ESPE2021 ePoster Category 2 Adrenals and HPA Axis (57 abstracts)
Serum cortisol and cortisone, and urinary cortisol, cortisone, and tetrahydro-metabolites concentrations in school-aged children born very preterm adequate for gestational age
Gonzalo Dominguez-Menendez , Maria Fernanda Ochoa-Molina , Helena Poggi Mayorga , Fidel Allende Sanzana , Sandra Solari Guajardo , Carlos E. Fardella Bello , Cristian A. Carvajal , Carmen Campino Johnson , Rene Baudrand Biggs , Hernan Garcia Bruce , Rosario Moore Valdes , Ivonne D’apremont Ormeño & Alejandro Martinez-Aguayo
Pontificia Universidad Catolica de Chile Santiago, Chile
Introduction: Cortisol homeostasis dysregulation has been associated to essential hypertension in adults. Higher levels of cortisol have been described in preterm-born individuals, who have also a higher risk of hypertension at younger ages. Several enzymes modulate peripheric cortisol metabolism. The 11b-hydroxysteroid dehydrogenase (11b-HSD) type 2 metabolizes cortisol into cortisone, preventing mineralocorticoid receptors’ activation by cortisol. The inverse process is mediated by 11b-HSD type 1. The A-ring reductases inactivate cortisol and cortisone to tethahydrometabolites, tetrahydrocortisol (THF) and tetrahydrocortisone (THE). Defects in 11-bHSD2 produce cortisol-dependent mineralocorticoid excess, which is expressed with increased urinary cortisol/cortisone (F/E) ratio. Furthermore, 11b-HSD1 overexpression has been associated with hypertension and metabolic disorders. The urinary THF/THE ratio reflects 11b-HSD1 function.
Objective: To compare the serum concentrations of cortisol and cortisone, and urinary concentrations of cortisol (F), cortisone (E), THF and THE between very preterm (VPT) born and at term-born school-aged children, all adequate for gestational age (AGA).
Methods: In this cross-sectional study, 69 very preterm (< 32 gestational weeks) and 42 full-term (> 37 gestational weeks) school-aged children (4.9 to 8.9 years old) were included. Urine and serum samples were collected in early morning after an overnight fasting period. All the metabolites were measured by mass spectrometry.
Results: Serum cortisol and cortisone had similar profiles in both groups. However, urinary cortisone had a higher concentration in preterm children (p-value=0.01), but they maintain similar F/E ratio. In this way, the concentration of THE are higher in born VPT, as well.
| Very-preterm (n = 69) | Full term (n = 42) | P-value | |
| Serum | |||
| Cortisol (ug/dL) | 6.88 (5.09-9.33) | 7.83 (5.20-9.98) | 0.53 |
| Cortisone (ug/dL) | 2.22 (1.88-2.68) | 2.45 (1.99-2.95) | 0.35 |
| F/E ratio | 3.16 (2.52-3.58) | 2.91 (2.44-3.72) | 0.64 |
| Urine | |||
| F (ng/ml) | 15.08 (8.29-22.71) | 12.44 (8.01-18.02) | 0.21 |
| E (ng/ml) | 45.68 (31.41-60.42) | 33.7 (22.92-46.39) | 0.01 |
| F/E ratio | 0.34 (0.26-0.42) | 0.36 (0.31-0.43) | 0.40 |
| THF (ng/ml) | 11.05 (7.3-17.82) | 9.58 (6.48-15.31) | 0.26 |
| THE (ng/ml) | 12.08 (8.74-25.42) | 10.35 (6.12-15.86) | 0.03 |
| THF/THE ratio | 0.81 (0.62-1.06) | 1.01 (0.76-1.20) | 0.02 |
| Results are expressed in median and IQR | |||
Conclusion: In this sample, school-aged children born VPT AGA had similar profiles of serum cortisol. However, at renal level, the VPT children showed higher concentrations of cortisone and THE, inactive metabolites, that could be caused by a disbalance between 11b-HSD1 and 11b-HSD2 function, with a predominance of 11b-HSD2. This disbalance could reflect an initial protective mechanism in preterm born children to prevent blood hypertension in the first years of life.
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