The cortisol-cortisone shuttle in children born with intrauterine growth retardation

We evaluated the involvement of a possible dysfunction of 11 beta-hydroxyst eroid dehydrogenase type 2 (11 beta-HSD2) in the fetal growth retardation a nd poor growth rates of children born with intrauterine growth retardation (IUGR). Children with IUGR have a nephron deficit and are also at risk of d eveloping cardiovascular diseases, high blood pressure, glucose intolerance , and dyslipidemia later in life. The major site of 11 beta-HSD2 production is the kidney and its deficit causes hypertension. We investigated plasma concentrations of cortisol (F) and cortisone (E) and the F/E ratio in 26 co ntrol children and in 40 IUGR children without catch-up growth. We also det ermined cholesterol, HbA1C, insulin, and glucose levels in plasma. Mean F v alues were 106 +/- 54.2 ng/mL in control children and 114.6 +/- 53.2 ng/mL in IUGR children. Mean E values were 19.5 +/- 7.1 ng/mL in control children and 17.9 +/- 6.85 ng/mL in IUGR children. The mean F/E ratio for control c hildren was 5.5 +/- 1.7. Eight (20%) of the IUGR children (IUGR children of group I) had high F/E ratios more than 2 SD above the normal mean: 13.15 /- 4.26, (p < 0.0001) as compared to control children, whereas the other 32 children (IUGR children of group 2) had normal F/E ratios: 5.40 +/- 1.43 ( p = 0.68). Childhood height was significantly lower for group 1 than group 2 children (-3.63 SD and -2.92 SD, respectively: p < 0.01) and was negative ly correlated with the F/E ratio (p < 0.01). Systolic blood pressure was hi gher for group 1 (p = 0.005) and for group 2 (p = 0.015) than for control c hildren. The diastolic pressure in IUGR children of group 1 was higher than that in control children (p = 0.013) and slightly higher than that in grou p 2 (p = 0.1, ns). Cholesterol concentrations were higher in group 1 than i n group 2 (p = 0.029), and controls (p = 0.017) and correlated positively w ith F/E (0.02 < p < 0.05). Fasting insulin concentrations were higher in gr oup 1 than in group 2 (ns) and controls (ns). There was no difference in me an fasting glucose concentrations, or HbA1C between the three groups. Twent y percent of our children with IUGR and poor growth rates had high F/E rati os, suggesting a possible partial 11 beta-HSD2 deficit. Whether these child ren are at high risk of developing cardiovascular diseases as adults remain s to be further evaluated.