Endocrine Abstracts

Endocrine presentation of a renal disorder. Baby boy born at full term with Birth weight of 4.3 kg and discharged the next day. Baby initially breastfed but losing weight. Advised combination feeding with expressed breast milk and formula milk. Even after increasing feed volume by health visitor baby losing weight. On Day 28 was admitted to the Children’s Assessment Unit following a health visitor referral. Baby had a 2 day history of abdominal discomfort and loose stools but no vomiting. On admission baby looked well, not dehydrated. Examination normal with normal genitalia. Blood test showed hyponatraemia (113 mmol/l) and hyperkalaemia (6.7 mmol/l) and admitted to PICU. Urinary steroid profile and 17OHP obtained and started on antibiotics in view of suspected sepsis. Hydrocortisone with Fludrocortisone commenced for suspected diagnosis of Congenital Adrenal Hyperplasia with IV fluids and hyperkalaemia management. Remained stable, and started gaining weight. 17OHP normal (1.3 nmol/l). Sodium supplements and Fludrocortisone were discontinued and electrolytes remained stable. However, a urine sample grew E. coli. Cortisol sample sent before starting Hydrocortisone treatment was insufficient, therefore adrenal insufficiency could not be excluded at this point. Baby discharged with open access, a weaning plan for Hydrocortisone, sick day rules and emergency IM Hydrocortisone training. Short Synacthen test arranged. An ultrasound of the renal system showed Hydronephrosis of the left kidney with dilatation of left ureter. Prophylactic Trimethoprim commenced and MCUG and DMSA arranged. Urinary steroid profile normal with a large peak of cholesterol suggestive of a urinary tract infection. MCUG showed Grade 5 vescicureteric reflux and DMSA showed 12%function on left 88% on right kidney. Baby successfully weaned off Hydrocortisone and Short Synacthen test normal. Gaining weight and no further UTI. This case highlights the importance of checking urine and sending for culture in babies with poor weight gain. Patients presenting with suspected adrenal insufficiency must undergo urinalysis and culture to exclude infections. We advise prioritising samples before starting steroids to avoid critical samples being missed, which will help to avoid dynamic testing later.