TY - JOUR
T1 - RETROSPECTIVE REVIEW OF SYNACTHEN TESTING IN INFANTS
AU - Tan, Timothy Shao Ern
AU - Manfredonia, Claire
AU - Kumar, Rakesh
AU - Jones, Julie
AU - O'Shea, Elaine
AU - Padidela, Raja
AU - Skae, Mars
AU - Ehtisham, Sarah
AU - Ivison, Fiona
AU - Tetlow, Lesley
AU - Clayton, Peter
AU - Banerjee, Indraneel
AU - Patel, Leena
PY - 2018
Y1 - 2018
N2 - Background A subnormal cortisol response (30 min level (C30min)<550 nmol/L) to synthetic adrenocorticotrophic hormone/Synacthen test (SDST) in all infants does not necessarily indicate underlying or persistent hypothalamic–pituitary–adrenal axis pathology.
Methods We retrospectively evaluated the diagnoses and outcomes in 68 infants who had a SDST at age <6 months from 2011 to 2014.
Results 29 (43%) infants had a subnormal SDST. Causative pathology was identified in 9/29 (31%). In 20/29 (69%) with no identified pathology, repeat SDST was normal in 18/20 (90%) at median age 0.6 (range 0.1–3.2) years but persistently subnormal in 2. Those with a transient abnormality were more likely to be small for gestational age (P=0.03) and had higher initial SDST C30min (390 nmol/L vs 181 nmol/L, P=0.01) than those with pathology.
Conclusion Specific aetiology can be identified in a third of infants with a subnormal SDST. When the aetiology remains elusive, adrenal function should be reassessed as the problem can be transient.
AB - Background A subnormal cortisol response (30 min level (C30min)<550 nmol/L) to synthetic adrenocorticotrophic hormone/Synacthen test (SDST) in all infants does not necessarily indicate underlying or persistent hypothalamic–pituitary–adrenal axis pathology.
Methods We retrospectively evaluated the diagnoses and outcomes in 68 infants who had a SDST at age <6 months from 2011 to 2014.
Results 29 (43%) infants had a subnormal SDST. Causative pathology was identified in 9/29 (31%). In 20/29 (69%) with no identified pathology, repeat SDST was normal in 18/20 (90%) at median age 0.6 (range 0.1–3.2) years but persistently subnormal in 2. Those with a transient abnormality were more likely to be small for gestational age (P=0.03) and had higher initial SDST C30min (390 nmol/L vs 181 nmol/L, P=0.01) than those with pathology.
Conclusion Specific aetiology can be identified in a third of infants with a subnormal SDST. When the aetiology remains elusive, adrenal function should be reassessed as the problem can be transient.
U2 - 10.1136/archdischild-2017-313819
DO - 10.1136/archdischild-2017-313819
M3 - Article
SN - 0003-9888
JO - Archives of Disease in Childhood
JF - Archives of Disease in Childhood
ER -