Charlotte Elder

• BSc MBBS PhD DRCOG MRCPCH
• Lecturer at The University of Sheffield

Introduction Cortisol is an essential stress hormone and failure of its production, known as adrenal insufficiency (AI), is associated with significant mortality due to adrenal crisis. The Short Synacthen Test (SST) is the current diagnostic test of choice for AI, but it is both invasive and resource intensive. Globally, there is an unmet need for...

Context Glucocorticoids suppress the hypothalamic–pituitary–adrenal (HPA) axis, resulting in tertiary adrenal insufficiency (AI). When weaning patients off glucocorticoids there is no consensus on whether to maintain patients on prednisolone or convert to hydrocortisone. Objective To investigate HPA axis recovery in patients on long-term prednisol...

Objective Worldwide, 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 adrenocorticot...

Context The adrenocorticotropin hormone stimulation test (AST) is used to diagnose adrenal insufficiency, and is often repeated in patients 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...

Disclosure: N.R. Lawrence: None. B.G. Keevil: None. C. Elder: None. J. Fearnside: None. S. Caunt: None. S. Dixon: None. J.D. Newell-Price: Consulting Fee; Self; Diurnal, Recordati, Crinetics, HRA Pharma. R.J. Ross: Employee; Self; Diurnal. M. Debono: None. Background: The ACTH (Cosyntropin) stimulation test (AST) is the reference standard for diagn...

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...

Hirsutism, unwanted terminal hair growth in androgen-dependent areas, is a common presentation to general paediatricians, dermatologists and endocrinologists. Polycystic ovarian syndrome is the most common cause but can be challenging to diagnose in young people due to the significant overlap of features with the healthy adolescent population. Ther...

BACKGROUND Worldwide, adults and children are at risk of adrenal insufficiency as a result of adrenal suppression from use of anti-inflammatory glucocorticoids and opiates, as well as infectious diseases. The adrenocorticotropin (ACTH) stimulation test is the reference standard for diagnosis of adrenal insufficiency but requires clinic attendance a...

Background: Limited data support concerns that corticosteroid use in pregnancy, for maternal health reasons, can suppress the neonatal Hypothalamic-Pituitary-Adrenal (HPA) axis. We sought to determine if neonates born to mothers on high-dose steroids are at risk of adrenal suppression. Methodology: Our tertiary neonatal unit guidance advises that...

Objective Measurement of salivary glucocorticoids is an accepted method for testing adrenal function but there is little data on stability during home collection. Current salivary collection techniques require active participation or present a choking hazard and are unsuitable for young children. We sought to: compare different salivary collection...

Objectives Measuring testicular volume (TV) by orchidometer is routine in the clinic when staging male puberty. We have developed a simulation model for TV estimation and investigated whether training medical students, using a workshop with simulation models, could improve the accuracy and reliability of TV estimation. Methods All participating me...

Context The Short Synacthen Test (SST) is the gold standard for diagnosing adrenal insufficiency. It requires invasive administration of Synacthen, venous sampling and is resource-intensive. Objective To develop a nasally administered SST, with salivary glucocorticoids measurement, to assess the adrenal response. Design We conducted five studies:...

Steroid biosynthesis is a complex process in which cholesterol is converted to steroid hormones with the involvement of multiple enzymes and cofactors. Inborn conditions affecting adrenal steroidogenesis are relatively common in paediatric practice and have serious implications on patient mortality and morbidity. This paper provides an overview of...

Objective We aimed to document current practice in the medical management of paediatric hyperthyroidism in the UK and compare to international recommendations. Design A 27 question online survey distributed via an electronic newsletter in August 2018. Participants Responses from 48 members (11%) of the British Society for Paediatric Endocrinology...

Context Measuring testicular volume (TV) by orchidometer is the standard method of male pubertal staging. A paucity of evidence exists as to its inter‐ and intra‐observer reliability and the impact of clinicians’ gender, training and experience on accuracy. Objective Prosthetic testicular models were engineered to investigate accuracy and reliabil...

Objective: The short synacthen test (SST) is widely used to assess patients for adrenal insufficiency but the frequency and protocols used across different centres for the low-dose test (LDT) are unknown. This study aimed to survey centres and test the accuracy of ten different synacthen preparation strategies used for the LDT. Methods: Members...

Background Left hand and wrist X-rays are conventionally used to assess skeletal maturity using methods such as Tanner-Whitehouse 3 (TW3). We noted a number were poor quality, caused by difficulty with hand placement. We introduced a simple radiolucent hand template to assist in hand positioning and assessed changes in X-ray quality and repeat X-ra...

Context: Salivary cortisone reflects serum cortisol levels, is more sensitive than salivary cortisol at lower values of serum cortisol and is non-invasive. Objective: To investigate the relationship between serum cortisol and salivary cortisol and cortisone following low and high-dose synacthen. Design and setting: Prospective pharmacodynamic...

Aims The low-dose Short Synacthen test is a popular diagnostic test of adrenal insufficiency in children. It is employed by 82% of UK paediatric endocrinologists. Although various dosing strategies exist, 1 mcg is most commonly employed, however none of the low-dose forms of Synacthen are commercially available. A ‘British Society for Paediatric En...

In February 2016, NHS England released a patient safety alert highlighting the associated mortality and morbidity when desmopressin is omitted in individuals with cranial diabetes insipidus (DI).1 Over a 7-year period, the UK National Reporting and Learning System had identified 76 near misses, 56 dosing errors leading to harm and 4 cases where des...

The teaching and training of doctors-in-training in paediatrics has become increasingly challenging in recent times. All too often there is a perception that training must come second to service provision. In this article, the case of a child with community-acquired pneumonia is considered and used to illustrate how a culture of teaching can be emb...

Background: Measuring testicular volume (TV) by orchidometer is a standard method of pubertal staging in boys. A paucity of evidence exists as to its inter and intra-user reliability and the impact of clinicians’ gender, training and experience on the accuracy of measurements. Specifically engineered prosthetic models of different size testes were...

Background Effective communication is recognised as a cornerstone of good medical practice and is key to maintaining patient safety. Poor communication is often highlighted as a factor in medical errors. Despite structured communication tools (e.g. SBAR) and guidelines to encourage collaborative working between middle grade trainees (MGT) and on-ca...

Whilst Listeria monocytogenes (L. monocytogenes) meningitis is more common in neonates and the immunosuppressed, consideration of listeriosis is also warranted in otherwise healthy children. We present a case of L. monocytogenes meningitis in an immunocompetent 6-year-old girl. She presented with fever, irritability, pain on neck flexion and signs...

Thomas Addison first described Addison's disease in 1855 in patients who had adrenal tuberculosis, highlighting the importance of the adrenal cortex to survive. In 1952, a decade after the medical landmark discovery of cortisone as a treatment for inflammatory conditions, the first case of adrenal crisis and death in a patient on glucocorticoid the...

Introduction: The short Synacthen test (SST) is a popular diagnostic investigation for adrenal insufficiency (AI). Cannulation and blood sampling are required making it invasive, time-consuming and resource-intensive. Salivary cortisol is a well-established alternative to serum sampling. We have developed a non-invasive alternative to the 1 μg SST,...

Background: Limited evidence exists regarding the effect of antenatal prednisolone (ANP) on neonatal adrenal function. Our regional neonatal unit screens these babies by measuring three random serum cortisol levels 8 h apart on day 3 of life. Adrenal function is considered adequate if two cortisol levels are >100 nmol/l. Those with inadequate rando...

Background: Bone age studies require X-ray of the left hand and wrist to assess skeletal maturity. The Tanner-Whitehouse 3 (TW3) scoring method provides an objective framework for calculating bone age and specifies exact placement of the hand. In our service we have noted a number of poor quality films, caused by difficulty with hand placement, e.g...

This commentary is on the original article by Weidauer et al. on pages of this issue.

Rickets, historically referred to as "the English disease", is common worldwide. Absence of phosphate at the growth plate and mineralising bone surfaces due to inadequate vitamin D supply either from sunlight exposure or diet is the main cause. Inherited disorders causing hypophosphataemia have shown the intricacies of phosphate metabolism. Present...

We read with interest the paper by Chitale et al (1) and agree that the 60-minute sample is essential to the standard 250 mcg Short Synacthen Test (SSST), in contrast to the low-dose Short Synacthen Tests (LDSST), and welcome any research helping to clarify the optimal use of the Short Synacthen Test in terms of dose, sampling times and diagnostic...

There is a paucity of long-term data examining the relationship between early glycaemic control, in children and young people diagnosed with type 1 diabetes mellitus (T1DM), and long-term control. We wanted to determine whether early glycaemic control can predict long-term control. In addition, we examined whether initial presentation with ketoacid...

Supported by meta-analyses, the low-dose Synacthen test (LDST) has gained in popularity, with many believing it to be more sensitive than the supraphysiological standard (250 µg) short ST (SSST), particularly when assessing children prescribed high-dose inhaled corticosteroids (HDICS). However, consensus is lacking about its specific clinical appli...

We prospectively studied 124 consecutive hypoglycaemia screens performed on children attending our emergency department over a 27-month period (March 2006 to May 2008). In keeping with most other paediatric services in the UK, we routinely collect a number of samples to permit investigation of low blood sugar, including metabolic investigations, an...

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. Randomised trial of two doses (20 or 40 IU/m(2) body surface area/week by daily subcutaneous injection) of r-hGH in 29 (24 male, 5 female) FSS children with assessme...

We present results from a questionnaire study of doctors (mainly paediatricians) and pharmacists which revealed that 24% of respondents prescribe incorrectly when asked to interpret how many antibiotic doses to prescribe in a specified time span. This contrasts with a 100% correct response when prescribing using total number of drug doses. We sugge...

To examine the role of ethnic group and family status on body dissatisfaction and eating behavior. One hundred women (Asian mothers and daughters, n = 50; white mothers and daughters, n = 50) completed a questionnaire about their perceived ethnic identity (acculturation), body image, and eating behavior. The results showed no matching between mothe...