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 20122018 (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).
|Screening cortisols||Synacthen tests|
|Number of patients Split||143 (=83%) 66.4% (n=95/143): single screening cortisol test 33.6% (n=48/143): ³2 screening cortisol tests||29 (=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.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes