Endocrine Abstracts

We would like to present a case which, through unexpected results, caused us to examine the communication, both written and verbal, that is provided to patients prior to undergoing dynamic tests in our unit, and which subsequently led to a change in our practice.

A 48-year-old lady was referred from the GP with a raised testosterone of 5.0 nmol/l (reference range 0.2–2.9 nmol/l), irregular periods and late onset hirsutism. A low dose dexamethasone test (LDDT) was requested to exclude the possibility of an androgen secreting tumour.

Alarmingly, day 1 pre-dexamethasone 0900 h. cortisol was reported as 16.0 nmol/l (reference range 140–700 nmol/l). Telephone contact was immediately made with the patient, at which point she denied taking any steroids or over the counter medication which could affect the result.

An urgent short synacthen test (SST) was arranged for the next day, together with emergency oral hydrocortisone cover. GP surgery agreed to fax through a list of the patient’s medications, which arrived just prior to commencement of the SST. This included triamcinolone i.m. injection administered four days prior to day 1 LDDT. Even on direct questioning, the patient still denied receiving any steroid injection, until her husband reminded her that her tennis elbow had recently been treated with an injection. ‘Was that a steroid?’!

This is an important reminder of the need to clarify terminology and to make no assumptions with regard to a patient’s understanding. On the strength of this, we have amended, and hopefully improved, the information sheet that is sent out to patients, not only for this test, but also for any dynamic test where cortisol is being measured. We are also more mindful of the way in which we phrase our verbal questions. Only by asking the right questions do we get the right answers!