ESPE Abstracts

The diagnosis of central adrenal insufficiency (CAI) is challenging. The most popular diagnostic tool in pediatric population remains low-dose (1 μg) cosyntropin (LDC) test. Nevertheless, there is still a need for the CAI markers that might be used on an outpatient setting as a first-line screening. In adult patients morning cortisol and dehydroepiandrosterone sulphate (DHEAS) has been postulated as a possible markers. The aim of the study was to evaluate the usefulness of basal morning serum cortisol and DHEAS assessment to diagnose CAI in the pediatric population. Material and methods: In 94 pediatric patients suspected to have CAI basal cortisol and DHEAS levels were assessed, and LDC and was performed. Results: On the basis of LDC test 9 patients were diagnosed with CAI (group 1, maximal cortisol level < 140 ng/mL), in 70 CAI was excluded (group 2, maximal cortisol level > 200 ng/mL), in the rest the test results indicated partial CAI. Basal morning cortisol level was significantly lower in group 1, than in group 2 (33.3 vs. 112.1 ng/ml, P=0.04) as well as DHEAS level (16.8 vs. 86.5 µg/ml, P=0.00007). Despite these differences, it was not possible to determine the value of the cut-off point for any of the parameters. Conclusion: In pediatric patients with CAI basal morning cortisol and DHEAS levels are significantly lower than in patients with normal adrenal function. Nevertheless, due to the impossibility of drawing a cut-off point, they cannot replace stimulation tests.