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.
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.
|Screening cortisols||Synacthen tests|
|Number of patients||143 (=83%)||29 (=17%)|
|Split||66.4% (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.
19 Sep 2019 - 21 Sep 2019