ESPE Abstracts (2019) 92 P3-299

Review of Neonatal Cortisol Evaluation between 2012-2018 in a Single Centre: Trends, Outcomes and Associations

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


1Oxford Children's Hospital, Oxford, United Kingdom. 2John Radcliffe Hospital, Oxford, United Kingdom


Background: Neonatal cortisol assessment is indicated in suspected adrenal insufficiency. Clinical presentation includes: low blood glucose, low blood pressure, ambiguous genitalia, electrolyte abnormalities, midline abnormalities.

Aims: Review the trends, outcomes and associations of cortisol assessment in neonates within our Trust between 2012-2018.

Objectives: Review:

• trends in cortisol assessments

• indications for 'random/serial' cortisol tests.

• Indications/outcomes for Synacthen tests

• relationships between gestational age (GA), birth weight (BW) and cortisol assessment.

Methodology: Cortisol tests performed on neonates (≤30 days age) at our Trust, over 7years: 2012-2018 (inclusive) were retrieved. We identified random/serial ('screening cortisols') versus cortisols done as part of Synathen tests.

We looked at trends for testing, and further data collection was done 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 and long term outcomes, relationship to BW/GA.

Results: There were 412 cortisol tests over the 7 years, in 172 patients. Numbers were stable between 2012-2014, but between 2015/2016 and 2017/2018 there was a significant increase in overall cortisol tests= 230%; and Syacnthen tests=430%. This was not comparable to stable admission rates: 1997 patients over 2015/2016 and 1916 in 2017/2018.

Table 1: Screening cortisol versus Synacthen tests.
Screening cortisolsSynacthen tests
Number of patients143 (=83%)29 (=17%)
Split66.4% (n=95):single screening cortisol level. 33.6% (n=48): 2 or more screening cortisol levels. 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 the screening results. Subsequent Synacthen test 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.

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).

Summary/Conclusions: There is an exponential increase in cortisol assessments, out of keeping with changes in admission rates. However 91% of testing indications were appropriate. 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.

Article tools

My recent searches

No recent searches.