FETAL ADRENAL SIZE IS PITUITARY ACTH-DEPENDENT THROUGHOUT GESTATION

Abstract

Studies in a limited number of normal, anencephalic (Ac), and congenital adrenal hyperplasia (CAH) fetuses suggest that trophic factors other than ACTH may control adrenal growth in early fetal life. Combined adrenal weights were recorded in 102 fresh, non-macerated fetuses (gestional age, GA, 15-27 wk), 39 Ac fetuses (GA 13-25 wk) and 3 fetuses with CAH (GA, 17, 18.5, 30 wk). GA was calculated from the foot length. Mean adrenal weight in normals increased 4-fold between 15-27 wk. Adrenal weight did not increase in Ac fetuses between 13-21 wk. At 17 wk GA, mean ± SEM adrenal weights in normals (n=11) and Ac fetuses (n=8) were 1.0 ± 0.15 g and 0.3 ± 0.08 g respectively (p<0.001). Adrenal weights in 2 female CAH fetuses at this GA were 2.4 g and 4.4 g. Both had clitoromegaly and labial fusion; cardiac blood steroid levels in one fetus were:-17OH-progesterone 246, androstenedione 216, testosterone 22 nmol/l. A preterm (30 wk) CAH fetus who died also had large adrenals. Adrenal histology in all 3 CAH fetuses showed widening of the fetal zone and large cell size.

This comparative study of normal, Ac and CAH fetuses confirms the pivotal trophic role for ACTH in adrenal growth and steroidogenesis from early fetal Life.

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