title: Term neonates with infection and shock display high cortisol precursors despite low levels of normal cortisol.
abstract: OBJECTIVE
  Neonatal therapy-resistant septic shock is a common problem in middle and low-income countries. We investigated whether newborn infants with infection and therapy-resistant hypotension showed evidence of abnormal levels of cortisol or cortisol precursors.
  
  
  METHODS
  A total of 60 term or near term neonates with evidence of infection were enrolled after informed consent. Of these, 30 had an infection and refractory shock and 30 had an infection without shock. There were no detectable differences between the groups in the length of gestation, birth weight or gender distribution. Serum was obtained during days four and 14 after birth. Cortisol and cortisol precursor concentrations were analysed using liquid chromatography-tandem mass spectrometry.
  
  
  RESULTS
  The cortisol concentrations were low considering the expected responses to stress and they did not differ between the groups. The infants with infection and shock had higher serum dehydroepiandrosterone (DHEA) levels than those without shock (319.0 ± 110.3 μg/dL, versus 22.3 ± 18.3 μg/dL; p < 0.0001) and they also had higher 17-hydroxy-pregnenolone, pregnenolone and progesterone concentrations. There were no detectable differences in the levels of 17-hydroxy-progesterone, 11-deoxy-cortisol, cortisol or cortisone.
  
  
  CONCLUSIONS
  Septic newborn infants with therapy-resistant hypotension had very high DHEA levels, suggesting that 3-beta-hydroxysteroid dehydrogenase activity limited the rate of cortisol synthesis.
authors.affiliation: PEDEGO Research Center and Medical Research Center Oulu, University of Oulu, Oulu, Finland.|Department of Paediatrics and Neonatology, Suez Canal University Hospital, Ismailia, Egypt.
authors.forename: Abdelmoneim
authors.initials: A
authors.lastname: Khashana
authors.affiliation: PEDEGO Research Center and Medical Research Center Oulu, University of Oulu, Oulu, Finland.|Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.
authors.forename: Marja
authors.initials: M
authors.lastname: Ojaniemi
authors.affiliation: Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.
authors.forename: Markku
authors.initials: M
authors.lastname: Leskinen
authors.affiliation: Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.
authors.forename: Timo
authors.initials: T
authors.lastname: Saarela
authors.affiliation: PEDEGO Research Center and Medical Research Center Oulu, University of Oulu, Oulu, Finland.|Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.
authors.forename: Mikko
authors.initials: M
authors.lastname: Hallman
mesh_terms: D003348:Cortisone / Q000097:blood; D003687:Dehydroepiandrosterone / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000096:biosynthesis / Q000097:blood*; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000097:blood*; D007239:Infections / Q000097:blood*; D011284:Pregnenolone / Q000097:blood; D011374:Progesterone / Q000097:blood; D012769:Shock / Q000097:blood*
chemical_list: D003687:Dehydroepiandrosterone; D011374:Progesterone; D011284:Pregnenolone; D003348:Cortisone; D006854:Hydrocortisone
keywords: Circulatory collapse; Cortisol; Dehydroepiandrosterone; Newborn infant; Sepsis