BSPED2021 Oral Communications Oral Communications 9 (6 abstracts)
1The University of Sheffield, Sheffield, United Kingdom; 2Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; 3Sheffield Childrens NHS Foundation Trust, Sheffield, United Kingdom
Background: The Short Synacthen Test (SST) is the most popular test of adrenal insufficiency (AI) worldwide. The current SST protocol at Sheffield Childrens Hospital (SCH) recommends measurement of serum cortisol at baseline, then 30- and 60-minutes post stimulation. A peak cortisol of >429nmol/l constitutes a pass. Our practise has evolved to consider results between 350 and 429nmol/l as borderline and these patients may be treated with stress dosing steroids only rather than replacement, depending on the clinical scenario. Our group has previously published a study examining the variation in dose following dilution of Synacthen during a low-dose SST (LDSST). We undertook a review of our SST data over a nine-year period.
Methods: We conducted a retrospective analysis of all SSTs performed at SCH from 2011-2019. Numbers of tests performed, Synacthen dose, cortisol results, time of peak cortisol, steroid history and outcome were extracted from laboratory records and electronic patient notes. We used descriptive statistics to summarise the data.
Results: We analysed 1275 SSTs. The number of SSTs being performed at SCH have increased 54%, from 114/yr to 175, but the incidence of AI remained constant (~40 cases/yr). The proportion of tests using the standard dose (SDSST) has increased annually and by 2019 all tests were performed using 145mcg/m2 dose. Timing of peak cortisol was dependant on SST dose with 58% (214/367) of LDSST peaking at 30mins and 96% (483/501) of SDSST peaking at 60-mins. Only sampling at 60mins during the SDSST would have resulted in a cost saving of £948 in 2019. Peak cortisol results were borderline in 122 (9.6%) patients, and this proportion remained consistent over the decade. The management of patients with a borderline result depended on their pre-test probability for AI, cortisol result, and steroid history.
Discussion: Our SST requests, dose and interpretative practice have evolved over the last decade. The number of SSTs conducted each year continues to increase without a change in the incidence of AI. We postulate this is due to increasing concern about steroid induced AI and indicates a need for more effective screening of patients deemed to be at risk.