Free, glucuro and sulfo conjugated C21 corticosteroids have been studied in the urine of premature neonates. In control subjects, as well as in infants with respiratory distress, or after administration of ACTH, a large proportion of 6β-hydroxycortisol, cortisol, cortisone, tetrahydrocortisol, tetrahydrocortisone and corticosterone is excreted as sulfate ester up until at least 1 month postnatally. Under stress or ACTH, glucuro-conjugation may be increased, suggesting that it is not maximal in the resting state. It is suggested that sulfation may serve to inactivate a number of circulating C21 corticosteroids during fetal and neonatal life, and that the infant may thus be protected against a rich steroid environment until his relative deficiency to conjugate with glucuronic acid is fully corrected.

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