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: 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 ...

Background: The Short Synacthen Test (SST) is the most popular test of adrenal insufficiency (AI) worldwide. The current SST protocol at Sheffield Children’s Hospital (SCH) recommends measurement of serum cortisol at baseline, then 30- and 60-minutes post stimulation. A peak cortisol of >429nmol/l constitutes a pass. Our practise has evolved to consider results between 350 and 429nmol/l as “borderline” and these patients may be treated with stress dosing ste...

Introduction: There is evidence that an early morning plasma cortisol (EMC) below <160 nmol/l is predictive of failing the SST and the corollary is seen with an EMC above >340 nmol/l. Using an EMC to screen patients for AI has been advocated, although there is a paucity of paediatric studies. Modern sensitive and specific cortisol assays make deriving local diagnostic thresholds important. We analysed our SST data since the introduction of a new cortisol assay to deriv...

Introduction: Diagnostic cut-offs for plasma cortisol on Short Synacthen Test (SST) are controversial, made more complicated by modern assays and paediatric normative values extrapolated from adult data. Some advocate a division between biochemical and clinical AI, with different cut-offs and management strategies. For asymptomatic children, with a low-index of suspicion, and borderline SST results our department has evolved a tendency to advise hydrocortisone replacement in t...