSIUM ON ADRENAL FUNCTION IN INFANTS AND CHILDREN Get access Endocrinology, Volume 55, Issue 3, 1 September 1954, Pages 367–368, https://doi.org/10.1210/endo-55-3-367b Published: 01 September 1954