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Publications (3)8.15 Total impact

  • Ketan Dhatariya, Patrick Musonda, Alan McGregor
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    ABSTRACT: We are very grateful to be given the opportunity to reply to the letters by Evans et al and King about this paper. Evans et al mention that there are several potential sources for error and misinterpretation when using cortisol readings unadjusted for either gender or assay type. However, in clinical practice cortisol measurements are often reported as only 'time zero', 'time 30 minutes' and 'time 60 minutes', with no additional data on how these should be adjusted according to gender and assay and thus how these values should be interpreted without these sources of bias being known. Most decisions would be based only on the clinical interpretation of the three provided values. Thus, whilst we accept that there are methodological influences on the actual values provided by the test; to the jobbing clinician these may play a minor role in influencing individual patient management. We would welcome a debate as to whether the additional information on gender and assay differences should be provided by different laboratories for every short synacthen test report to see if this changes treatment decisions. This, however, would necessitate a prospective study to address the validity of the proposed upper limits of normal for the different assays. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 08/2013; · 3.40 Impact Factor
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    ABSTRACT: Current demographic trends suggest that there will be increasing numbers of older people in the future. Relatively little information is available regarding factors which influence mortality in the acutely unwell oldest old. This study uses the CART technique on data relating to the oldest old, to identify potential predictors of inpatient mortality in patients over 90 years old admitted acutely to the hospital due to various medical emergencies in two UK centers. The sample included 393 patients aged 90 years and older, with 67.5% females and 32.5% males and a mean age of 91.1 years. We aimed to generate hypotheses in order to identify potential acute illness prognostic indicators of inpatient mortality in this age group. The factors identified in this analysis which were associated with inpatient mortality in this patient population were raised serum urea concentration (>13.95mmol/L), low oxygen saturation levels (<94%), hyponatremia (<128mmol/L), and raised white cell count (>17×10(9)/L). The predictability of using these cut off points in inpatient as well as early in-hospital death should be validated in future studies.
    Archives of gerontology and geriatrics 08/2012; · 1.36 Impact Factor
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    ABSTRACT: OBJECTIVE: Despite the widespread use of the short synacthen test (SST), there remains no clear consensus on sampling times for the measurement of serum cortisol that best determines adrenal reserve. We set out to establish whether there is any value in measuring serum cortisol at 60 minutes following administration of synacthen. DESIGN: Retrospective data analysis of 500 SST results measuring 0, 30 and 60 minute cortisol levels after administration of 250μg of synacthen at 2 large urban National Health Teaching Hospitals in the UK. PATIENTS AND MEASUREMENTS: Individuals thought to have primary or secondary adrenal insufficiency given 250μg of synacthen. MEASUREMENTS: Serum cortisol levels measured at 0, 30 and 60 minutes, looking to see how many people who had adrenal insufficiency at the 30 minute sample but in whom the 60 minute sample showed adequate adrenal reserve. RESULTS: The results from 384 people were analysed. 276 had normal responses at 30 minutes and also at 60 minutes. 33 individuals had 'insufficient' (i.e. <550nmol/L) 30 minute cortisol levels, rising to >550nmol/L at the 60 minute test. All 75 individuals who were insufficient at 60 minutes were also insufficient at 30 minutes. No individuals passed (>550nmol/L) at 30 minutes and then failed (<550nmol/L) at 60 minutes. CONCLUSIONS: These results suggest that a significant proportion of people undergoing a SST may be inappropriately diagnosed as having adrenal insufficiency if the 60 minute sample is not measured. We suggest that the 60 minute sample is measured in all individuals having a SST to prevent unnecessary over-diagnosis of adrenal insufficiency. © 2012 Blackwell Publishing Ltd.
    Clinical Endocrinology 07/2012; · 3.40 Impact Factor