ESPE Abstracts (2014) 82 P-D-3-3-919

Dynamic Stimulation Testing in Pediatric Endocrinology: Experience of a Pediatric Endocrine Unit in a Developing Country

Janani Sundaram, Hemchand Krishna Prasad, Gnanabalan Murugesan, Ravisekar Vasudevan & Thangavelu Sangaralingam

Mehta Children’s Hospital, Chennai, India

Background: Basal or unstimulated hormone levels frequently do not provide sufficient diagnostic information in the investigation of endocrine disorders. A range of dynamic or provocative tests are available to assess the dynamic responses of hormones and make necessary diagnoses.

Objective and hypotheses: To describe the experiences with dynamic stimulation testing of a Paediatric Endocrine Unit in a developing country.

Method: Retrospective review of case records of children who underwent dynamic stimulation testing in a Pediatric Endocrine Unit in a 1 year period (March 2013–February 2014).

Results: During the study period, 35 children warranted dynamic testing, of whom 29 underwent testing, reasons for not testing include: costs (50%) and risk explained (17%) and unknown (33%). GH stimulation testing done: stimulant: glucagon (n=4) and clonidine (n=7). Interpretations: GH deficiency; GH sufficiency; GH insensitivity; and neurosecretory dysfunction. Synacthen stimulation testing; indications – low basal cortisol levels (n=3) and abnormal neonatal congenital adrenal hyperplasia screening test (n=1): adequate cortisol reserve established. GnRH analogue test (n=4); diagnosis of thelarche variant (n=2); central precocious puberty (n=1); and hypothalamic amenorrhea (n=1). Other tests done water deprivation test, dexamethasone suppression test practical modifications include: combining two tests to share stimulant costs; reducing the number of blood samples; using analogues and avoiding i v cannulation. Three minor complications encountered during the study: minor anaphylactic reaction (Synacthen), hypotension (clonidine) and symptomatic hypoglycaemia (glucagon); no deaths. The average cost Indian rupees 6500±840 (€77); laboratory expenditure 76.3%. Other difficulties include discrepancy between dosage of stimulant calculated by body weight and surface area, difficulty in fasting infants, and inadvertent collection of sample in inappropriate container.

Conclusion: Dynamic stimulation tests are feasible in resource scarce settings of developing countries. They must be done in day care settings with all necessary precautions.

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