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Research paper thumbnail of Multivariable model to predict an ACTH stimulation test to diagnose adrenal insufficiency using previous test results

Journal of the Endocrine Society

Context The ACTH stimulation test (AST) is used to diagnose adrenal insufficiency, and often repe... more Context The ACTH stimulation test (AST) is used to diagnose adrenal insufficiency, and often repeated in patient’s when monitoring recovery of the hypothalamo-pituitary-adrenal axis. Objective To develop and validate a prediction model that uses previous AST results with new baseline cortisol to predict the result of a new AST. Design Retrospective, longitudinal cohort study in patients who had undergone at least two ASTs. Fractional polynomial regression with backwards variable selection. Setting Tertiary UK adult endocrinology centre. Patients Developed from 258 paired ASTs over 5 years in 175 adults (mean age 52.4 years, SD 16.4), validated on data from 111 patients over 1 year (51.8, 17.5) from the same centre collected after model development. Interventions Synacthen administered after baseline blood tests. Previous test baseline adrenocorticotropin hormone (ACTH) and cortisol alongside 30-minute cortisol, days between tests, and new baseline ACTH and cortisol used with calcula...

Research paper thumbnail of Defining the basal serum cortisol cut-off for weaning patients off glucocorticoids in suspected tertiary adrenal insufficiency

Research paper thumbnail of Real world evidence supports waking salivary cortisone as a screening test for adrenal insufficiency

Clinical Endocrinology

ObjectiveWorldwide, adults and children are at risk of adrenal insufficiency largely due to infec... more ObjectiveWorldwide, adults and children are at risk of adrenal insufficiency largely due to infectious diseases and adrenal suppression from use of anti‐inflammatory glucocorticoids. Home waking salivary cortisone is an accurate screening test for adrenal insufficiency, it has potential to reduce costs, and patients prefer it to the adrenocorticotropin (ACTH) (synacthen) stimulation test. We carried out a service evaluation of home waking salivary cortisone in clinical care to identify implementation barriers.Design, Patients and MeasurementsService evaluation in a centre where 212 patients referred for adrenal insufficiency had a waking salivary cortisone. Problems encountered during testing were recorded and patient feedback, via focus groups, collected.ResultsFrom all patients providing a waking salivary cortisone 55% had a normal test, 23% adrenal suppression, and 22% an equivocal result requiring a clinical centre ACTH stimulation test. The median (interquartile range [IQR]) fo...

Research paper thumbnail of Patient attendance in virtual paediatric and adolescent gynaecology clinics since the COVID-19 pandemic

Research paper thumbnail of Home Waking Salivary Cortisone to Screen for Adrenal Insufficiency

NEJM evidence, Jan 24, 2023

Research paper thumbnail of Emergency and perioperative management of adrenal insufficiency in children and young people: British Society for Paediatric Endocrinology and Diabetes consensus guidance

Archives of Disease in Childhood, Apr 12, 2023

Adrenal insufficiency (AI) is characterised by lack of cortisol production from the adrenal gland... more Adrenal insufficiency (AI) is characterised by lack of cortisol production from the adrenal glands. This can be a primary adrenal disorder or secondary to adrenocorticotropic hormone deficiency or suppression from exogenous glucocorticoids. Symptoms of AI in children may initially be non-specific and include growth faltering, lethargy, poor feeding, weight loss, abdominal pain, vomiting and lingering illnesses. AI is treated with replacement doses of hydrocortisone. At times of physiological stress such as illness, trauma or surgery, there is an increased requirement for exogenous glucocorticoids, which if untreated can lead to an adrenal crisis and death. There are no unified guidelines for those <18 years old in the UK, leading to substantial variation in the management of AI. This paper sets out guidance for intercurrent illness, medical, dental and surgical procedures to allow timely and appropriate recognition and treatment of AI and adrenal crisis for children and young people.

Research paper thumbnail of Response to Alleyn et al. Comparison of longitudinal point-of-care and high-performance liquid chromatography HbA1c measurements in a multi-centre trial

Diabetic Medicine, Aug 13, 2012

Research paper thumbnail of Retrospective study of steroid weaning in tertiary adrenal insufficiency comparing prednisolone and hydrocortisone

Endocrine Abstracts, May 2, 2023

Research paper thumbnail of Salivary sampling in neonates, infants, and young children: glucocorticoid stability under different conditions and the introduction of a novel collection technique

Endocrine Abstracts, Oct 17, 2022

Research paper thumbnail of HbA1c league tables? How to get promoted and avoid relegation!

Research paper thumbnail of Changes in trends in Short Synacthen Test use over a decade - a single centre experience

Research paper thumbnail of How long is a day?" Discrepancies in prescribing practice: a questionnaire study

Paediatric and Perinatal Drug Therapy, 2005

Research paper thumbnail of Fifteen-minute consultation: The child with obesity

Archives of Disease in Childhood-education and Practice Edition, Apr 8, 2021

This is a repository copy of Fifteen-minute consultation : the child with obesity.

Research paper thumbnail of Waking salivary cortisone as screening test for adrenal insufficiency

Research paper thumbnail of Fifteen-minute consultation: Approach to the adolescent presenting with hirsutism

Archives of Disease in Childhood-education and Practice Edition, Jan 19, 2023

Research paper thumbnail of Screening for adrenal insufficiency using home waking salivary cortisone is accurate and lowers NHS costs

Research paper thumbnail of Effect of high-dose maternal steroids on neonatal adrenal function

Research paper thumbnail of Recommendations for hydrocortisone doses for emergency management and peri-operative care for childhood adrenal insufficiency. BSPED consensus guidelines

Research paper thumbnail of A Randomised Study of the Effect of Two Doses of Biosynthetic Human Growth Hormone on Final Height of Children with Familial Short Stature

Hormone Research in Paediatrics, 2008

Background/Aims: The effects of biosynthetic human growth hormone (r-hGH) in children with famili... more Background/Aims: The effects of biosynthetic human growth hormone (r-hGH) in children with familial short stature (FSS) are varied. We determined whether responsivity to r-hGH in FSS is dose-dependent. Method: Randomised trial of two doses (20 or 40 IU/m2 body surface area/week by daily subcutaneous injection) of r-hGH in 29 (24 male, 5 female) FSS children with assessment at adult height. Results: Age range at presentation was 5.1–10.5 years, height less than 1.5 standard deviation scores (SDS) below the mean, height velocity SDS greater than –1.5 and peak growth hormone response to provocative testing over 13.5 mU/l. Adult height data (SDS) at 16.5 ± 2.1 years for the low-dose group and 16.1 ± 1.1 years for the high-dose group (p = 0.62) were similar [low dose –1.06 (SD 0.75), high dose –1.02 (SD 0.83); p = 0.88]. The incremental effect of both doses on stature was minimal [low-dose difference in height actual-predicted 0.79 (SD 0.94), high dose 1.27 (SD 0.88); p = 0.12]. Conclusi...

Research paper thumbnail of Current Dilution Methods Cause Large Variations and Inaccuracies when Making up 1 μg Synacthen Dose

55th ESPE Meeting, Aug 19, 2016

Research paper thumbnail of Multivariable model to predict an ACTH stimulation test to diagnose adrenal insufficiency using previous test results

Journal of the Endocrine Society

Context The ACTH stimulation test (AST) is used to diagnose adrenal insufficiency, and often repe... more Context The ACTH stimulation test (AST) is used to diagnose adrenal insufficiency, and often repeated in patient’s when monitoring recovery of the hypothalamo-pituitary-adrenal axis. Objective To develop and validate a prediction model that uses previous AST results with new baseline cortisol to predict the result of a new AST. Design Retrospective, longitudinal cohort study in patients who had undergone at least two ASTs. Fractional polynomial regression with backwards variable selection. Setting Tertiary UK adult endocrinology centre. Patients Developed from 258 paired ASTs over 5 years in 175 adults (mean age 52.4 years, SD 16.4), validated on data from 111 patients over 1 year (51.8, 17.5) from the same centre collected after model development. Interventions Synacthen administered after baseline blood tests. Previous test baseline adrenocorticotropin hormone (ACTH) and cortisol alongside 30-minute cortisol, days between tests, and new baseline ACTH and cortisol used with calcula...

Research paper thumbnail of Defining the basal serum cortisol cut-off for weaning patients off glucocorticoids in suspected tertiary adrenal insufficiency

Research paper thumbnail of Real world evidence supports waking salivary cortisone as a screening test for adrenal insufficiency

Clinical Endocrinology

ObjectiveWorldwide, adults and children are at risk of adrenal insufficiency largely due to infec... more ObjectiveWorldwide, adults and children are at risk of adrenal insufficiency largely due to infectious diseases and adrenal suppression from use of anti‐inflammatory glucocorticoids. Home waking salivary cortisone is an accurate screening test for adrenal insufficiency, it has potential to reduce costs, and patients prefer it to the adrenocorticotropin (ACTH) (synacthen) stimulation test. We carried out a service evaluation of home waking salivary cortisone in clinical care to identify implementation barriers.Design, Patients and MeasurementsService evaluation in a centre where 212 patients referred for adrenal insufficiency had a waking salivary cortisone. Problems encountered during testing were recorded and patient feedback, via focus groups, collected.ResultsFrom all patients providing a waking salivary cortisone 55% had a normal test, 23% adrenal suppression, and 22% an equivocal result requiring a clinical centre ACTH stimulation test. The median (interquartile range [IQR]) fo...

Research paper thumbnail of Patient attendance in virtual paediatric and adolescent gynaecology clinics since the COVID-19 pandemic

Research paper thumbnail of Home Waking Salivary Cortisone to Screen for Adrenal Insufficiency

NEJM evidence, Jan 24, 2023

Research paper thumbnail of Emergency and perioperative management of adrenal insufficiency in children and young people: British Society for Paediatric Endocrinology and Diabetes consensus guidance

Archives of Disease in Childhood, Apr 12, 2023

Adrenal insufficiency (AI) is characterised by lack of cortisol production from the adrenal gland... more Adrenal insufficiency (AI) is characterised by lack of cortisol production from the adrenal glands. This can be a primary adrenal disorder or secondary to adrenocorticotropic hormone deficiency or suppression from exogenous glucocorticoids. Symptoms of AI in children may initially be non-specific and include growth faltering, lethargy, poor feeding, weight loss, abdominal pain, vomiting and lingering illnesses. AI is treated with replacement doses of hydrocortisone. At times of physiological stress such as illness, trauma or surgery, there is an increased requirement for exogenous glucocorticoids, which if untreated can lead to an adrenal crisis and death. There are no unified guidelines for those <18 years old in the UK, leading to substantial variation in the management of AI. This paper sets out guidance for intercurrent illness, medical, dental and surgical procedures to allow timely and appropriate recognition and treatment of AI and adrenal crisis for children and young people.

Research paper thumbnail of Response to Alleyn et al. Comparison of longitudinal point-of-care and high-performance liquid chromatography HbA1c measurements in a multi-centre trial

Diabetic Medicine, Aug 13, 2012

Research paper thumbnail of Retrospective study of steroid weaning in tertiary adrenal insufficiency comparing prednisolone and hydrocortisone

Endocrine Abstracts, May 2, 2023

Research paper thumbnail of Salivary sampling in neonates, infants, and young children: glucocorticoid stability under different conditions and the introduction of a novel collection technique

Endocrine Abstracts, Oct 17, 2022

Research paper thumbnail of HbA1c league tables? How to get promoted and avoid relegation!

Research paper thumbnail of Changes in trends in Short Synacthen Test use over a decade - a single centre experience

Research paper thumbnail of How long is a day?" Discrepancies in prescribing practice: a questionnaire study

Paediatric and Perinatal Drug Therapy, 2005

Research paper thumbnail of Fifteen-minute consultation: The child with obesity

Archives of Disease in Childhood-education and Practice Edition, Apr 8, 2021

This is a repository copy of Fifteen-minute consultation : the child with obesity.

Research paper thumbnail of Waking salivary cortisone as screening test for adrenal insufficiency

Research paper thumbnail of Fifteen-minute consultation: Approach to the adolescent presenting with hirsutism

Archives of Disease in Childhood-education and Practice Edition, Jan 19, 2023

Research paper thumbnail of Screening for adrenal insufficiency using home waking salivary cortisone is accurate and lowers NHS costs

Research paper thumbnail of Effect of high-dose maternal steroids on neonatal adrenal function

Research paper thumbnail of Recommendations for hydrocortisone doses for emergency management and peri-operative care for childhood adrenal insufficiency. BSPED consensus guidelines

Research paper thumbnail of A Randomised Study of the Effect of Two Doses of Biosynthetic Human Growth Hormone on Final Height of Children with Familial Short Stature

Hormone Research in Paediatrics, 2008

Background/Aims: The effects of biosynthetic human growth hormone (r-hGH) in children with famili... more Background/Aims: The effects of biosynthetic human growth hormone (r-hGH) in children with familial short stature (FSS) are varied. We determined whether responsivity to r-hGH in FSS is dose-dependent. Method: Randomised trial of two doses (20 or 40 IU/m2 body surface area/week by daily subcutaneous injection) of r-hGH in 29 (24 male, 5 female) FSS children with assessment at adult height. Results: Age range at presentation was 5.1–10.5 years, height less than 1.5 standard deviation scores (SDS) below the mean, height velocity SDS greater than –1.5 and peak growth hormone response to provocative testing over 13.5 mU/l. Adult height data (SDS) at 16.5 ± 2.1 years for the low-dose group and 16.1 ± 1.1 years for the high-dose group (p = 0.62) were similar [low dose –1.06 (SD 0.75), high dose –1.02 (SD 0.83); p = 0.88]. The incremental effect of both doses on stature was minimal [low-dose difference in height actual-predicted 0.79 (SD 0.94), high dose 1.27 (SD 0.88); p = 0.12]. Conclusi...

Research paper thumbnail of Current Dilution Methods Cause Large Variations and Inaccuracies when Making up 1 μg Synacthen Dose

55th ESPE Meeting, Aug 19, 2016