ADRENOCORTICAL STEROID METABOLISM IN NEWBORN INFANTS. III. URINARY EXCRETION OF 17-HYDROXYCORTICOSTEROIDS FOLLOWING MAJOR SURGERY AND STIMULATION WITH ADRENOCORTICOTROPIN*

Abstract

The excretion of 17-hydroxycorticosteroids (17-OH-CS) extractable from urine with methylene dichlo-ide both before and after incubation with B-glucuronidase was measured in a group of 9 newborn infants undergoing major surgery and in another group of 4 infants with hyperbilirubinemia who received single or multiple injections of adrenocorticotropin (ACTH). In the infants operated upon during the first four days of life, there was no rise in corticoid excretion in association with the operative procedure. Stimulation with ACTH in 1 of these infants resulted in an increased excretion of 17-OH-CS during the second week of life. In the infants operated upon after the first week of life, the operative procedure was associated with a rise in corticoid excretion similar to that seen in the adult and older child; excretion decreased in the days following surgery. In 1 of these infants, stimulation with ACTH induced an increase in the excretion of corticoids, but to a level no greater than that induced by surgery. Single or multiple injection of ACTH failed to increase urinary corticoid excretion in 4 infants with hyperbilirubinemia during the first week of life. In 1 of these infants there was a threefold rise in corticoid excretion when the ACTH was again given during the second week of life. The low levels for urinary excretion of 17-OH-CS seen in the youngest infants may have been due to actual adrenal gland unresponsiveness or to differences in the rates and routes of metabolism of cortisol and its derivatives.