Here are some abstracts, about the adequacy of different testing methods. Each of them focuses on only part of the question of which is most accurate, so I think you have to evaluate them together. The basic conclusions are that:
1. A single 17-OHP number, used to evaluate control, is not sufficient.
2. Blood spot (otherwise known as filter paper) testing, which can give numbers for different times of the day, is much more accurate.
3. Urine testing basically gives the same information as blood spot testing, so the two are of comparable value.
With that in mind, I think you have to consider practical issues. For a child who is not toilet trained, getting urine samples reliably is tough, so blood spot testing would be the way to go, if it is available. Blood spot testing, I believe, is much more commonly used in the UK and Australia. In the US, it may be available in those states, which have newborn screening, but it probably involves a bit of leg work on the part of the pediatric endocrinologist, to make this happen.
After a child is of age, however, getting a urine sample is no big deal and, in fact, much less of a hassle, overall, than having to bring the child to the hospital for a blooddraw. It's true that it is "archaic," which, according to the dictionary means that it is "antiquated," "outdated," or "old-fashioned." But one automatically assumes that that means that it is inferior. But, it wasn't abandoned because it was considered inaccurate---just sometimes messy and unpleasant---so, blood-draws became more porpular. But, talk about "throwing out the baby with the bathwater"---it's not as if a bringing the kids in for their blood-draws doesn't cause a whole host of other problems.
| 1: J Pediatr Endocrinol Metab 2000 Feb;13(2):205-10 | Related Articles,  Books |
Correlation of blood-spot 17-hydroxyprogesterone daily profiles and urinary steroid profiles in congenital adrenal hyperplasia.
Erhardt E, Solyom J, Homoki J, Juricskay S, Soltesz G.
Department of Pediatrics, University Medical School, Pecs, Hungary.
OBJECTIVE: To compare the value of blood-spot 17-hydroxyprogesterone (17-OHP) daily profiles and urinary steroid excretion in untreated and treated patients with congenital adrenal hyperplasia (CAH). PATIENTS: Ten patients with CAH were investigated during steroid replacement therapy (Group 1), and 11 patients were investigated without treatment (Group 2). METHODS: Capillary blood samples were collected for measurement of blood-spot 17-OHP values by non-chromatographic radioimmunoassay. Steroid profiles of 24-h urine samples were analyzed by gas chromatography. RESULTS: There was a close correlation between the individual daily means of blood-spot 17-OHP measurements and the pregnanetriol/ tetrahydrocortisone ratio in both groups of patients (Group 2: r=0.839, p<0.001; Group 1: r=0.686, p<0.001). Almost the same correlation was found between the blood-spot 17-OHP value and the sum of three 17-hydroxyprogesterone metabolites/the sum of three cortisol/cortisone metabolites ratio (Group 2: r=0.918, p<0.001; Group 1: r=0.741, p<0.001). CONCLUSIONS: Blood-spot 17-OHP measurements and 24-h urinary steroid profile have the same impact in identification and monitoring therapy of children with CAH.
PMID: 10711668 [PubMed - indexed for MEDLINE]
| J Paediatr Child Health 1993 Aug;29(4):302-4 | Related Articles, Books |
17-Hydroxyprogesterone rhythms and growth velocity in congenital adrenal hyperplasia.
Pincus DR, Kelnar CJ, Wallace AM.
Gold Coast Hospital, Queensland, Australia.
Six patients on steroid replacement therapy for congenital adrenal hyperplasia provided capillary blood samples collected at 0800, 1200, 1700, and 2200 h, on to filter paper for 17-hydroxyprogesterone analysis. There was a strong correlation between 17-hydroxyprogesterone day profiles and height velocity over a 4 year period of study. Steroid over-replacement, identified by significantly decreased height velocity (Standard Deviation Score [SDS] 1.92), caused suppression of 17-hydroxyprogesterone concentrations to below 10 nmol/L throughout the day. Near average height velocity (Standard Deviation Score 0.245) was accompanied by suppression of 17-hydroxyprogesterone concentrations below 40 nmol/L but with significant diurnal variation. Under-replacement with rapid height velocity and bone maturation was accompanied by non-suppression of 17-hydroxyprogesterone concentrations (i.e. > 40 nmol/L). These results suggest that serial blood spot 17-hydroxyprogesterone measurements are a convenient and helpful supplement to measurements of height velocity and bone age maturation to monitor steroid replacement therapy in congenital adrenal hyperplasia. These measurements may be useful particularly in differentiating between over-replacement and appropriate replacement, and should allow adjustments in dose before abnormal growth patterns are established.
PMID: 8373678 [PubMed - indexed for MEDLINE]
| 1: Arch Dis Child 1981 Mar;56(3):208-13 | Related Articles, Books |
Circadian patterns of plasma cortisol, 17-hydroxyprogesterone, and testosterone in congenital adrenal hyperplasia.
Frisch H, Parth K, Schober E, Swoboda W.
In 11 children aged between 2 and 17 years with (nonsalt-losing) congenital adrenal hyperplasia (21-hydroxylase deficiency) blood was drawn at 90-minute intervals during a 24-hour period and levels of 17-hydroxyprogesterone, testosterone, and cortisol were measured. Levels of 17-ketosteroids and pregnanetriol were measured too in 24-hour urine samples. These measurements were taken under different regimens of treatment and after interruption of treatment. Cortisol level rose and fell rapidly after administered corticosteroid, and reached unphysiologically high levels. Testosterone levels showed pronounced variations but stayed in the normal range for most of the time even in untreated patients; thus testosterone provides a poor control parameter. Levels of 17-hydroxyprogesterone showed extreme fluctuations and very high peak levels in untreated patients; standard treatment with two or three daily doses of corticosteroids did not prevent a pronounced rise in its level after midnight. After the first morning dose of hydrocortisone a very steep fall was observed. The 24-hour pregnanetriol excretion correlated well with the corresponding total integrated 17-hydroxyprogesterone area. It is concluded that single 17-hydroxyprogesterone values are unlikely to give adequate information about the quality of treatment.
PMID: 7212759 [PubMed - indexed for MEDLINE]
| 1: Indian J Pediatr 1994 Jul-Aug;61(4):341-6 | Related Articles, Books |
Morning steroid profile in children with congenital adrenal hyperplasia under different hydrocortisone schedules.
Silva IN, Oliveira-Junior DF, Simal CJ, Viana MB, Chagas AJ.
Pediatric Department of Medical School, Federal University of Minas Gerais, Brasil.
We studied 13 children with 21-hydroxyalse deficiency to explore the immediate potential suppressive effect of hydrocortisone dose schedule on the adrenal cortex. They were given 20 mg/m2 daily in a controlled trial. After random administration of a greater dose in the morning (7 patients) or at night (6 patients), we measured plasma levels of 17-hydroxyprogesterone, testosterone, and androstenedione at times-24, 0, 2, 4, and 6h. Considerable fluctuation of the steroid levels, unrelated to the drug intake, was observed. There was no statistically significant differences between the "morning dose" and "night dose" groups for any steroid. We conclude that; (i) the greater night dose did not avoid the 17-hydroxyprogesterone morning peaks, and (ii) the variation in plasma steroid levels is so marked that a single morning sample is unreliable to reflect the degree of adrenal suppression.