Skip to main content

Advertisement

SpringerLink
Log in

Neonatal endocrine labomas - pitfalls and challenges in reporting neonatal hormonal reports

  • Rational Diagnostics
  • Published:
Indian Pediatrics Aims and scope Submit manuscript

Abstract

This review highlights pitfalls and challenges in interpreting neonatal hormone reports. Pre-analytical errors contribute to nearly 50% of all errors. Modern chemiluminescence assay are more accurate, have lower risk of Hook’s effect, but continue to have problems of assay interference. Liquid chromatography mass spectroscopy is gold standard for most hormone assays. Neonatal hypoglycemia diagnostic cut-offs are lower than adults. Random growth hormone testing is of value in diagnosing growth hormone deficiency in neonates. 17-hydroxy-progesterone testing in first three days of life for congenital adrenal hyperplasia (CAH) remains a challenge due to crossreactivity with maternal circulating steroids, prematurity and lack of adrenal maturation. Both T4 and TSH testing is encouraged after 48 hours of delivery for diagnosing neonatal hypothyroidism; repeat testing should be done immediately for confirmation of diagnosis. There is an urgent need to develop age- sex- and ethnicity-based normative data for different hormone parameters in neonates. Laboratory should develop their own neonatal references and avoid using ranges from manufacturers. In neonatal endocrinopathies, the clinical scenario should primarily dictate the treatment formulation with hormonal assay to supplement treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Coffin CM, Hamilton MS, Pysher TJ, Bach P, Ashwood E, Schweiger J, et al. Pediatric laboratory medicine current challenges and future opportunities. Am J Clin Pathol. 2002;117:683–90.

    Article  PubMed  Google Scholar 

  2. Verras P, Greaves R. Interpreting paediatric biochemistry results. Aust Prescr. 2005;28:126–9.

    Article  Google Scholar 

  3. Dutta D, Chowdhury S. Endocrine Labomas. Indian J Endocr Metab. 2012;16:S275–8

    Article  Google Scholar 

  4. Harms E, Olgemöller B. Neonatal screening for metabolic and endocrine disorders. Dtsch Arztebl Int. 2011;108: 11–22.

    PubMed  PubMed Central  Google Scholar 

  5. Thornton PS, Stanley CA, De Leon DD, Harris D, Haymond MW, Hussain K, et al.; Pediatric Endocrine Society. Recommendations from the Pediatric Endocrine Society for evaluation and management of persistent hypoglycemia in neonates, infants, and children. J Pediatr. 2015;167:238–45.

    Article  PubMed  Google Scholar 

  6. McKinlay CJ, Alsweiler JM, Ansell JM, Anstice NS, Chase JG, Gamble GD, et al.; CHYLD Study Group. Neonatal glycemia and neurodevelopmental outcomes at 2 years. N Engl J Med. 2015;373:1507–18.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Stanley CA, Rozance PJ, Thornton PS, De leon DD, Harris D, Haymond MW, et al. Re-evaluating “transitional neonatal hypoglycemia”: mechanism and implications for management. J Pediatr. 2015;166:1520–25.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Nangia S. Point of care estimation of blood glucose in neonates. Indian Pediatr. 2012;49:612–3.

    PubMed  Google Scholar 

  9. Hawkes CP, Grimberg A. Measuring growth hormone and insulin-like growth factor-I in infants: What is normal? Pediatr Endocrinol Rev. 2013;11:126–46.

    PubMed  PubMed Central  Google Scholar 

  10. Kurtoðlu S, Kondolot M, Mazicioðlu MM, Hatipoðlu N, Akin MA, Akyildiz B. Growth hormone, insulin like growth factor-1, and insulin-like growth factor-binding protein-3 levels in the neonatal period: a preliminary study. J Pediatr Endocrinol Metab. 2010;23:885–9.

    Google Scholar 

  11. Wit JM, van Unen H. Growth of infants with neonatal growth hormone deficiency. Arch Dis Child. 1992;67:920–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Senniappan S, Hussain K. An evaluation of growth hormone and IGF-1 responses in neonates with hyperinsulinaemic hypoglycaemia. Int J Endocrinol. 2013;2013:638257.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ong K, Kratzsch J, Kiess W, Costello M, Scott C, Dunger D. Size at birth and cord blood levels of insulin, insulin-like growth factor I (IGF-I), IGF-II, IGF-binding protein-1 (IGFBP-1), IGFBP-3, and the soluble IGF-II/mannose-6- phosphate receptor in term human infants. The ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood. J Clin Endocrinol Metab. 2000;85:4266–9.

    CAS  PubMed  Google Scholar 

  14. Speiser PW, Azziz R, Baskin LS, Ghizzoni L, Hensle TW, Merke DP, et al. Congenital adrenal hyperplasia due to steroid 21-Hydroxylase deficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2010; 95:4133–60

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. van der Kamp HJ, Oudshoorn CG, Elvers BH, van Baarle M, Otten BJ, Wit JM, et al. Cutoff levels of 17-alphahydroxyprogesterone in neonatal screening for congenital adrenal hyperplasia should be based on gestational age rather than on birth weight. J Clin Endocrinol Metab. 2005;90:3904–7.

    Article  PubMed  Google Scholar 

  16. al Saedi S, Dean H, Dent W, Cronin C. Reference ranges for serum cortisol and 17-hydroxyprogesterone levels in preterm infants. J Pediatr. 1995;126:985–7.

    Article  PubMed  Google Scholar 

  17. La Franchi SH. Approach to the diagnosis and treatment of neonatal hypothyroidism. J Clin Endocrinol Metab. 2011;96:2959–2967.

    Article  Google Scholar 

  18. Wang SL, Su PH, Jong SB, Guo YL, Chou WL, Päpke O. In utero exposure to dioxins and polychlorinated biphenyls and its relations to thyroid function and growth hormone in newborns. Environ Health Perspect. 2005;113:1645–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Williams FL, Simpson J, Delahunty C, Ogston SA, Bongers-Schokking JJ, Murphy N; Collaboration from the Scottish Preterm Thyroid Group. Developmental trends in cord and postpartum serum thyroid hormones in preterm infants. J Clin Endocrinol Metab. 2004;89:5314–20.

    Article  CAS  PubMed  Google Scholar 

  20. Straussman S, Levitsky LL. Congenital hypothyroidism–Monitoring thyroid function in infants. Eur Endocrinol. 2012;8:53–6.

    Article  Google Scholar 

  21. Williams FL, Ogston SA, van Toor H, Visser TJ, Hume R. Serum thyroid hormones in preterm infants: associations with postnatal illnesses and drug usage. J Clin Endocrinol Metab. 2005;90:5954–63.

    Article  CAS  PubMed  Google Scholar 

  22. Mahyar A. Effects of exchange transfusion on neonatal thyroid function. Indian J Pediatr. 2007;74:511–2.

    Article  PubMed  Google Scholar 

  23. Sharma LK, Sharma N, Gadpayle AK, Dutta D. Prevalence and predictors of hyperprolactinemia in subclinical hypothyroidism. Eur J Intern Med. 2016;35:106–10.

    Article  CAS  PubMed  Google Scholar 

  24. Kumar M, Mukhopadhyay S, Dutta D. Challenges and controversies in diagnosis and management of gonadotropin dependent precocious puberty: An Indian perspective. Indian J Endocrinol Metab. 2015;19:228–35.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Garagorri JM, Rodríguez G, Lario-Elboj AJ, Olivares JL, Lario-Muñoz A, Orden I. Reference levels for 17- hydroxyprogesterone, 11-desoxycortisol, cortisol, testosterone, dehydroepiandrosterone sulfate and androstenedione in infants from birth to six months of age. Eur J Pediatr. 2008;167:647–53.

    Article  CAS  PubMed  Google Scholar 

  26. Sharma LK, Dutta D, Gadpayle AK, Sharma N. The increasing problem of subclinical and overt hypervitaminosis-D in India: An institutional experience and review. Nutrition. 2017;34:76–81.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Endocrinology, Department of Medicine, Gandhi Medical College (GMC) and Hamidia Hospital, Bhopal, India

    Sachin Chittawar

  2. Department of Endocrinology, Venkateshwar Hospitals, Sector 18A, Dwarka, New Delhi, India

    Deep Dutta

  3. Department of Endocrinology, Maharaja Agrasen Hospital, Dwarka; New Delhi, India

    Deepak Khandelwal

  4. Department of Endocrinology, Kalpravriksh Superspeciality Clinic, Dwarka; New Delhi, India

    Rajiv Singla

Authors
  1. Sachin Chittawar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Deep Dutta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Deepak Khandelwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rajiv Singla
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Society for Promotion of Education in Endocrinology & Diabetes (SPEED) Group

Corresponding author

Correspondence to Deep Dutta.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chittawar, S., Dutta, D., Khandelwal, D. et al. Neonatal endocrine labomas - pitfalls and challenges in reporting neonatal hormonal reports. Indian Pediatr 54, 757–762 (2017). https://doi.org/10.1007/s13312-017-1170-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13312-017-1170-7

Keywords

Search

Navigation