What is it about?
Dynamic endocrine studies are highly specialized investigations. hey include glucose tolerance tests, synacthen (cortrosyn) stimulation and dexamethasone suppression tests, growth hormone (GH) stimulation tests (using growth hormone releasing hormone, clonidine, arginine, glucagon, insulin, levodopa and exercise), thyrotropin-releasing hormone (TRH) and gonadotropin-releasing hormone (GnRH) stimulation tests, water deprivation and water loading tests. Some of these tests involve significant risk for the patients, such as anaphylactic reactions to the stimulating agent. They are also often very tedious and stressful for children because they require adherence to very strict protocols, some with several timed blood specimens.
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Why is it important?
53 patients (79%) undertook 56 endocrine dynamic tests. The patients had similar sex distribution, 27 male (48%) and 29 female (52%) patients, with a median age of 11 years (age range 1–18 years). Only Four (7%) of the tests were reported as positive, based on predefined diagnostic criteria. Two of them (50%) were false positive.
Perspectives
Our results suggest that too many endocrine dynamic tests are being requested in children by paediatricians based in District hospitals like ours, because lack of evidence-based and validated guidelines. The low positive rate (4 out of 56) probably reflects a practice of ‘defensive medicine’. It represents an inefficient management of health resources. A careful review of the literature would suggest that some of the dynamic endocrine tests were not necessary.
Dr Michael O Ogundele
Mid Cheshire Hospitals NHS Foundation Trust Postgraduate Medical Centre
Read the Original
This page is a summary of: Oversubscribing for dynamic endocrine tests in children? Need for national and international guidelines, Journal of Evaluation in Clinical Practice, December 2008, Wiley,
DOI: 10.1111/j.1365-2753.2007.00897.x.
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