Cortisol and other adrenal steroids in critical neonatal disease associated with shock

I found that serum concentrations of cortisol were not statistically different between neonates who had refractory hypotension and those who responded to the conventional treatment. This result was unexpected because the critically ill neonates were presumed to have higher cortisol concentrations during extreme stress.

However, the increase in steroids proximal to the 3β- hydroxysteroid dehydrogenase activity was higher in neonates with apparent cortisol insufficiency, suggesting that this enzyme may be rate limiting. I found that the serum cortisol concentrations did not increase in the critically ill neonates with circulatory collapse.

However, these neonates responded favorably to hydrocortisone treatment and their clinical signs and symptoms related to adrenal insufficiency improved. Thus, circulatory collapse in term or late preterm neonates with life-threatening illnesses and refractory hypotension may possibly be a consequence of the insufficient synthesis of cortisol during excessive stress.