title: The use of an early ACTH test to identify hypoadrenalism-related hypotension in low birth weight infants.
abstract: OBJECTIVE
  To investigate if in preterm newborns, an early adrenocorticotropin hormone (ACTH) test can identify possible transient adrenal insufficiency (TAI), using significant hypotension as a clinical marker.
  
  
  METHODS
  We studied 40 premature newborns born 24 to 29 weeks gestational age (GA) before 8 h of life. Serum cortisol levels were obtained before and 40 min after administration of 1.0 mcg kg(-1) cosyntropin. Inotropes were used to treat hypotension based on clinical assessment following no response to fluid boluses. Functional echocardiogram was used to support the clinical diagnosis of hypotension. The accuracy of the ACTH test was evaluated using receiver operating characteristic (ROC) curve.
  
  
  RESULTS
  Study patients had mean GA of 26.6 weeks and birth weight of 876 g. In all, 30% required inotropes. The area under the ROC curve for the ACTH test was 87%. Using a cutoff of an increase in cortisol below 12% from baseline had 75% sensitivity and 93% specificity for detecting hypotension. This cutoff was associated with bronchopulmonary dysplasia (8/12 vs 7/28, 95% CI: 0.1 to 0.72), but not with other morbidities or death.
  
  
  CONCLUSIONS
  An early ACTH test using the above cutoff has high specificity for detecting hypotension, and thus, can serve as a marker for potential TAI in preterm newborns. Future studies should focus on identifying those newborns for which steroid supplementation would be most beneficial.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Children's & Women's Health Centre of British Columbia, Vancouver, BC, Canada.
authors.forename: O
authors.initials: O
authors.lastname: Hochwald
authors.forename: L
authors.initials: L
authors.lastname: Holsti
authors.forename: H
authors.initials: H
authors.lastname: Osiovich
mesh_terms: D000309:Adrenal Insufficiency / Q000175:diagnosis*; D000324:Adrenocorticotropic Hormone / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001997:Bronchopulmonary Dysplasia / Q000097:blood / Q000175:diagnosis; D003366:Cosyntropin; D042241:Early Diagnosis; D004452:Echocardiography; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007022:Hypotension / Q000175:diagnosis*; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000097:blood / Q000175:diagnosis*; D008297:Male; D011247:Pregnancy; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D003366:Cosyntropin; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone