Endocrine Abstracts

Introduction: Unstimulated cortisol is commonly used as a screening test for adrenal insufficiency. In the UK over the last decade there has been a large increase in the numbers of requests for cortisol being made in both primary and secondary care. To increase the specificity of an unstimulated cortisol, and thus reduce unnecessary referrals and Short Synacthen Tests, the recommendation is that an early morning cortisol (EMC) is performed between 08:00 and 09:00 h. There is e...

Background: Diabetes is a primarily self-managed condition, and education to patients and families is an essential component of a diabetes service. In line with accepted UK practice, our diabetes team provides a comprehensive education program at diagnosis and regularly thereafter.Methods: From October 2017 to January 2018, all patients attending diabetes clinic were offered a pseudo-anonymised mixed methods survey, covering experience of education, barr...

Introduction: The COVID-19 pandemic accelerated the execution of the 2019 NHS Long Term Plan with rapid introduction and widescale uptake of virtual consulting. While these are associated with lower Was Not Brought (WNB) rates, we observed that patients in our Paediatric and Adolescent Gynaecology (PAG) clinics were frequently absent, with parents (usually mothers) attending alone, unlike Face-To-Face (F2F) consultations, where the patients are always present....

Introduction: The National Paediatric Diabetes Audit (NPDA) provides a benchmark of performance for paediatric diabetic services across the UK. Whether intentional or not, a league table is created comparing units based on their mean HbA1c. Although the coordinators suggest submitting the patients’ most recent HbA1c, this may not necessarily be a universally adopted phenomenon. We examined the effect of selecting patient’s best, yearly average, and latest HbA1c on ou...

Background: Over the last two decades, supported by two metanalyses, the low-dose Synacthen Test (LDST) has gained in popularity, with many believing it to be more sensitive than the supra-physiological Standard (250 microgram) Short Synacthen Test (SSST). The literature reveals lack of consensus about its specific clinical applications, what is considered “low-dose” and how that dose is made up.Methods: To ascertain current UK practice,...

Background: Adrenocorticotrophic hormone (ACTH) measurements can help determine the cause of adrenal insufficiency (AI), but AI is diagnosed using peak cortisol levels following Synacthen stimulation, not ACTH levels. ACTH levels are high in primary and low in secondary and tertiary AI. Primary AI is rare in childhood. At Sheffield Children’s Hospital (SCH) ACTH is measured as part of screening for AI, paired with an early morning cortisol, and at baseline (0 minutes) as ...

Introduction: Although not directly inherited, genetics play a significant role in the chances of developing Type1 Diabetes (T1DM), yielding a risk of 2–40% depending on the first degree relative (FDR) affected. T1DM is a self-managed condition in which education and patient/carer engagement are key. We had noted cases of poor engagement and glycaemic control in our patients with a FDR with T1DM but found a paucity of literature examining this relationship.<p class="a...

Background: The low-dose short synacthen test (LDSST) is the most popular diagnostic test for adrenal insufficiency in UK. Although various dosing strategies exist 1 μg is most commonly employed but not commercially available. A BSPED survey revealed 14 different methods for diluting the 250 μg/ml ampoules. We investigated whether differing dilution strategies, made up using standard ward not laboratory equipment, result in differences in Synacthen dose administered....

Background: X-rays of the left hand and wrist are used to assess skeletal maturity. The Tanner-Whitehouse 3 (TW3) scoring method provides a framework for calculating bone age but specifies exact hand position. We noted a number of poor quality films, caused by difficulty with hand placement, e.g. scrunching of the fingers. This compromises the ability to score accurately and in a proportion necessitates re-X-ray, resulting in additional time, cost and radiation exposure. We in...

Introduction: The short Synacthen test (SST) is a popular diagnostic investigation for adrenal insufficiency (AI). Cannulation and blood sampling are required making it invasive, time-consuming and resource-intensive. Salivary cortisol is a well-established alternative to serum sampling. We have developed a non-invasive alternative to the 1 μg SST, using a novel formulation of Synacthen (with a nasal drug enhancer, chitosan) given nasally and utilising saliva to measure t...