Should Pediatric Endocrinologists Consider More Carefully When to Perform a Stimulation Test?

Area of Science:

• Pediatric Endocrinology
• Endocrinology
• Hormone Testing

Background:

• Pediatric endocrine stimulation tests are essential but resource-intensive.
• Optimizing these tests is crucial for efficient healthcare delivery and public health planning.

Purpose of the Study:

• To analyze the patterns and pathological findings of pediatric endocrine stimulation tests over one year.
• To evaluate the potential of single basal hormone concentrations in reducing the number of unnecessary stimulation tests.

Main Methods:

• A retrospective study was conducted, collecting data on pediatric endocrine stimulation tests performed in 2019 at a tertiary center.
• Analysis included test distribution, pathological response rates, and the potential impact of basal hormone measurements.

Main Results:

• 278 tests were performed on 206 patients; the most common were arginine tolerance (34%), LHRH (24%), and Synacthen (19%) tests.
• Insulin tolerance and LHRH tests showed high pathological response rates (81% and 50%, respectively).
• Basal hormone measurements could potentially reduce standard dose Synacthen tests by 88% and LHRH tests by 61%.

Conclusions:

• Single basal hormone concentrations can spare up to half of the stimulation tests, leading to significant cost savings (estimated €32,000-€79,000 annually).
• Specific basal hormone cut-offs (cortisol <108 nmol/L for adrenal insufficiency, IGF-1 <-1.5 SDS for growth hormone deficiency) were identified as valid for reducing unnecessary testing.