ESPE2024 Free Communications Adrenals and HPA Axis 2 (6 abstracts)
Plasma concentrations of renin and ACTH in children and adolescents from the general population: new reference intervals according to sex, age, and pubertal stage
Pernille Edström 1,2 , Stine A. Holmboe 1,2 , Lea Vilmann 1,2 , Veronica R. Grøndahl 1,2 , Charlotte E. Thomsen 1,2 , Andrés Ø. Fritzbøger 1,2 , Lise Aksglaede 1,2 , Casper P. Hagen 1,2 , Jørgen H. Petersen 1,2,3 , Niklas R. Jørgensen 4,5,6 , Anders Juul 1,2,4 & Trine Holm Johannsen 1,2
1Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark. 2The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 3Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark. 4Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. 5Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Copenhagen, Denmark. 6The Translational Research Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
Introduction: Management of children with adrenal disorders such as congenital adrenal hyperplasia involves thorough clinical monitoring, including measurements of plasma renin concentrations (PRC) and ACTH. However, sex- and age-related reference intervals (RIs) for PRC and ACTH using novel immunoassays are needed.
Aim: To evaluate circulating concentrations of renin and ACTH in children and adolescents from the general population according to sex, age, and pubertal stage.
Methods: In total, 633 children (58% girls) aged 5.8 – 20.9 years from six schools in greater Copenhagen participated in the Copenhagen Puberty Study III (ClinTrials.gov #NCT04884620). Pubertal development was clinically assessed according to Tanner staging. Pubertal onset was defined as breast stage ≥ B2 in girls and testicular volume ≥ 4 mL in boys. Blood sampling was performed after 10 minutes rest in a supine position. Immunoassays were used for quantification of PRC (IDS-iSYS Direct Renin, REF IS-3400, Immuno Diagnostic Systems plc)) and ACTH (Cobas 8000 platform, Roche Diagnostics GmbH). Mann-Whitney U test assessed if median concentrations differed according to pubertal development.
Preliminary Results: RIs for PRC and ACTH will be calculated using the Generalized Additive Model for Location, Scale, and Shape (GAMLSS).
PRC: All samples had concentrations above limit of detection (LOD) (1.8 × 10-3 IU/L) and showed large interindividual variation (6 – 240 × 10-3 IU/L). In girls, the median PRC was 43.0 × 10-3 IU/L (IQR: 28 – 65 × 10-3 IU/L). PRC was significantly higher in prepubertal girls (56.0 × 10-3 IU/L) than in pubertal girls (36.0 × 10-3 IU/L, P <0.001). In boys, PRC was 45.0 × 10-3 (34 – 66) IU/L. PRC was significantly higher in prepubertal boys (47 × 10-3 IU/L) than in pubertal boys (42 × 10-3 IU/L), P = 0.02.
ACTH: In girls, two samples had concentrations < LOD (0.66 pmol/L), the rest showed large interindividual variation (0.9 – 22.2 pmol/L). In girls, the ACTH concentration was 4.0 (3.0 – 5.3) pmol/L. No significant difference in ACTH concentration was found between prepubertal (3.8 pmol/L) and pubertal girls (4 pmol/L), P = 0.4. In boys, the ACTH concentration was 4.9 (3.6 – 6.4) pmol/L. Prepubertal boys had significantly lower concentrations of ACTH (4.4 pmol/L) compared with pubertal boys (5.4 pmol/L), P = 0.004.
Conclusion: We plan to present RIs for PRC and ACTH in children and adolescents according to sex, age, and pubertal development. This novel tool is important in monitoring children and adolescents with adrenal disorders
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