Transient hyper-17-OHPnemia unrelated to cross-reactions with residual fetal adrenal cortex products.
ABSTRACT To clarify the pathogenesis of transient hyper-17alpha-hydroxyprogesteronemia, we initiated a laboratory investigation in a pre-term infant with persistently high serum 17alpha-hydroxyprogesterone (17-OHP) until 2 months of age.
Serum 17-OHP level was measured by high-performance liquid chromatography and radioimmunoassay, and gene analysis of CYP21A2 (21-hydroxylase) was performed.
Serum 17-OHP level on the 29th day of life was 25.4 ng/ml, and the urinary steroid profile showed low pregnanetriolone. Gene analysis of 21-hydroxylase disclosed no mutation, and 17-OHP normalized by 3 months of age without specific treatment.
Transient elevations in 17-OHP, which do not appear related to cross-reactions with products of a residual fetal adrenal cortex, may occur in the first few months of life.
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ABSTRACT: Urinary steroid profile analysis using gas chromatography/mass spectrometry (GC/MS) has been reported for the diagnosis of abnormal steroidogenesis in newborn infants with some success. We tried to establish the reference values of 63 urinary steroids in Japanese newborn infant, using GC/MS in selected ion monitoring (SIM) that utilizes two characteristic mass ions for each steroid for definitive identification. We studied 36 healthy full-term newborn infants (1-56 days of age) on spot urine samples to define the reference values (mg/g creatinine, median and 10-90 percentile range) and to investigate the possible difference between daytime and nighttime levels. We also studied 23 healthy adult females (20-24 years of age) on 24-hour-urine for the comparison of the reference values of newborn infants. Fifty metabolites of DHEA, pregnenolone, 17-hydroxypregnenolone, androstenedione, progesterone, 17-hydroxyprogesterone, 21-deoxycortisone, corticosterone, 18-hydroxycorticosterone, aldosterone, 18-hydroxycortisol, 11-deoxycortisol, cortisone, cortisol, and estrogen in each infant were measurable without interference, but 13 metabolites of 11-hydroxyandrostenedione, pregnenolone, 11-deoxycorticosterone, corticosterone, 11-dehydrocorticosterone, 21-deoxycortisol, 11-deoxycortisol and cortisol were unmeasurable in each infant due to the interference of fetal cortex steroids as confirmed by abnormal peak area ratios of two mass ions. All 63 metabolites in each control adult were measurable without interference. 16alpha-, 16beta-, and 15beta-hydroxy metabolites of 3beta-hydroxy-5-en-steroids, and 6beta-, 18-hydroxy and 11-oxo-metabolites of corticosteroids were significantly higher in full-term newborn infants than those in adults as previously reported. Urinary steroids showed little circadian variation in the newborn infants, indicating that spot urine can substitute for 24-hour urine.Endocrine Journal 01/2004; 50(6):783-92. · 2.23 Impact Factor
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ABSTRACT: Adrenal steroidogenesis was evaluated in 25 sick premature infants with a gestational age of less than 30 weeks. ACTH stimulation tests were performed on the fourth day of life using synthetic ACTH (36 micrograms/kg). Considering the stress and degree of illness, preterm newborns had low basal cortisol levels (mean +/- SEM, 207.4 +/- 23.5 nmol/L), and their levels were similar to basal levels reported for healthy full-term newborns (170.7 +/- 26.8 nmol/L; P = 0.31; reference data from Endocrine Sciences, Inc., Calabasas Hills, CA). However, compared to term neonates, preterm infants had markedly elevated basal levels of 17-hydroxypregnenolone (54.3 +/- 11.2 nmol/L), 17-hydroxyprogesterone (19.7 +/- 4.0 nmol/L), and 11-deoxycortisol (19.1 +/- 3.3 nmol/L), which were 7-, 18-, and 8-fold higher, respectively, than values for term infants. The activity of 3 beta-hydroxysteroid dehydrogenase was not significantly reduced in extremely premature neonates (mean basal ratio of 17-hydroxypregnenolone/17-hydroxyprogesterone, 2.9 +/- 0.2; ACTH-stimulated ratio, 6.5 +/- 0.4). In contrast, the mean basal substrate/product ratio of 11-deoxycortisol was markedly elevated in the preterm infants (11.9 +/- 2.2, ratio x 10(-2) compared to that in the full-term infants (2.1 +/- 0.4, ratio x 10(-2); P < 0.001). These findings are consistent with decreased activity of 11 beta-hydroxylase (11 beta OH) in preterm infants born at less than 30 weeks gestation. Decreased 11 beta OH activity appears to be more prominent than the deficiency of 3 beta-hydroxysteroid dehydrogenase that has been found in infants with lesser degrees of prematurity, suggesting that 11 beta OH activity may be regulated during fetal development to increase during the latter part of gestation.Journal of Clinical Endocrinology & Metabolism 02/1994; 78(2):266-70. · 6.43 Impact Factor
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ABSTRACT: We examined the in situ localization of key steroidogenic enzymes in adrenal gland sections from midgestation (17-24 weeks) human fetuses and late gestation (130-142 days; term = 165 days) rhesus monkey fetuses. The rhesus monkey fetal adrenals were used as a model for the late gestation human fetal adrenal. The enzymes examined were cytochrome P450 cholesterol side-chain cleavage (P450scc), cytochrome P450 17 alpha-hydroxylase/17,20-lyase (P450c17), and 3 beta-hydroxysteroid dehydrogenase/isomerase (3 beta HSD). In human fetal adrenals, P450scc and P450c17 proteins and mRNAs were detected only in fetal zone (innermost cortical zone) and transitional zone (between the fetal and definitive zone) cells, not in definitive zone cells. Expression of 3 beta HSD was not detected in any cortical zone cells in midgestation human fetal adrenals. In rhesus monkey fetal adrenals, a similar pattern of P450scc and P450c17 expression was observed in the fetal and transitional zones. In the definitive zone cells of rhesus monkey fetal adrenals, expression of both P450scc and 3 beta HSD was detected. In addition, low levels of 3 beta HSD expression could be detected in some transitional zone cells. P450c17 expression was lacking in definitive zone cells from rhesus monkey fetal adrenals. These data suggest that early in gestation, cortisol is not produced by the human fetal adrenal cortex in vivo (because it does not express 3 beta HSD), whereas androgen production occurs in the transitional and fetal zones (which express P450scc and P450c17). Later in gestation, the definitive zone may produce minearlocorticoids (because it expresses P450scc and 3 beta HSD, but lacks P450c17), and the transitional zone may produce glucocorticoids (it expresses P450scc, P450c17, and 3 beta HSD), whereas the fetal zone continues to produce androgens. Thus, late in gestation the functional zonation of the human fetal adrenal cortex may be similar to that of the adult, with the definitive zone being analogous to the nascent zona glomerulosa, the transitional zone analogous to the zona fasciculata, and the fetal zone analogous to the zona reticularis.Journal of Clinical Endocrinology & Metabolism 12/1993; 77(5):1184-9. · 6.43 Impact Factor