Endocrine Abstracts

Introduction: Measurement of bloodspot 17-OHP is the current method of assessing hydrocortisone replacement in patients with congenital adrenal hyperplasia (CAH). Bloodspot 17-OHP has been measured in Southampton by LC–MS/MS since August 2011. Clinical observations of signs and symptoms of under- and over-treatment are equally as important.

The aim of this audit was to assess whether the 17-OHP profile results are being appropriately used for adjustments to hydrocortisone in patients with CAH by the Paediatric Endocrinologists in Southampton.

Method: 17-OHP profile results were collected from August 2011 to June 2013, excluding patients not treated by the Southampton Endocrinologists. Clinic notes and letters were used to obtain information regarding clinical observations and changes to hydrocortisone dosage.

The data was compared to 17-OHP guidelines used by the Endocrinologists in Southampton, as well as ranges quoted by Cardiff University Hospital, to assess any potential differences in outcome. The expected outcomes based on these ranges were compared to the actual outcomes.

Results: A total of 54 profiles were collected, from 31 patients with CAH. The 17-OHP results and patient symptoms agreed with the outcome in 76% cases. In 22% the hydrocortisone dose was changed without clinical indication, but the change was based on the 17-OHP results. In one case, the 17-OHP profile and clinical symptoms suggested an increase in dosage was required, but no change was made.

On comparison to the Cardiff guidelines, there was a difference in interpretation in 30% compared to the Southampton guidelines, but in all cases the outcome was appropriate based on either the 17-OHP or the clinical details.

Discussion: The Southampton 17-OHP ranges were adhered to in 98% of cases. These guidelines are appropriate as any medication adjustments have been clinically well-tolerated with no adverse effects. There was no difference in expected outcome when compared to the Cardiff guidelines.