Endocrine Abstracts

Background: Neonatal cortisol assessment is indicated in suspected adrenal insufficiency.

Aims/objectives: Review of neonatal cortisol assessment within our Trust over seven years, to analyse trends, indications, outcomes; and relationships between gestational age (GA), birth weight (BW) and cortisol assessment.

Methodology: From cortisol results on neonates (≤30 days age) between 2012–2018 (inclusive) we identified random/serial (‘screening cortisols’) versus cortisols done as part of Synathen tests. We analysed trends for testing. Further data collection was as follows:

• screening cortisols: Indication, number of tests, outcomes.

• Synacthen tests: Indication, type of test [short Synacthen test (SST) vs low dose Synacthen test (LDST)], results, short/long term outcomes, relationship to BW/GA.

Results: There were 412 cortisol tests over the 7 years, in 172 patients. Numbers were stable between 2012 and 2014, but between 2015/2016 and 2017/2018 there was a 230% increase in cortisol; and 430% rise in Syacnthen tests. This was despite stable admission rates: 1997 patients over 2015/2016 and 1916 in 2017/2018. Further results: Table 1.

There was no significant relationship between premature versus term deliveries and abnormal Synacthen tests (P=0.32); or between BW (i.e. SGA vs AGA) and abnormal Synacthen tests (P=0.67).

Summary/conclusions: Despite an exponential increase in cortisol assessments, 91% of testing indications were appropriate. Initial pick-up of adrenal insufficiency was low (6%). Subsequent reassessment of adrenal function is imperative as 64% of these results were transient. There were no associations between BW or GA and abnormal Syancthen results.