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Augsburger P, Liimatta J, Flück CE. Update on Adrenarche-Still a Mystery. J Clin Endocrinol Metab 2024; 109:1403-1422. [PMID: 38181424 DOI: 10.1210/clinem/dgae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/07/2024]
Abstract
CONTEXT Adrenarche marks the timepoint of human adrenal development when the cortex starts secreting androgens in increasing amounts, in healthy children at age 8-9 years, with premature adrenarche (PA) earlier. Because the molecular regulation and significance of adrenarche are unknown, this prepubertal event is characterized descriptively, and PA is a diagnosis by exclusion with unclear long-term consequences. EVIDENCE ACQUISITION We searched the literature of the past 5 years, including original articles, reviews, and meta-analyses from PubMed, ScienceDirect, Web of Science, Embase, and Scopus, using search terms adrenarche, pubarche, DHEAS, steroidogenesis, adrenal, and zona reticularis. EVIDENCE SYNTHESIS Numerous studies addressed different topics of adrenarche and PA. Although basic studies on human adrenal development, zonation, and zona reticularis function enhanced our knowledge, the exact mechanism leading to adrenarche remains unsolved. Many regulators seem involved. A promising marker of adrenarche (11-ketotestosterone) was found in the 11-oxy androgen pathway. By current definition, the prevalence of PA can be as high as 9% to 23% in girls and 2% to 10% in boys, but only a subset of these children might face related adverse health outcomes. CONCLUSION New criteria for defining adrenarche and PA are needed to identify children at risk for later disease and to spare children with a normal variation. Further research is therefore required to understand adrenarche. Prospective, long-term studies should characterize prenatal or early postnatal developmental pathways that modulate trajectories of birth size, early postnatal growth, childhood overweight/obesity, adrenarche and puberty onset, and lead to abnormal sexual maturation, fertility, and other adverse outcomes.
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Affiliation(s)
- Philipp Augsburger
- Pediatric Endocrinology, Diabetology, and Metabolism, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
- Department of BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
| | - Jani Liimatta
- Pediatric Endocrinology, Diabetology, and Metabolism, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
- Department of BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
- Kuopio Pediatric Research Unit (KuPRU), University of Eastern Finland and Kuopio University Hospital, 70029 Kuopio, Finland
| | - Christa E Flück
- Pediatric Endocrinology, Diabetology, and Metabolism, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
- Department of BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
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Orlandi L, Rodriguez Y, Leostic A, Giraud C, Lang ML, Vialard F, Mauffré V, Motte-Signoret E. Preterm birth affects both surfactant synthesis and lung liquid resorption actors in fetal sheep. Dev Biol 2024; 506:64-71. [PMID: 38081502 DOI: 10.1016/j.ydbio.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION After birth, the lungs must resorb the fluid they contain. This process involves multiple actors such as surfactant, aquaporins and ENaC channels. Preterm newborns often exhibit respiratory distress syndrome due to surfactant deficiency, and transitory tachypnea caused by a delay in lung liquid resorption. Our hypothesis is that surfactant, ENaC and aquaporins are involved in respiratory transition to extrauterine life and altered by preterm birth. We compared these candidates in preterm and term fetal sheeps. MATERIALS AND METHODS We performed cesarean sections in 8 time-dated pregnant ewes (4 at 100 days and 4 at 140 days of gestation, corresponding to 24 and 36 weeks of gestation in humans), and obtained 13 fetal sheeps in each group. We studied surfactant synthesis (SP-A, SP-B, SP-C), lung liquid resorption (ENaC, aquaporins) and corticosteroid regulation (glucocorticoid receptor, mineralocorticoid receptor and 11-betaHSD2) at mRNA and protein levels. RESULTS The mRNA expression level of SFTPA, SFTPB and SFTPC was higher in the term group. These results were confirmed at the protein level for SP-B on Western Blot analysis and for SP-A, SP-B and SP-C on immunohistochemical analysis. Regarding aquaporins, ENaC and receptors, mRNA expression levels for AQP1, AQP3, AQP5, ENaCα, ENaCβ, ENaCγ and 11βHSD2 mRNA were also higher in the term group. DISCUSSION Expression of surfactant proteins, aquaporins and ENaC increases between 100 and 140 days of gestation in an ovine model. Further exploring these pathways and their hormonal regulation could highlight some new explanations in the pathophysiology of neonatal respiratory diseases.
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Affiliation(s)
- Leona Orlandi
- Paris-Saclay University, UVSQ, UFR-SVS, UMR1198-BREED-RHuMA, 2 avenue de la source de la Bièvre, 78180, Montigny le Bretonneux, France
| | - Yoann Rodriguez
- Paris-Saclay University, UVSQ, UFR-SVS, UMR1198-BREED-RHuMA, 2 avenue de la source de la Bièvre, 78180, Montigny le Bretonneux, France
| | - Anne Leostic
- Paris-Saclay University, UVSQ, UFR-SVS, UMR1198-BREED-RHuMA, 2 avenue de la source de la Bièvre, 78180, Montigny le Bretonneux, France; Poissy St Germain Hospital, Obstetrics and Gynaecology, Poissy, France
| | - Corinne Giraud
- Paris-Saclay University, UVSQ, UFR-SVS, UMR1198-BREED-RHuMA, 2 avenue de la source de la Bièvre, 78180, Montigny le Bretonneux, France
| | - Maya-Laure Lang
- Poissy St Germain Hospital, Neonatal Intensive Care Unit, Poissy, France
| | - François Vialard
- Paris-Saclay University, UVSQ, UFR-SVS, UMR1198-BREED-RHuMA, 2 avenue de la source de la Bièvre, 78180, Montigny le Bretonneux, France; Poissy St Germain Hospital, Genetics, Poissy, France
| | - Vincent Mauffré
- Paris-Saclay University, UVSQ, UFR-SVS, UMR1198-BREED-RHuMA, 2 avenue de la source de la Bièvre, 78180, Montigny le Bretonneux, France; Ecole Nationale Vétérinaire d'Alfort, BREED, 94700, Maisons-Alfort, France
| | - Emmanuelle Motte-Signoret
- Paris-Saclay University, UVSQ, UFR-SVS, UMR1198-BREED-RHuMA, 2 avenue de la source de la Bièvre, 78180, Montigny le Bretonneux, France; Poissy St Germain Hospital, Neonatal Intensive Care Unit, Poissy, France.
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Miller WL, White PC. History of Adrenal Research: From Ancient Anatomy to Contemporary Molecular Biology. Endocr Rev 2023; 44:70-116. [PMID: 35947694 PMCID: PMC9835964 DOI: 10.1210/endrev/bnac019] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Indexed: 01/20/2023]
Abstract
The adrenal is a small, anatomically unimposing structure that escaped scientific notice until 1564 and whose existence was doubted by many until the 18th century. Adrenal functions were inferred from the adrenal insufficiency syndrome described by Addison and from the obesity and virilization that accompanied many adrenal malignancies, but early physiologists sometimes confused the roles of the cortex and medulla. Medullary epinephrine was the first hormone to be isolated (in 1901), and numerous cortical steroids were isolated between 1930 and 1949. The treatment of arthritis, Addison's disease, and congenital adrenal hyperplasia (CAH) with cortisone in the 1950s revolutionized clinical endocrinology and steroid research. Cases of CAH had been reported in the 19th century, but a defect in 21-hydroxylation in CAH was not identified until 1957. Other forms of CAH, including deficiencies of 3β-hydroxysteroid dehydrogenase, 11β-hydroxylase, and 17α-hydroxylase were defined hormonally in the 1960s. Cytochrome P450 enzymes were described in 1962-1964, and steroid 21-hydroxylation was the first biosynthetic activity associated with a P450. Understanding of the genetic and biochemical bases of these disorders advanced rapidly from 1984 to 2004. The cloning of genes for steroidogenic enzymes and related factors revealed many mutations causing known diseases and facilitated the discovery of new disorders. Genetics and cell biology have replaced steroid chemistry as the key disciplines for understanding and teaching steroidogenesis and its disorders.
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Affiliation(s)
- Walter L Miller
- Department of Pediatrics, Center for Reproductive Sciences, and Institute for Human Genetics, University of California, San Francisco, CA, USA
| | - Perrin C White
- Division of Pediatric Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Flück CE, Kuiri-Hänninen T, Silvennoinen S, Sankilampi U, Groessl M. The Androgen Metabolome of Preterm Infants Reflects Fetal Adrenal Gland Involution. J Clin Endocrinol Metab 2022; 107:3111-3119. [PMID: 35994776 DOI: 10.1210/clinem/dgac482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT The human adrenal cortex changes with fetal-neonatal transition from the fetal to the adult organ, accompanied by changes in the steroid metabolome. OBJECTIVE As it is unclear how the observed developmental changes differ between preterm and full-term neonates, we investigated whether the involution of the fetal adrenals is following a fixed time course related to postmenstrual age or whether it is triggered by birth. Furthermore, the fetal and postnatal androgen metabolome of preterm infants was characterized in comparison to term babies. METHODS This was a prospective, longitudinal, 2-center study collecting spot urines of preterm and term infants during the first 12 to 18 months of life. Steroid metabolites were measured from spot urines by gas chromatography-mass spectrometry. Data relating were modeled according to established pre- and postnatal pathways. RESULTS Fetal adrenal involution occurs around term-equivalent age in preterm infants and is not triggered by premature birth. Testosterone levels are higher in preterm infants at birth and decline slower until term compared to full-term babies. Dihydrotestosterone levels and the activity of the classic androgen biosynthesis pathway are lower in premature infants as is 5α-reductase activity. No difference was found in the activity of the alternate backdoor pathway for androgen synthesis. CONCLUSION Human adrenal involution follows a strict timing that is not affected by premature birth. By contrast, prematurity is associated with an altered androgen metabolome after birth. Whether this reflects altered androgen biosynthesis in utero remains to be investigated.
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Affiliation(s)
- Christa E Flück
- Department of Pediatrics, Division of Endocrinology, Diabetology and Metabolism, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- Department of BioMedical Research, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Tanja Kuiri-Hänninen
- Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, 70029 Kuopio, Finland
| | - Sanna Silvennoinen
- Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, 70029 Kuopio, Finland
| | - Ulla Sankilampi
- Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, 70029 Kuopio, Finland
| | - Michael Groessl
- Department of BioMedical Research, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
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Allvin K, Ankarberg-Lindgren C, Dahlgren J. Longitudinal Sex Steroid Data in Relation to Birth Weight in Preterm Boys. J Clin Endocrinol Metab 2022; 107:e4212-e4221. [PMID: 35972993 PMCID: PMC9721340 DOI: 10.1210/clinem/dgac477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT There is a lack of knowledge on longitudinal sex steroid patterns during infancy, especially for boys born preterm or with low birth weight (LBW). OBJECTIVE To find out whether LBW boys have a disturbed sex steroid profile during infancy. DESIGN AND SETTING Population-based longitudinal study performed at Sahlgrenska University Hospital, Gothenburg, Sweden. PARTICIPANTS Ninety-eight singleton boys (47 LBW) born at gestational age 32.0 to 36.9 weeks were included. Because of dropout, 83 of the boys were still in the study at 10 months' corrected age. MAIN OUTCOME MEASURES Serum androgen and estrogen concentrations were analyzed by gas chromatography-tandem mass spectrometry and IGF-I was determined with radioimmunoassay in umbilical cord and at 0, 2, 5, and 10 months' corrected age. RESULTS Serum levels of androstenedione, estrone, and estradiol declined gradually from birth to 10 months corrected age. In both LBW boys and their counterparts, a surge was seen at 2 months' corrected age (3 months' chronological age) for testosterone, median (range) 6.5 (2.0-18.9) nmol/L, and in dihydrotestosterone 1.2 (0.4-4.3) nmol/L. At birth, LBW boys had higher median testosterone (0.7 vs 0.4 nmol/L, P = 0.019), and at 0 months' corrected age, both had higher testosterone (5.7 vs 3.5 nmol/L, P = 0.003) and dihydrotestosterone (1.2 vs 0.9 nmol/L, P = 0.006) than their counterparts. At 10 months' corrected age, catch-up in weight SD score from birth correlated with testosterone (rho = 0.27, P = 0.044) and androstenedione (rho = 0.29, P = 0.027). CONCLUSIONS Moderately to late preterm LBW boys showed a disturbed sex hormone profile, with elevated concentrations of androgens in early infancy.
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Affiliation(s)
- Kerstin Allvin
- Correspondence: Kerstin Allvin, MD, Division of Neonatology, The Queen Silvia Children’s Hospital, S-416 85 Gothenburg, Sweden.
| | - Carina Ankarberg-Lindgren
- Gothenburg Pediatric Growth Research Center, Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, S-416 85 Gothenburg, Sweden
| | - Jovanna Dahlgren
- Gothenburg Pediatric Growth Research Center, Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, S-416 85 Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Pediatric Endocrinology, S-416 85 Gothenburg, Sweden
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Stoye DQ, Boardman JP, Osmond C, Sullivan G, Lamb G, Black GS, Homer NZM, Nelson N, Theodorsson E, Mörelius E, Reynolds RM. Saliva cortisol diurnal variation and stress responses in term and preterm infants. Arch Dis Child Fetal Neonatal Ed 2022; 107:558-564. [PMID: 35256524 PMCID: PMC9411886 DOI: 10.1136/archdischild-2021-321593] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 02/11/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To determine if preterm birth is associated with adaptation of the hypothalamic-pituitary-adrenal (HPA) axis and whether HPA axis programming relates to the degree of prematurity (defined as extremely preterm birth at <28 weeks or very preterm birth at 28-32 weeks gestation). DESIGN This study reports findings from a prospective birth cohort. Saliva cortisol concentrations were measured prevaccination and postvaccination, and in the morning and evening, at 4 months chronological age. SETTING Infants born at a single Scottish hospital. PARTICIPANTS 45 term-born, 42 very preterm and 16 extremely preterm infants. OUTCOMES Cortisol stress response to vaccination (postvaccination minus prevaccination cortisol concentrations), diurnal slope (log-transformed morning minus log-transformed evening cortisol values) and mean log-transformed daily cortisol. RESULTS Compared with infants born at term, infants born extremely preterm had a blunted cortisol response to vaccination (5.8 nmol/L vs 13.1 nmol/L, difference in means: -7.3 nmol/L, 95% CI -14.0 to -0.6) and a flattened diurnal slope (difference in geometric means: -72.9%, 95% CI -87.1 to -42.8). In contrast, the cortisol response to vaccination (difference in means -2.7 nmol/L, 95% CI -7.4 to 2.0) and diurnal slope at 4 months (difference in geometric means: -33.6%, 95% CI -62.0 to 16.0) did not differ significantly in infants born very preterm compared with infants born at term. CONCLUSIONS Infants born extremely preterm have blunted cortisol reactivity and a flattened diurnal slope. These patterns of HPA axis regulation are commonly seen after childhood adversity and could contribute to later metabolic and neurodevelopmental phenotypes observed in this population.
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Affiliation(s)
- David Q Stoye
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - James P Boardman
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Gemma Sullivan
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - Gillian Lamb
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - Gill S Black
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - Natalie Z M Homer
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Nina Nelson
- Department of Clinical and Experimental Medicine, Linköping University, Linkoping, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Elvar Theodorsson
- Division of Clinical Chemistry, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linkoping, Sweden
| | - Evalotte Mörelius
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Rebecca M Reynolds
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
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Ruhnau J, Hübner S, Sunny D, Ittermann T, Hartmann MF, De Lafollie J, Wudy SA, Heckmann M. Impact of Gestational and Postmenstrual Age on Excretion of Fetal Zone Steroids in Preterm Infants Determined by Gas Chromatography-Mass Spectrometry. J Clin Endocrinol Metab 2021; 106:e3725-e3738. [PMID: 33822093 DOI: 10.1210/clinem/dgab194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Fetal zone steroids (FZSs) are excreted in high concentrations in preterm infants. Experimental data suggest protective effects of FZSs in models of neonatal disease. OBJECTIVE We aimed to characterize the postnatal FZS metabolome of well preterm and term infants. METHODS Twenty-four-hour urinary FZS excretion rates were determined in early preterm (<30 weeks' gestation), preterm (30-36 weeks), and term (>37 weeks) infants. Pregnenolone and 17-OH-pregnenolone metabolites (n = 5), and dehydroepiandrosterone sulfate and metabolites (n = 12) were measured by gas chromatography mass spectrometry. Postnatal concentrations of FZSs were compared with already published prenatal concentrations in amniotic fluid. RESULTS Excretion rates of total FZSs and most of the single metabolites were highest in early preterm infants. In this group, excretion rates approach those of term infants at term equivalent postmenstrual age. Preterm infants of 30-36 weeks had more than half lower median excretion rates of FZSs than early preterm infants at the same time of postmenstrual age. Postnatal concentrations of FZSs were partly more than 100-fold higher in all gestational age groups than prenatal concentrations in amniotic fluid at midgestation. CONCLUSION The excretion rates of FZSs as a proxy of the involution of the fetal zone of the most immature preterm infants approached those of term infants at term equivalent. In contrast, the fetal zone in more mature preterm infants undergoes more rapid involution. These data in exclusively well neonates can serve as a basis to investigate the effects of illness on the FZS metabolome in future studies.
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Affiliation(s)
- Johanna Ruhnau
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Stephanie Hübner
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany
| | - Donna Sunny
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Michaela F Hartmann
- Paediatric Endocrinology & Diabetology, Laboratory for Translational Hormone Analytics, Steroid Research & Mass Spectrometry Unit, Center of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany
| | - Jan De Lafollie
- Department of General Pediatrics and Neonatology, Center of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany
| | - Stefan A Wudy
- Paediatric Endocrinology & Diabetology, Laboratory for Translational Hormone Analytics, Steroid Research & Mass Spectrometry Unit, Center of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany
- Department of General Pediatrics and Neonatology, Center of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany
| | - Matthias Heckmann
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany
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Prelipcean I, Wynn JL, Thompson L, Burchfield DJ, James-Woodley L, Chase PB, Barnes CP, Bernier A. Absence of relationship between serum cortisol and critical illness in premature infants. Arch Dis Child Fetal Neonatal Ed 2021; 106:408-412. [PMID: 33541918 PMCID: PMC8852370 DOI: 10.1136/archdischild-2020-319970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 12/05/2020] [Accepted: 12/10/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Inadequate cortisol production in response to critical illness in extremely preterm infants may exacerbate poor outcomes. Despite commonly measuring cortisol concentration and administering hydrocortisone for presumed adrenal insufficiency, the relationship between serum cortisol concentration and illness severity remains unclear in this unique population. OBJECTIVE To determine the relationship between cortisol concentrations and illness severity as measured by the Score for Neonatal Acute Physiology II, neonatal Sequential Organ Failure Assessment and Vasoactive-Inotropic Score in premature infants. DESIGN/METHODS This retrospective, single-center cohort study included preterm infants born <30 weeks gestational age admitted to a level IV neonatal intensive care unit (NICU) between June 2011 and July 2018, who had a serum cortisol obtained for clinical indications before 36 weeks PMA. Demographic data were collected on infants and mothers. Nine clinical variables were identified a priori that could potentially modify cortisol concentration including critical illness. Univariate and multivariable analyses determined the relationship between cortisol concentration and each of these variables. RESULTS A total of 224 preterm infants with pretreatment serum cortisol concentration met criteria for inclusion. The median (IQR) gestational age at birth was 25 weeks (24, 26) and at cortisol measurement was 26 weeks (25, 28). The median cortisol was 13.3 ug/dL. Non-survivors had the highest values. Cortisol concentration did not correlate with any of the selected illness severity scores. CONCLUSIONS Cortisol concentrations in extremely preterm infants did not correlate with illness severity regardless of gestational age. Further studies are needed to identify clinically useful mediators of adrenal dysfunction and to guide clinical management.
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Affiliation(s)
- Irina Prelipcean
- Pediatrics, University of Rochester, Rochester, New York, USA .,Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - James L. Wynn
- Department of Pediatrics, University of Florida, Gainesville, Florida,Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, Florida
| | - Lindsay Thompson
- Department of Pediatrics, University of Florida, Gainesville, Florida
| | | | | | - Philip B. Chase
- Clinical and Translational Science - Informatics and Technology, University of Florida
| | - Christopher P. Barnes
- Clinical and Translational Science - Informatics and Technology, University of Florida
| | - Angelina Bernier
- Department of Pediatrics, University of Florida, Gainesville, Florida
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Schumacher M, Liere P, Ghoumari A. Progesterone and fetal-neonatal neuroprotection. Best Pract Res Clin Obstet Gynaecol 2020; 69:50-61. [PMID: 33039311 DOI: 10.1016/j.bpobgyn.2020.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 02/05/2023]
Abstract
The role of progesterone goes beyond the maintenance of pregnancy. The hormone, indeed, protects the developing fetal brain and influences its maturation. Metabolomes analyzed by mass spectrometric methods have revealed the great diversity of steroids in maternal plasma and fetal fluids, but their developmental significance remains to be investigated. Progesterone and its metabolites reach highest levels during the third trimester, when the brain growth spurt occurs: its volume triples, synaptogenesis is particularly active, and axons start to be myelinated. This developmental stage coincides with a period of great vulnerability. Studies in sheep have shown that progesterone and its metabolite allopregnanolone protect the vulnerable fetal brain. Work in rats and mice have demonstrated that progesterone plays an important role in myelin formation. These experimental studies are discussed in relation to preterm birth. Influences of progesterone on very early stages of neural development at the beginning of pregnancy are yet to be explored.
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Affiliation(s)
- Michael Schumacher
- U1195 "Diseases and Hormones of the Nervous System", Inserm and University Paris-Saclay, 80, Rue Du Général Leclerc, 94276, Kremlin-Bicêtre, France.
| | - Philippe Liere
- U1195 "Diseases and Hormones of the Nervous System", Inserm and University Paris-Saclay, 80, Rue Du Général Leclerc, 94276, Kremlin-Bicêtre, France
| | - Abdelmoumen Ghoumari
- U1195 "Diseases and Hormones of the Nervous System", Inserm and University Paris-Saclay, 80, Rue Du Général Leclerc, 94276, Kremlin-Bicêtre, France
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10
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Cortisol production in preterm infants with or without late-onset adrenal insufficiency of prematurity: A prospective observational study. Pediatr Neonatol 2019; 60:504-511. [PMID: 30670349 DOI: 10.1016/j.pedneo.2018.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/02/2018] [Accepted: 12/18/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Immature adrenocortical function in preterm infants may cause inadequate production of cortisol under stress, resulting in adrenal insufficiency of prematurity (AOP). The objective of this study is to compare cortisol production in preterm infants with and without late-onset AOP. METHODS Of 27 preterm infants born at less than 32 weeks gestation, cortisol production was analyzed in those who did (patients, group P) and did not (controls, group C) eventually develop late-onset AOP. Blood samples were prospectively collected every two weeks after birth, and steroid hormone concentrations in the pathway to cortisol production were measured retrospectively. RESULTS We restricted the initial subjects to infants with gestation less than 29 weeks to adjust for confounding factors, culminating in matched infants in groups P (n = 8) and C (n = 11). The cortisol concentrations did not differ between the groups before AOP onset (P = 0.20), but the total concentrations of precursors for cortisol were higher in group P (P < 0.0001). The total concentrations of precursors in group C were inversely correlated with postmenstrual age (ρ = -0.38, P < 0.01). The pattern of changes in total concentrations of precursors differed between the groups (P < 0.05). CONCLUSION Adrenal cortex maturity in preterm infants develops in parallel with postmenstrual age. Infants with late-onset AOP have undeveloped maturation of adrenocortical function after birth. CLINICAL TRIAL REGISTRATION UMIN000022453.
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11
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Allvin K, Ankarberg-Lindgren C, Niklasson A, Jacobsson B, Dahlgren J. Altered umbilical sex steroids in preterm infants born small for gestational age. J Matern Fetal Neonatal Med 2019; 33:4164-4170. [PMID: 30895831 DOI: 10.1080/14767058.2019.1598362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Boys born small for gestational age (SGA) are at increased risk of testicular dysgenesis syndrome, and girls born SGA face the risk of polycystic ovary syndrome later in life. Our aim was to study whether neonates born SGA have an altered profile of steroid hormones at birth.Materials and methods: A total of 168 singletons (99 boys, 69 girls) born at 32.0-36.9 gestational weeks were recruited to a population-based, university hospital, single-center study. Of these, 31 infants (17 boys, 14 girls) were born SGA. The concentrations of dehydroepiandrosterone sulfate (DHEAS), androstenedione, testosterone, dihydrotestosterone, estrone, estradiol, cortisone, and cortisol were analyzed in umbilical cord serum with mass spectrometry.Results: Girls born SGA had higher levels of androstenedione than girls born appropriate for gestational age (AGA) (4.0 versus 2.6 nmol/L, p = .002). Boys born SGA had lower levels of estrone than boys born AGA (33 822 versus 62 471 pmol/L, p = .038). Infants born SGA had lower levels of cortisone than infants born AGA, both in girls (340 versus 579 nmol/L, p = .010) and in boys (308 versus 521 nmol/L, p = .045). Furthermore, boys born SGA had a higher cortisol/cortisone ratio than boys born AGA (0.41 versus 0.25, p = .028). Gestational age correlated with DHEAS (boys r = 0.48, p = .000, girls r = 0.35, p = .013), and cortisol (boys r = 0.48, p = .000, girls r = 0.29, p = .039).Conclusions: In moderate-to-late preterm infants born SGA, we observed a different steroid hormone profile in cord serum. Girls born SGA show increased levels of androstenedione and boys born SGA show decreased levels of estrone in cord serum, which could be related to placental aromatase deficiency in intrauterine growth restriction.
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Affiliation(s)
- Kerstin Allvin
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Carina Ankarberg-Lindgren
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Aimon Niklasson
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Jovanna Dahlgren
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
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Regelmann MO, Kamboj MK, Miller BS, Nakamoto JM, Sarafoglou K, Shah S, Stanley TL, Marino R. Adrenoleukodystrophy: Guidance for Adrenal Surveillance in Males Identified by Newborn Screen. J Clin Endocrinol Metab 2018; 103:4324-4331. [PMID: 30289543 DOI: 10.1210/jc.2018-00920] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/24/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Adrenoleukodystrophy (ALD) is a peroxisomal disorder associated with neurologic decompensation and adrenal insufficiency. Newborn screening for ALD has recently been implemented in five states with plans to expand to all 50 states in the United States. Adrenal insufficiency ultimately develops in most males with ALD, but the earliest age of onset is not well established. OBJECTIVE These clinical recommendations are intended to address screening for adrenal insufficiency in boys identified to have ALD by newborn screen. PARTICIPANTS Seven members of the Pediatric Endocrine Society Drug and Therapeutics/Rare Diseases Committee, with clinical experience treating children with ALD and adrenal insufficiency, and a pediatric endocrinologist and laboratory director were selected to be on the working committee. CONSENSUS PROCESS The authors comprised the working group and performed systematic reviews of the published literature regarding adrenal insufficiency and ALD. The recommendations were reviewed and approved by the larger Pediatric Endocrine Society Drug and Therapeutics/Rare Diseases Committee and then by the Pediatric Endocrine Society Board of Directors. CONCLUSIONS There is limited literature evidence regarding monitoring of evolving adrenal insufficiency in male infants and children with ALD. The recommendations suggest initiating assessment of adrenal function at diagnosis with ALD and regular monitoring to identify boys with adrenal insufficiency in a timely manner and prevent life-threatening adrenal crisis. These recommendations are intended to serve as an initial guide, with the understanding that additional experience will inform future guidelines.
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Affiliation(s)
- Molly O Regelmann
- Division of Pediatric Endocrinology and Diabetes, Children's Hospital at Montefiore, Albert Einstein School of Medicine, Bronx, New York
| | - Manmohan K Kamboj
- Section of Endocrinology, Department of Pediatrics, Nationwide Children's Hospital at The Ohio State University, Columbus, Ohio
| | - Bradley S Miller
- Division of Endocrinology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | - Jon M Nakamoto
- Quest Diagnostics Nichols Institute, San Juan Capistrano, California
| | - Kyriakie Sarafoglou
- Division of Endocrinology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
- Division of Genetics and Metabolism, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | - Sejal Shah
- Division of Pediatric Endocrinology and Diabetes, Stanford University, Stanford, California
| | - Takara L Stanley
- Pediatric Endocrine Unit, Massachusetts General Hospital for Children and Harvard Medical School, Boston, Massachusetts
| | - Rose Marino
- Pediatric Endocrine Unit, Massachusetts General Hospital for Children and Harvard Medical School, Boston, Massachusetts
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13
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Lotfi CFP, Kremer JL, dos Santos Passaia B, Cavalcante IP. The human adrenal cortex: growth control and disorders. Clinics (Sao Paulo) 2018; 73:e473s. [PMID: 30208164 PMCID: PMC6113920 DOI: 10.6061/clinics/2018/e473s] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/26/2018] [Indexed: 12/15/2022] Open
Abstract
This review summarizes key knowledge regarding the development, growth, and growth disorders of the adrenal cortex from a molecular perspective. The adrenal gland consists of two distinct regions: the cortex and the medulla. During embryological development and transition to the adult adrenal gland, the adrenal cortex acquires three different structural and functional zones. Significant progress has been made in understanding the signaling and molecules involved during adrenal cortex zonation. Equally significant is the knowledge obtained regarding the action of peptide factors involved in the maintenance of zonation of the adrenal cortex, such as peptides derived from proopiomelanocortin processing, adrenocorticotropin and N-terminal proopiomelanocortin. Findings regarding the development, maintenance and growth of the adrenal cortex and the molecular factors involved has improved the scientific understanding of disorders that affect adrenal cortex growth. Hypoplasia, hyperplasia and adrenocortical tumors, including adult and pediatric adrenocortical adenomas and carcinomas, are described together with findings regarding molecular and pathway alterations. Comprehensive genomic analyses of adrenocortical tumors have shown gene expression profiles associated with malignancy as well as methylation alterations and the involvement of miRNAs. These findings provide a new perspective on the diagnosis, therapeutic possibilities and prognosis of adrenocortical disorders.
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Affiliation(s)
- Claudimara Ferini Pacicco Lotfi
- Departamento de Anatomia, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Jean Lucas Kremer
- Departamento de Anatomia, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Barbara dos Santos Passaia
- Departamento de Anatomia, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Isadora Pontes Cavalcante
- Departamento de Anatomia, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, Sao Paulo, SP, BR
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14
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Miller WL. Steroidogenesis: Unanswered Questions. Trends Endocrinol Metab 2017; 28:771-793. [PMID: 29031608 DOI: 10.1016/j.tem.2017.09.002] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 01/06/2023]
Abstract
Until the mid-1980s studies of steroidogenesis largely depended on identifying steroid structures and measuring steroid concentrations in body fluids. The molecular biology revolution radically revolutionized studies of steroidogenesis with the cloning of known steroidogenic enzymes, by identifying novel factors, and delineating the genetic basis of known and newly discovered diseases. Unfortunately, this dramatic success has led many young research-oriented endocrinologists to regard steroidogenesis as a 'solved area'. However, many important and exciting questions remain, especially concerning the mechanisms of cholesterol delivery to the steroidogenic machinery, the biochemistry of androgen synthesis, the regulation and biological role of adrenarche, fetal adrenal development and involution, the roles of steroids made in 'extraglandular' cells, and the search for genetic disorders. This review outlines some of these questions, but this list is necessarily incomplete.
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Affiliation(s)
- Walter L Miller
- Center for Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, CA 94143-0556, USA.
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15
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Karsli T, Strickland D, Livingston J, Wu Q, Mhanna MJ, Shekhawat PS. Assessment of neonatal adrenal size using high resolution 2D ultrasound and its correlation with birth demographics and clinical outcomes. J Matern Fetal Neonatal Med 2017; 32:377-383. [PMID: 28889777 DOI: 10.1080/14767058.2017.1378340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Assessment of adrenal function in a sick neonate remains a challenge in spite of major advances in neonatal care. We used 2D ultrasound of adrenal glands to assess maturity of adrenal glands in extremely preterm infants and sick term and near term infants. STUDY DESIGN We collected demographics details of 99 mother-infants pairs (24-41 weeks) and obtained 2D ultrasound scans of adrenal glands in first week of life to measure adrenal volume, fetal zone size, and adrenal to kidney ratios. Relationship between adrenal measurements, antenatal factors, and postnatal outcomes were studied. RESULTS We reported normative adrenal gland volume data during gestation from 80 appropriate for gestational age (AGA) infants. In a binary analysis, adrenal size was significantly related to gender, race, intrauterine growth restriction (IUGR), maternal chorioamnionitis, and maternal hypertension. Linear regression analysis showed that fetal zone is significantly related to not only gestational age but also chorioamnionitis and later development of intraventricular hemorrhage (IVH). Adrenal volume likewise is also related to gestational age, preeclampsia, and IVH. CONCLUSIONS Antenatal maternal factors and uterine environment affects adrenal growth and development thus postnatal high resolution 2D US scan of adrenal glands can provide useful information to predict outcomes. This information can complement hormone and adrenocorticotrophic hormone (ACTH) stimulation assays.
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Affiliation(s)
- Tijen Karsli
- a Department of Pediatrics , Greenville , NC , USA
| | - Diana Strickland
- b Department of Obstetrics and Gynecology , Greenville , NC , USA
| | | | - Qiang Wu
- c Department of Biostatistics , East Carolina University , Greenville , NC , USA
| | - Maroun J Mhanna
- d Department of Pediatrics, Division of Neonatology , Case Western Reserve University, MetroHealth Medical Center , Cleveland , OH , USA
| | - Prem S Shekhawat
- d Department of Pediatrics, Division of Neonatology , Case Western Reserve University, MetroHealth Medical Center , Cleveland , OH , USA
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16
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Kim D, Epperson CN, Ewing G, Appleby D, Sammel MD, Wang E. Methodology for Using 3-Dimensional Sonography to Measure Fetal Adrenal Gland Volumes in Pregnant Women With and Without Early Life Stress. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2029-2037. [PMID: 27562975 DOI: 10.7863/ultra.15.10046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 12/23/2015] [Indexed: 06/06/2023]
Abstract
Fetal adrenal gland volumes on 3-dimensional sonography have been studied as potential predictors of preterm birth. However, no consistent methodology has been published. This article describes the methodology used in a study that is evaluating the effects of maternal early life stress on fetal adrenal growth to allow other researchers to compare methodologies across studies. Fetal volumetric data were obtained in 36 women at 20 to 22 and 28 to 30 weeks' gestation. Two independent examiners measured multiple images of a single fetal adrenal gland from each sonogram. Intra- and inter-rater consistency was examined. In addition, fetal adrenal volumes between male and female fetuses were reported. The intra- and inter-rater reliability was satisfactory when the mean of 3 measurements from each rater was used. At 20 weeks' gestation, male fetuses had larger average adjusted adrenal volumes than female fetuses (mean, 0.897 versus 0.638; P = .004). At 28 weeks' gestation, the fetal weight was more influential in determining values for adjusted fetal adrenal volume (0.672 for male fetuses versus 0.526 for female fetuses; P = .034). This article presents a methodology for assessing fetal adrenal volume using 3-dimensional sonography that can be used by other researchers to provide more consistency across studies.
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Affiliation(s)
- Deborah Kim
- Penn Center for Women's Behavioral Wellness, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania USA, Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, Philadelphia, Pennsylvania USA
| | - C Neill Epperson
- Penn Center for Women's Behavioral Wellness, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania USA, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania USA, Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, Philadelphia, Pennsylvania USA
| | - Grace Ewing
- Penn Center for Women's Behavioral Wellness, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania USA, Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, Philadelphia, Pennsylvania USA
| | - Dina Appleby
- Penn Center for Women's Behavioral Wellness, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania USA, Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, Philadelphia, Pennsylvania USA
| | - Mary D Sammel
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania USA, Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, Philadelphia, Pennsylvania USA
| | - Eileen Wang
- Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania USA
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17
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Potential role of increased oxygenation in altering perinatal adrenal steroidogenesis. Pediatr Res 2015; 77:298-309. [PMID: 25470028 DOI: 10.1038/pr.2014.194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 08/13/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND At birth, the large fetal adrenal involutes rapidly, and the patterns of steroidogenesis change dramatically; the event(s) triggering these changes remain largely unexplored. Fetal abdominal viscera receive hypoxic blood having a partial pressure of oxygen of only ~2 kPa (20-23 mm Hg); perinatal circulatory changes change this to adult values (~20 kPa). We hypothesized that transition from fetal hypoxia to postnatal normoxia participates in altering perinatal steroidogenesis. METHODS We grew midgestation human fetal adrenal cells and human NCI-H295A adrenocortical carcinoma cells in 2% O2, then transitioned them to 20% O2 and quantitated steroidogenic mRNAs by quantitative PCR and microarrays. RESULTS Transitioning fetal adrenal cells from hypoxia to normoxia increased mRNAs for 17α-hydroxylase/17,20 lyase (P450c17), 3β-hydroxysteroid dehydrogenase (3βHSD2), and steroidogenic acute regulatory protein (StAR). We repeated the protocol with NCI-H295A cells acclimated to hypoxia for 15 d, quantitating 31,255 transcripts by microarray. Using an arbitrary 1.5-fold difference, 1 d of normoxia increased 4 transcripts and decreased 56, whereas 2 d of normoxia increased 62 transcripts and decreased 105. P450c17, 3βHSD2, and StAR were ranked among the top eight increased transcripts. CONCLUSION These data suggest that the hypoxic/normoxic transition at birth contributes to perinatal changes in adrenal steroidogenesis.
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Lalli E, Figueiredo BC. Pediatric adrenocortical tumors: what they can tell us on adrenal development and comparison with adult adrenal tumors. Front Endocrinol (Lausanne) 2015; 6:23. [PMID: 25741319 PMCID: PMC4332354 DOI: 10.3389/fendo.2015.00023] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 02/08/2015] [Indexed: 12/05/2022] Open
Abstract
Adrenocortical tumors (ACT) in children are very rare and are most frequently diagnosed in the context of the Li-Fraumeni syndrome, a multiple cancer syndrome linked to germline mutations of the tumor suppressor gene TP53 with loss of heterozygosity in the tumors. A peak of children ACT incidence is present in the states of southern Brazil, where they are linked to the high prevalence in the population of a specific TP53 mutation (R337H). Children ACT have specific features distinguishing them from adult tumors in their pathogenetic mechanisms, genomic profiles, and prognosis. Epidemiological and molecular evidence suggests that in most cases they are derived from the fetal adrenal.
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Affiliation(s)
- Enzo Lalli
- Institut de Pharmacologie Moléculaire et Cellulaire CNRS, Valbonne, France
- University of Nice-Sophia-Antipolis, Valbonne, France
- Associated International Laboratory (LIA) NEOGENEX, CNRS, Valbonne, France
- *Correspondence: Enzo Lalli, Institut de Pharmacologie Moléculaire et Cellulaire CNRS, 660 route des Lucioles – Sophia Antipolis, Valbonne 06560, France e-mail: ; Bonald C. Figueiredo, Instituto de Pesquisa Pelé Pequeno Principe, Av. Silva Jardim, 1632, Curitiba, Paraná CEP 80250-060, Brazil e-mail:
| | - Bonald C. Figueiredo
- Associated International Laboratory (LIA) NEOGENEX, CNRS, Valbonne, France
- Federal University of Paraná, Curitiba, Brazil
- Instituto de Pesquisa Pelé Pequeno Principe, Curitiba, Brazil
- *Correspondence: Enzo Lalli, Institut de Pharmacologie Moléculaire et Cellulaire CNRS, 660 route des Lucioles – Sophia Antipolis, Valbonne 06560, France e-mail: ; Bonald C. Figueiredo, Instituto de Pesquisa Pelé Pequeno Principe, Av. Silva Jardim, 1632, Curitiba, Paraná CEP 80250-060, Brazil e-mail:
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Abstract
Pregnancy is marked by alterations in a number of endocrine systems, including activation of the renin-angiotensin-aldosterone system and the hypothalamic-pituitary-adrenal axis. The placenta, the fetal adrenal glands and the liver constitute an interactive endocrine entity, known as the fetoplacental unit. In the fetoplacental unit, the fetal adrenal glands are the primary source of dehydroepiandrosterone sulphate, which is further metabolized by the fetal liver and placenta to produce a variety of oestrogens. Several disorders can affect both the fetal and maternal adrenal glands during pregnancy. The most common fetal adrenal disorder, steroid 21-hydroxylase deficiency, leads to abnormalities in sexual development and can be life threatening for the neonate. Although rare, maternal adrenal disorders are associated with considerable maternal mortality and morbidity if not promptly recognized and treated. However, diagnosis is often difficult to establish because of the endocrine changes occurring during normal pregnancies and the lack of reference values for the majority of the adrenal steroids. This Review provides an overview of adrenal steroid metabolism during pregnancy and focuses on diagnosis and treatment of the most common fetal and maternal adrenal disorders.
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Affiliation(s)
- Silvia Monticone
- Department of Physiology, Georgia Health Sciences University, 1120 15th Street, Augusta, GA 30912, USA
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20
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100th anniversary of the discovery of the human adrenal fetal zone by Stella Starkel and Lesław Węgrzynowski: how far have we come? Folia Histochem Cytobiol 2011; 48:491-506. [PMID: 21478089 DOI: 10.2478/v10042-010-0062-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Year 2010 marks a centennial anniversary of the description by Stella Starkel and Lesław Węgrzynowski, Polish students of the Faculty of Medicine, University of Lwów, the fetal zone of the human fetal adrenal gland. In 1911 both, Starkel and Węgrzynowski were graduated from the Faculty of Medicine of Lwow University. The paper appeared in the German Arch. Anat. Physiol. and its original title was "Beitrag zur Histologie der Nebeniere bei Feten und Kindern" ("Contribution to histology of adrenals of fetuses and children"). The studies were performed on 100 adrenal glands obtained from fetuses (from 6th month of gestation) and up to 5-year-old children. They described the fetal zone as a "medullary zone", also as "immature cortex", which undergoes involution in first years of life. To commemorate this discovery, this review aimed to present the most important achievements of studies on the development and involution of the human adrenal fetal zone.
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Tegethoff M, Raul JS, Jamey C, Khelil MB, Ludes B, Meinlschmidt G. Dehydroepiandrosterone in nails of infants: A potential biomarker of intrauterine responses to maternal stress. Biol Psychol 2011; 87:414-20. [DOI: 10.1016/j.biopsycho.2011.05.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Revised: 04/17/2011] [Accepted: 05/21/2011] [Indexed: 11/17/2022]
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Ishimoto H, Jaffe RB. Development and function of the human fetal adrenal cortex: a key component in the feto-placental unit. Endocr Rev 2011; 32:317-55. [PMID: 21051591 PMCID: PMC3365797 DOI: 10.1210/er.2010-0001] [Citation(s) in RCA: 198] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Continuous efforts have been devoted to unraveling the biophysiology and development of the human fetal adrenal cortex, which is structurally and functionally unique from other species. It plays a pivotal role, mainly through steroidogenesis, in the regulation of intrauterine homeostasis and in fetal development and maturation. The steroidogenic activity is characterized by early transient cortisol biosynthesis, followed by its suppressed synthesis until late gestation, and extensive production of dehydroepiandrosterone and its sulfate, precursors of placental estrogen, during most of gestation. The gland rapidly grows through processes including cell proliferation and angiogenesis at the gland periphery, cellular migration, hypertrophy, and apoptosis. Recent studies employing modern technologies such as gene expression profiling and laser capture microdissection have revealed that development and/or function of the fetal adrenal cortex may be regulated by a panoply of molecules, including transcription factors, extracellular matrix components, locally produced growth factors, and placenta-derived CRH, in addition to the primary regulator, fetal pituitary ACTH. The role of the fetal adrenal cortex in human pregnancy and parturition appears highly complex, probably due to redundant and compensatory mechanisms regulating these events. Mounting evidence indicates that actions of hormones operating in the human feto-placental unit are likely mediated by mechanisms including target tissue responsiveness, local metabolism, and bioavailability, rather than changes only in circulating levels. Comprehensive study of such molecular mechanisms and the newly identified factors implicated in adrenal development should help crystallize our understanding of the development and physiology of the human fetal adrenal cortex.
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Affiliation(s)
- Hitoshi Ishimoto
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
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23
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Abstract
During the early phases of development, adrenal glands share a common origin with kidneys and gonads. The action of diverse transcription factors, signalling pathways and endocrine signals is required for the individualization of the adrenal primordium and its subsequent differentiation into an adult adrenal gland, with massive remodelling taking place around the time of birth in humans. Here I summarize the most important steps by which the adrenal cortex is shaped and present an overview of the current understanding of the genes and molecular pathways implicated in adrenal development and involved in the pathogenesis of its congenital diseases. Evidence is accumulating that some pivotal factors acting during adrenocortical development also play an important role to regulate the growth of adrenocortical tumors, representing promising therapeutical targets for a biology-oriented therapy.
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Affiliation(s)
- Enzo Lalli
- Institut de Pharmacologie Moléculaire et Cellulaire, CNRS UMR6097, 660 route des Lucioles, Sophia Antipolis, 06560 Valbonne, France.
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Bielinska M, Parviainen H, Kiiveri S, Heikinheimo M, Wilson DB. Review paper: origin and molecular pathology of adrenocortical neoplasms. Vet Pathol 2009; 46:194-210. [PMID: 19261630 DOI: 10.1354/vp.46-2-194] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Neoplastic adrenocortical lesions are common in humans and several species of domestic animals. Although there are unanswered questions about the origin and evolution of adrenocortical neoplasms, analysis of human tumor specimens and animal models indicates that adrenocortical tumorigenesis involves both genetic and epigenetic alterations. Chromosomal changes accumulate during tumor progression, and aberrant telomere function is one of the key mechanisms underlying chromosome instability during this process. Epigenetic changes serve to expand the size of the uncommitted adrenal progenitor population, modulate their phenotypic plasticity (i.e., responsiveness to extracellular signals), and increase the likelihood of subsequent genetic alterations. Analyses of heritable and spontaneous types of human adrenocortical tumors documented alterations in either cell surface receptors or their downstream effectors that impact neoplastic transformation. Many of the mutations associated with benign human adrenocortical tumors result in dysregulated cyclic adenosine monophosphate signaling, whereas key factors and/or signaling pathways associated with adrenocortical carcinomas include dysregulated expression of the IGF2 gene cluster, activation of the Wnt/beta-catenin pathway, and inactivation of the p53 tumor suppressor. A better understanding of the factors and signaling pathways involved in adrenal tumorigenesis is necessary to develop targeted pharmacologic and genetic therapies.
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Affiliation(s)
- M Bielinska
- Box 8208, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110, USA.
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Bibliography. Current world literature. Adrenal cortex. Curr Opin Endocrinol Diabetes Obes 2008; 15:284-299. [PMID: 18438178 DOI: 10.1097/med.0b013e3283040e80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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