Filter paper cortisol profiles in secondary adrenocortical insufficiency.

Abstract

The families were taught to use the lancets and filter papers to complete the profiles. The first capillary blood spot was taken before 8 am, another around midday, one at 6 pm, and a final sample the next morning before 8 am. Those children on hydrocortisone supplements took the blood before their morning and evening doses of hydrocortisone. To examine reproducibility the profiles were repeated two weeks later. The children were asked not to take blood samples if they were unwell. All the profiles were completed at home and the filter papers posted to the laboratory and stored till processing in batches.The laboratory cost of a single four point profile in a batch of four profiles (, The quality of the blood spots was generally good with blood fully soaked through the filter paper to give two discs of greater than 6 mm diameter for each time point.Median rather than mean values were determined for both the 24 hour four point plasma

The clinical utility of alternative, less invasive sampling techniques in the assessment of oral hydrocortisone therapy in children and adolescents with hypopituitarism

“…Bloodspot collection was tolerated in 50 out of our 52 patients. A similar level of acceptability has been reported in other studies, most importantly in one study in which parents collected the samples (9). The easy repeatability of the sampling technique and thus the ability to consider a set of values, rather than one point may help to minimise the problem of discordant result between serum and bloodspot cortisol.…”

“…Bloodspot sampling is useful in monitoring HC replacement in ambulant adult patients (4) and has a high degree of concordance with plasma cortisol levels (12). The technique of bloodspot collection has been successfully taught to parents and used in the home to monitor paediatric cortisol levels (9).…”

“…It has also been successfully used to screen for Cushing's syndrome in children (7,8). Capillary bloodspot collection onto filter paper, rarely used in paediatric practice, has been used in research studies in the assessment of children with adrenal insufficiency (9), neonates suspected of having congenital adrenal hyperplasia (10) and ill preterm neonates (11). Bloodspot sampling is useful in monitoring HC replacement in ambulant adult patients (4) and has a high degree of concordance with plasma cortisol levels (12).…”

Cortisol in dried blood screening specimens from newborns with raised 17‐hydroxyprogesterone and congenital adrenal hyperplasia

“…The measurement of cortisol in dried blood on filter‐paper has been reported earlier (Kraiem ., 1992) and was subsequently used to monitor ill preterm neonates (Hughes ., 1987) and children with adrenal insufficiency (Sieratzki ., 1995). The raised levels of 17‐OHP unrelated to CAH, that were found by us, were associated with premature, low birth weight or ill neonates.…”

Hydrocortisone replacement therapy in children and adolescents with hypopituitarism

“…Regular anthropometric assessment to ensure normal growth as well as some measure of appropriateness of hydrocortisone dosage in order to tailor dose requirements to individual patients therefore seems prudent. In this respect, measurements of urinary free cortisol (Trainer et al, 1993) in conjunction with home-based filter paper capillary blood profiles (Sieratzki et al, 1995) may prove more acceptable to children and adolescents than intravenous cannulation and repeated blood sampling in hospital. In summary, our cohort of patients with craniopharyngioma provides an excellent model for study of glucocorticoid replacement and demonstrates, as in adults, that the aim of mimicking the physiological nyctohemeral secretion of cortisol is difficult to achieve in practice and raises a number of important considerations unique to steroid replacement therapy in this age group.…”