Adrenal Cortical Function in Newly-Born Infants

Abstract

T HE anatomic features of the adrenal cortex of the newborn infant have long been known to differ strikingly from those of the adult. Furthermore, marked involutionary changes occur in this gland during the first few days of extra-uterine life. These facts raise the question as to whether there may be differences in function as well. Efforts to study this problem by assaying the excretion of adrenal cortical metabolites in the urine of newly-born infants have recently been made. These have demonstrated that small amounts of such substances, as measured by both chemical and biologic methods, are present in the urine during the newborn period (1, 2, 3). It has also been shown that the adrenal cortex of the newborn infant responds to stress in a manner similar to that of the adult (3).

Free Blood Corticoids in the Newborn Infant1

“…Infants in the first week of life respond to ACTH administration with a smaller fall in circulating eosinophils and a smaller increase in urinary corticosteroids than these same or other infants do when they are older (1,2). Since these findings seem to validate the suggestions that certain infants suffer from transient adrenal failure and that others are unable to withstand the stress of surgery in the newborn period because of a lack of adrenal cortical hormones (3,4), the logical inference is that these infants should be treated with adrenal cortical hormones.…”

The Function of the Adrenal Glands in the Newborn

“…than older ones (Venning et al, 1950) and the small dose, 5 mg. of A.C.T.H., used may be the reason for the failure of response on the first day by some of the newborns.…”

“…Until recent times, however, very little had been known about the function of the adrenal cortex during this period and it is questioned whether or not the adrenal, like the kidney, behaves differently from the adult gland at this time. Efforts have been made to study the problem by assaying the excretion of adrenal cortical metabolites in the urine of newlyborn infants and it has been shown that small quantities of such substances not only occur in the first few days of life (Venning, Randall and Gyorgy, 1949;Matson and Longwell, 1949) but also increase significantly in the second week (Read, Venning and Ripstein, 1950). Furthermore the reaction to stress as shown by the response to the administration of epinephrine suggests that the pituitary-adrenal axis is capable of normal function as early as the first day in full-term infants, although prematures do not show this response before the ninth day of life (Jailer, Wong and Engle, 1951).…”

A Reversible Salt-wasting Syndrome of the Newborn and Infant: Possible Infantile Hypoaldosteronism

“…Although this increase might not be considered significant, there was a concurrent fivefold increase in 17-ketosteroid output, and it is possible that the preparation used was predominantly of 17-ketosteroid rather than glucocorticoid stimulatory material (Bayliss and Steinbeck, 1954). Read, Venning and Ripstein (1950) have shown that the increase of glucocorticoid urinary output following the administration of corticotrophin during the second week of life may be no more than 0-22 mg. to 0-33 mg. per 24 hours from a basal level of 0-04 mg. to 0-14 mg. per 24 hours. They concluded that on the basis of body weight or surface area these increments were equivalent to the adult response.…”