ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 66 OC5.10 | DOI: 10.1530/endoabs.66.OC5.10

Review of neonatal cortisol evaluation between 2012-2018 in a single centre: trends, outcomes and associations

Taffy Makaya1, Satish Sarvasiddhi1, Elizabeth van Boxel1, Smrithi Menon2 & Brian Shine2

1Oxford Children’s Hospital, Oxford, UK; 2John Radcliffe Hospital, Oxford, UK

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).

Table 1 Screening cortisol versus Synacthen tests.
Screening cortisolsSynacthen tests
Number of patients Split143 (=83%) 66.4% (n=95/143): single screening cortisol test 33.6% (n=48/143): ³2 screening cortisol tests29 (=17%) 72.4% (n=21/29) were SSTs 27.6% (n=8/29) were LDSTs
Top 3 indications:Hypoglycaemia(35.6%), ambiguous genitalia(16%), conjugated jaundice(9%)Hypoglycaemia(44.8%), ambiguous genitalia(6.9%) and hyponatremia(6.9%)
Outcomes:Only ONE patient was started on treatment based on just screening results. Subsequent SST confirmed adrenal insufficiency.38% of the initial Synacthen tests were abnormal (n=11/29). Of these only 36% (n=4/11) remained on treatment after age of 2 years: Dx=2x Hypopitutarism + 1x Hypoglycaemia, SGA and maternal pre-eclampsia +1 Preterm (repeat SST pending).

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.

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