The Journal of Clinical Endocrinology and Metabolism Journal Article

Early Detection of Adrenal Insufficiency

November 28, 2023

Jonanlis Ramirez Alcantara, Natalie R Grant, Swathi Sethuram, Amanda Nagy, Catherine Becker, Inderneel Sahai, Takara Stanley, Alyssa Halper, Florian S Eichler
The Journal of Clinical Endocrinology & Metabolism, Volume 108, Issue 11, November 2023, Pages e1306–e1315
https://doi.org/10.1210/clinem/dgad286

Abstract

Context

Males with adrenoleukodystrophy (ALD) have an 80% lifetime risk of developing adrenal insufficiency (AI), which can be life-threatening when undetected. Newborn screening (NBS) for ALD has been implemented in 29 states, yet the impact of NBS upon clinical management has not been reported.

Objective

To investigate whether the implementation of NBS has altered the time to diagnosis of AI in children with ALD.

Design

We conducted a retrospective medical chart review of pediatric patients with ALD.

Setting

All patients were seen in a leukodystrophy clinic in an academic medical center.

Patients

We included all pediatric patients with ALD who were seen between May 2006 and January 2022. We identified 116 patients (94% boys).

Main Outcome Measures

We extracted information about ALD diagnosis in all patients and AI surveillance, diagnosis, and treatment in boys with ALD.

Results

Thirty-one (27%) patients were diagnosed with ALD by NBS, and 85 (73%) were diagnosed outside the newborn period. The prevalence of AI among boys in our patient population was 74%. AI diagnosis was made significantly earlier in boys diagnosed with ALD by NBS than in boys diagnosed outside the newborn period (median [IQR] age of diagnosis = 6.7 [3.9, 12.12] months vs 6.05 [3.74, 8.35] years) (P < .001). When maintenance dose of glucocorticoids were initiated, there were significant differences in ACTH and peak cortisol levels in patients diagnosed by NBS and outside the newborn period.

Conclusions

Our results suggest that implementing NBS for ALD leads to significantly earlier detection of AI and earlier initiation of glucocorticoid supplementation in boys affected by ALD.