NORMATIVE DATA FOR ADRENAL STEROIDOGENESIS IN A HEALTHY PEDIATRIC POPULATION - AGE-RELATED AND SEX-RELATED CHANGES AFTER ADRENOCORTICOTROPIN STIMULATION

The normal response to a single 0.25-mg dose of ACTH-(1-24) is not well established in infancy or childhood. We report the adrenal steroidogenic responses of 17-hydroxypregnenolone (17OH Preg), 17-hydroxyprogesterone (17OH Prog), 11-deoxycortisol, cortisol, deoxycorticosterone, dehydroepiandrosterone (DHEA), DHEA sulfate, androstenedione (A'dione), and testosterone in 102 healthy children who were divided into 5 groups: group 1 (< l yr old; n = 22), group 2 (1-5 yr old; n = 22), group 3 (6-12 yr old; n = 15), group 4 (early-midpuberty; n = 21), and group 5 (late puberty; n = 22). Baseline and stimulated levels of 17OH Preg were significantly higher in group 1 infants than in group 2 children (P < 0.01). Baseline levels of 17OH Prog increased in late puberty (P < 0.01). Baseline and stimulated levels of DHEA rose in late puberty (group 5 vs. group 3, P < 0.01). DHEA levels in late pubertal females were higher than those in their male counterparts (P < 0.01). DHEA sulfate levels did not change after ACTH administration in any age group. Basline and stimulated levels of A'dione rose significantly before the onset of puberty in female children (group 2 vs. group 3, P < 0.01). The calculated ratio of 17OH Preg/17OH Prog in group 1 was significantly higher than that in other groups of children (P < 0.01). The calculated, baseline DHEA/A'dione ratio was higher in group 1 than in older children (P < 0.01). Stimulated ratios were higher in late pubertal females than in males (P < 0.01). In both sexes baseline and stimulated ratios of 17OH Prog/deoxycorticosterone increased in puberty, such that late pubertal children had higher levels than prepubertal children (P < 0.01). These data confirm the need for interpretation ACTH stimulation test data to be based upon age- and sex-specific norms.