Endocrine Abstracts

Background: Bone age studies require X-ray of the left hand and wrist to assess skeletal maturity. The Tanner-Whitehouse 3 (TW3) scoring method provides an objective framework for calculating bone age and specifies exact placement of the hand. In our service we have 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, with time,...

Background: Paediatric diabetes is predominantly an outpatient based specialty, limiting the training opportunities available to paediatric trainees. At our centre, out of hours diabetes advice calls are managed by paediatric specialty trainees working on the middle grade rota, with 24 hour support from an oncall paediatric diabetes consultant. Feedback locally from families has highlighted the quality of out of hours advice as an area of concern. We aimed to assess the knowle...

Introduction: A 2009 BSPED survey revealed that 90% use a low dose Synacthen test (LDST) and 44% had noticed increased referrals of asthmatic children prescribed inhaled corticosteroids (ICS). Approximately 21% of UK children have asthma of whom 70% are prescribed ICS (10% at ‘high dose’). There is an increasing need for a simple, less invasive, alternative to the LDST to evaluate their adrenal function. We are developing a non-invasive LDST, with Synacthen administe...

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...

Background: Measurement of salivary glucocorticoids is gaining popularity as it offers a non-invasive collection technique, enabling sampling in the community or home environment, allowing tailored capture of steroid circadian rhythm and improved patient experience. Current popular salivary collection methods cannot be used in very young children due to choking and the requirement for active participation. There is little data on saliva stability during home collection.<p ...

Background: Limited data support concerns that corticosteroid use in pregnancy, for maternal health reasons, can suppress the neonatal Hypothalamic-Pituitary-Adrenal (HPA) axis. We sought to determine if neonates born to mothers on high-dose steroids are at risk of adrenal suppression.Methodology: Our tertiary neonatal unit guidance advises that babies born to mothers receiving ≥7.5 mg/day prednisolone for 28 consecutive days in the 3rd trimester u...

Background: The hypothalamic-pituitary-adrenal (HPA) axis can be suppressed by long-term exogenous glucocorticoids, resulting in tertiary adrenal insufficiency (AI). International expert consensus suggests that during weaning, prednisolone be converted to hydrocortisone to allow HPA axis reactivation(1). There is, however, little evidence to support this practice.Aim: To compare HPA axis recovery during treatment with prednisolone and immediat...

Background: Measuring testicular volumes by orchidometer is a standard method of pubertal staging in boys. A paucity of evidence exists as to its inter and intra-observer reliability and the impact of clinicians gender, experience and training on the accuracy of measurements. We are developing specifically engineered models with different testicular volumes to investigate inter and intra-observer reliability of testicular volume estimation for simulation training.<p class=...

Background: Currently we investigate children with possible GH deficiency, but who are healthy, with a normal short stature screen, and without suspicion of other pituitary dysfunction (‘simple short stature’), with full dynamic anterior pituitary function tests (APFT). An abnormal GH peak leads to a second GH stimulation test. We studied the cost implications of only performing a GH stimulation test initially, followed by full APFT if the initial GH peak was low, to...

Background: Limited evidence exists regarding the effect of antenatal prednisolone (ANP) on neonatal adrenal function. Our regional neonatal unit screens these babies by measuring three random serum cortisol levels 8 h apart on day 3 of life. Adrenal function is considered adequate if two cortisol levels are >100 nmol/l. Those with inadequate random cortisol levels undergo a low-dose Synacthen test (LDST). Our survey of UK tertiary Paediatric Endocrinology centres revealed...