Endocrine Abstracts

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 ...

A 50 years old man was seen in the Endocrine clinic with elevated calcium (2.80 mmol/l, normal 2.20-2.60) and Parathyroid hormone (10.7 pmol/l, normal 1.6-6.9) levels. His medical background includes Alport Syndrome, Renal Allografts (1st 1990, 2nd 2000 and 3rd 03/11/2005), and Osteopenia on DEXA scan in February 2020. He did not have any renal stones in the past. There was no family history of hypercalcemia. He was on Vitamin D 1000 Units daily (Vitamin D 55 nmol/l, normal 50...

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: The current screening test for adrenal insufficiency (AI) involves patients attending hospital for an “early” morning serum cortisol sample, generally taken some considerable time after the child has woken. This risks missing the morning cortisol peak, leading to false positive results. It requires venepuncture, which is unpleasant for children. Saliva collection is non-invasive, simple and can be undertaken on waking at home, providing a...