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Hi everyone. My name is Bartos the McGarr. I'm a medical doctor from the department of Under Chronology of the University Hospital in car. I would like to present the results of our work and titled Should the approach the nonclassic congenital other happy pleasure be changed I realize validation off and see a a diagnostic process. We have nothing to this closing connection with the presented study. First, let me give you some general information. Continue that other hypoplasia belongs to the group of inherited disorders off cortisol. Synthesis is it is in created in an autosomal recessive mother. The most common form is 2100 s allies deficiency imitation. See why people when t one t two gene and C H is a less severe form in which the activity off 21 hydroxylase is estimated about 20 to 50% compared to the classic form of activity at about 025% in NCH, symptoms appear later are varied and no specific because Intropin stimulation test is good diagnostic standard used to test for ch currently accepted threshold off center anti hydroxy progesterone level at which the cost Intropin stimulation test should be performed is greater than equal toe for eczema. Oh, no sperm military. Other observations showed that many patients referred for NCH diagnostics, in whom the consent dropping test results is ultimately negative. It requires clarification whether the current baseline kind of partisan other quickly specific. The aim of our study was very fine. The cutoff point from the guidelines they study included 400 Patient referred to the Department of Endocrinology and 2004 to 2021 day you took clinical suspicion. Alanssi Age in each subject, a standard 250 American grams cause it dropping stimulation test was performed 7 70 which was measured. ELISA, I say before for Team and 60 minutes after Cosyntropin intravenous injection and CHD noses was made. Of course, interpret stimulated 17 inch P level exceeded $10 per milliliter. Moreover, in the further part of the analyzes, the 70 HPI, off 15 mg per milliliter was used as a threshold for the diagnosis on CH. As it was more specific and all of the roll up more falls positive results. The embassy curve for both and 70 which be lovers, was that the mind and the basic kind of pointed the high sensitivity and specificity was established. Additionally, the Arrow See car force might for the most common problem reporter by the patients that this menstrual disorders medium age for the entire study group was 25 years. Medium baseline. 70 inch people value Waas. The 1.6 on a gas per milliliter. 208 famous complaint off Monster Irregularity 85 Patient were diagnosed with CH. This slide shows the R O C curve when the 70 which be cut off point to establish the diagnosis, was greater than equal 10 on a grasper militar. The area under top was 0.92 which proved the hype diagnostic value off our test based on the OCD on on This is for the guy my recommended 70 which because of value of the sensitivity, was 90.6% and the specificity was 77.5%. However, the same manner is showed a better car of point off Toprol in the 36 a grasper merely there, for which the sensitivity was 88.2% and specificity WAAS, 87%. Additionally, with better mind kind of point for the patient with off without menstrual disorders in, Um um, you might start dessert is the best 17 level kind of point was 2.38 9 or gas per milliliter, while for those without menstrual irregularities, it was higher 90.79 mg per minute. Later, in this life, we can see the arrow sick of on the 70 which pick out of point to establish. The diagnosis was greater than or equal 59 or grams per meter. The area under kind of level was only slightly over them for the level greater than or equal 10 nanograms per million with the same statistical significance. The best 70 yards baseline cutoff level off above mentioned cost Intropin stimulate and 70 much B level was 2.8500 g per minute leader comparing our to 70 because of points and city bitty for the 700.2 point 36 was on the slightly lower than for the point greater than on equal to a 360.0.0 nanograms per militar. Why it's specific City was much higher by almost 10%. Now let's look on the predictive value comparison. Then they got a predictive value for both points were similar by the positive predictive value was significantly higher for the 2.3600 jumpers. We need a threshold interestingly, in the group with 70 which be greater than or equal to one a grasper militar. There were fact two more false positive results. Therefore, shifting the kind of points towards 2.36 on the transfer. Military could reduce the number of false positive results, but as much as ever. 30%. The gray area was represented by the results between $2.0 grant Smelly and 2.4600 g per meal eater, in which there were 34 patient, while only two off them for the positive cosyntropin stimulation. Through that, therefore, we're ended toe rule out as many as 32 post positive. Why we didn't diagnose only two through positive cases coming back to the trust hope come up Arizona. Similar relationship was found on the base and 70 which, because of value off 2.85 on a grasper militar if we diagnosis was made with causing trumpets, has value greater done on equal 50 nanograms per milliliter. Why the number off most cases? 4.2 point 09 or grams milliliters was even higher. Subsequently, we compared the bison cut of points for the diagnosis might have 70 which be levels greater than on equal 10 or $15 per minute, and the fire cut off point. We kind slightly in sensitivity with an increasing specificity. At about 2% there are five fever false positive results. Interestingly, we try to determine how many patients among those suspected off see a shin to be diagnosed. To obtain one positive cosyntropin test result, we use the methodology usually used to calculate number needed to treat as a reference point. We assume the level off 70 which be greater than or equal 10 nanograms per meal eater at which the diagnosis was made. If we use our cutoff on a routine, or we could test about a place in less than using in the standard cut off point, tow, obtain and diagnoses, we also use a logistic regression model. In the statistical analysis, we can see that both for the whole group on for advice and cut off point off 70 much greater than or equal to 700.36 g per militar that tested the relationship was statistically significant. Why, for the room below the assume cut off point the study relationship were statistically insignificant. We obtained similar dependencies for the previously analyzed 0.70 HB, 2.85 mg per milliliter. However, they have not been presented in this presentation. Therefore, it can be concluded that the cutoff point recognize it, but, uh, it justified to somehow our results suggest considering up worship in the 17 HB trustful at which patient suspected for NCH would be referred for father evaluation. This may reduce the number of unnecessary cosyntropin stimulation tests particularily in patients with my not require any treatment. Start if equation 17 inch because the values, according the clinical presentation of patients suspected for NCH, might also be considered. Thank you for intention.