BSPED2018 Oral Communications Oral Communications 4 (8 abstracts)
Implementation of a novel non-invasive test for monitoring control in individuals with congenital adrenal hyperplasia
Irina Bacila 1 , Carlo L Acerini 2 , Ruth E Krone 3 , Leena Patel 4 , Sabah Alvi 5 , Tabitha Randel 6 , Evelin F Gevers 7 , Mehul Dattani 8 , Timothy Cheetham 9 , Fiona Ryan 10 , Elizabeth Crowne 11 , Justin Davies 12 , Ahmed Faisal 13 , Andreas Kyriakou 13 , Jo Adaway 14 , Lina Schiffer 15 , Brian Keevil 16 & Nils Krone 1
1Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK; 2Department of Paediatrics, University of Cambridge, Cambridge, UK; 3Birmingham Women’s & Children’s Hospital, Birmingham, UK; 4Royal Manchester Children’s Hospital, University of Manchester, Manchester, UK; 5Leeds General Infirmary, Leeds, UK; 6Nottingham Children’s Hospital, Nottingham, UK; 7Barts Health NHS Trust, London, UK; 8UCL GOS Institute of Child Health and Great Ormond Street Hospital, London, UK; 9Great North Children’s Hospital, University of Newcastle, Newcastle, UK; 10Oxford Children’s Hospital, Oxford, UK; 11Bristol Royal Hospital for Children, University Hospitals Bristol Foundation Trust, Bristol, UK; 12University Hospital Southampton, Southampton, UK; 13Royal Hospital for Children, University of Glasgow, Glasgow, UK; 14Department of Biochemistry, University Hospital South Manchester, Manchester, UK; 15Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; 16Clinical Biochemistry, Wythenshawe Hospital, Manchester, Manchester, UK.
Introduction: Monitoring of hormonal control represents a key part in the management of congenital adrenal hyperplasia (CAH). It remains suboptimal and relies on frequent blood tests, which are traumatising in children and young persons (CYP). Recent evidence suggests a crucial role of adrenal-derived 11-oxygenatedC19 androgens in the pathogenesis of CAH. Therefore, we aimed to establish a non-invasive test for monitoring of adrenal-specific androgens in CAH.
Objective: To establish the correlation between plasma and salivary androgens in CYP with CAH.
Patients and methods: Patients (n=78, 43 girls, 35 boys, 8–18 years (12.87±3.04 years) and matched controls (n=62) were recruited in a multicentre prospective study of CYP with CAH across the United Kingdom. Using liquid chromatography tandem mass spectrometry, we measured plasma and salivary concentrations for five steroid hormones: 17-hydroxyprogesterone, androstenedione, testosterone, 11-hydroxyandrostenedione and 11-ketotestosterone and established the correlation (Spearman) between plasma and salivary steroids to assess their usefulness in clinical practice.
Results: Plasma and salivary steroid concentrations show a good correlation, with androstenedione and 11-ketotestosterone providing the best information when used as non-invasive measurement from saliva: androstenedione (rs=0.928, P<0.001), testosterone (rs=0.864, P<0.001), 17-hydroxyprogesterone (rs=0.871, P<0.001), 11-hydroxyandrostenedione (rs=0.877, P<0.001), 11-ketotestosterone (rs=0.944, P<0.001). In addition, a high correlation was found in CYP with CAH when analysing subgroups based on gender and age. Clear differences were found for all plasma and salivary steroids between patients and controls. Analysing patients according to CAH control by 17-hydroxyprogesterone concentrations (<15 nmol/l; 15–30 nmol/l; >30 nmol/l), established clear correlations with plasma and salivary 11-ketotestosterone.
Conclusions: We have established close correlation between plasma and salivary concentrations of steroid hormones assessed for therapy control in CAH patients. Importantly, the best correlations were found for the adrenal-derived 11oxygenatedC19 androgen 11-ketotestosterone as well as 17-hydroxyprogesterone and androstenedione, which are widely used for CAH monitoring. Thus, we believe that this novel and improved combination of salivary steroid hormones can serve as a non-invasive monitoring tool in CAH providing a significant amount of additional information, and will ultimately improve patient acceptability, management and outcomes in CAH.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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