Transient adrenal insufficiency in the premature newborn.
OBJECTIVE
Relative adrenal insufficiency is a controversial phenomenon described in adults and children with critical illness, especially septic shock. In the past 2 decades, relative adrenal insufficiency has also been reported in the critically ill premature as well as term newborn. The present study will review the initial and more recent studies addressing adrenal insufficiency in the premature infant.


RESULTS
Studies suggest that 'relative adrenal insufficiency' is a contributing factor to hemodynamic instability in the sick preterm newborn. Many ill preterm newborns have inappropriately low serum cortisol concentrations and respond to steroid administration. Adrenal insufficiency is transient and likely reflects normal adrenal physiology at younger gestational ages. There is no general consensus on its diagnosis, effective minimum dose for treatment and duration of treatment.


CONCLUSIONS
More large scale, multicenter, randomized, double-blind studies are needed to make the diagnosis of relative adrenal insufficiency and to determine the indication, dose, complications and outcome of glucocorticoid therapy.
Quintos
Jose B
JB
Department of Pediatrics, Division of Endocrinology and Metabolism, Rhode Island Hospital/The Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA. jbquintos@brown.edu
Boney
Charlotte M
CM
D000311:Adrenal Glands / Q000196:embryology / Q000502:physiology; D000309:Adrenal Insufficiency / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D000324:Adrenocorticotropic Hormone; D005333:Fetus / Q000502:physiology; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000172:deficiency / Q000627:therapeutic use; D007231:Infant, Newborn; D007234:Infant, Premature
D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone