Diagnostic Protocols in Endocrinology

Foreword
Preface
Acknowledgments
Contents
About the Editors
1: Endocrinology Evaluation Protocol: Pituitary and Hypothalamus
	1.1	 Insulin-Induced Hypoglycaemia (IIH)/Insulin Tolerance Test
		1.1.1	 Principle
		1.1.2	 Indications
		1.1.3	 Contraindications
		1.1.4	 Preparation
		1.1.5	 Method
			1.1.5.1	 Troubleshooting
		1.1.6	 Side Effects
		1.1.7	 Interpretation
	1.2	 Clonidine Stimulation Test
		1.2.1	 Principle
		1.2.2	 Indication
		1.2.3	 Contraindications
		1.2.4	 Preparation
		1.2.5	 Method
		1.2.6	 Side Effects
		1.2.7	 Interpretation
		1.2.8	 Interpretation
	1.3	 Glucagon Stimulation Test
		1.3.1	 Principle
		1.3.2	 Indication
		1.3.3	 Contraindications
		1.3.4	 Preparation
		1.3.5	 Method
		1.3.6	 Side Effects
		1.3.7	 Interpretation
	1.4	 Levodopa Stimulation Test
		1.4.1	 Principle
		1.4.2	 Indication
		1.4.3	 Contraindications
		1.4.4	 Preparation
		1.4.5	 Method
		1.4.6	 Side Effects
		1.4.7	 Interpretation
	1.5	 IGF-1 Generation Test
		1.5.1	 Principle
		1.5.2	 Indication
		1.5.3	 Method
			1.5.3.1	 Standard 5 Day IGF-1 Generation Test
		1.5.4	 Interpretation
			1.5.4.1	 7-Day IGF-1 Generation Test
			1.5.4.2	 2-Week IGF-1 Generation Test
		1.5.5	 CEMRI Sella
		1.5.6	 Interpretation
	1.6	 Oral Glucose Tolerance Test for Acromegaly
		1.6.1	 Principle
		1.6.2	 Indication
		1.6.3	 Contraindication
		1.6.4	 Method
		1.6.5	 Side Effects
		1.6.6	 Interpretation
	1.7	 Bilateral Simultaneous Inferior Petrosal Sinus Sampling (BIPSS)
		1.7.1	 Principle
		1.7.2	 Indication
		1.7.3	 Contraindications
		1.7.4	 Preparation
		1.7.5	 Method
		1.7.6	 Side Effects
			1.7.6.1	 Interpretation
	1.8	 CRH Testing
		1.8.1	 Indication
		1.8.2	 Contraindications
		1.8.3	 Method
		1.8.4	 Side Effects
		1.8.5	 Interpretation
	1.9	 IV AVP Stimulation Test
		1.9.1	 Indication
		1.9.2	 Contraindications
		1.9.3	 Method
		1.9.4	 Side Effects
		1.9.5	 Interpretation
		1.9.6	 Interpretation
	1.10	 Low-Dose Dexamethasone Suppression Test (LDDST)
		1.10.1	 Principle
		1.10.2	 Indication
		1.10.3	 Contraindications
		1.10.4	 Method
		1.10.5	 Interpretation
	1.11	 High-Dose Dexamethasone Suppression Test (HDDST)
		1.11.1	 Indication
		1.11.2	 Contraindications
		1.11.3	 Method
		1.11.4	 Interpretation
	1.12	 Water Deprivation Test
		1.12.1	 Indication
		1.12.2	 Prerequisites
		1.12.3	 Contraindications
		1.12.4	 Preparation
		1.12.5	 Method
		1.12.6	 Side Effects
	1.13	 Prolonged Water Deprivation Test
		1.13.1	 Indication
		1.13.2	 Methods
		1.13.3	 Interpretation
	1.14	 Patient Instructions Sheet
		1.14.1	 Instructions to the Patient for Dexamethasone Suppression Test
	1.15	 Instructions to the Patient for Urine Collection for 24-h Urinary Free Cortisol Test
	1.16	 Instructions to the Patient for 11 pm Awake Cortisol and ACTH
	Suggested Reading
2: Endocrinology Evaluation Protocol: Diabetes and Thyroid
	2.1	 Standard Oral Glucose Tolerance Test (OGTT)
		2.1.1	 Aim
		2.1.2	 Indications [1]
		2.1.3	 Preparation
		2.1.4	 Prerequisites
		2.1.5	 Procedure
		2.1.6	 Interpretation (Table 2.1)
		2.1.7	 Troubleshooting
	2.2	 Gestational Diabetes Mellitus (GDM)
		2.2.1	 Procedure (One-Step Approach)
		2.2.2	 Two-Step Approach in the Diagnosis of GDM
	2.3	 Glucagon-Stimulated C-Peptide Test
		2.3.1	 Principle
		2.3.2	 Aim
		2.3.3	 Indication [7]
		2.3.4	 Contraindication
		2.3.5	 Preparation
		2.3.6	 Procedure
		2.3.7	 Interpretation [7]
		2.3.8	 Adverse Events
	2.4	 Mixed-Meal Test (MMT)
		2.4.1	 Aim
		2.4.2	 Indications
		2.4.3	 Contraindication
		2.4.4	 Preparation
		2.4.5	 Prerequisite
		2.4.6	 Procedure [8]
		2.4.7	 Interpretation [10]
	2.5	 Prolonged Supervised Fast (72-h Fast)
		2.5.1	 Principle
		2.5.2	 Aim
		2.5.3	 Indication
		2.5.4	 Contraindication
		2.5.5	 Preparation
		2.5.6	 Prerequisite
		2.5.7	 Procedure
		2.5.8	 At the Termination of Test
		2.5.9	 Interpretation [10]
	2.6	 Selective Arterial Calcium Stimulation (SACS) Test
		2.6.1	 Aim
			2.6.1.1	 Principle
		2.6.2	 Indication
		2.6.3	 Contraindications
		2.6.4	 Prerequisite
		2.6.5	 Preparation
		2.6.6	 Procedure [11]
		2.6.7	 Interpretation [11]
		2.6.8	 Complications
	2.7	 Thyrotrophin-Releasing Hormone (TRH) Test
		2.7.1	 Aim
			2.7.1.1	 Principle
		2.7.2	 Indication
		2.7.3	 Contraindications
		2.7.4	 Preparation
		2.7.5	 Procedure
		2.7.6	 Interpretation [13] (Table 2.5)
		2.7.7	 Side Effects
	2.8	 T3 Suppression Test
		2.8.1	 Principle
		2.8.2	 Aim
		2.8.3	 Indication
		2.8.4	 Contraindications
		2.8.5	 Prerequisite
		2.8.6	 Preparation
		2.8.7	 Procedure
		2.8.8	 Sampling
		2.8.9	 Interpretation [15]
			2.8.9.1	 Patient’s TFT
			2.8.9.2	 Father’s TFT
		2.8.10	 Interpretation
	Suggested Reading
3: Endocrinology Evaluation Protocol: Adrenals
	3.1	 Adrenal Insufficiency
		3.1.1	 Types of Test Available: Short Synacthen Test, Insulin Tolerance Test
			3.1.1.1	 Cosyntropin/Short Synacthen Test (SST)
				Principle
				Pharmacodynamics and Pharmacokinetics
				Aim
				Indications
				Contraindications
				Preparation
				Prerequisite
				Procedure
				Pitfalls of SST
					Falsely Stimulable (“Sufficient,” i.e., Serum Cortisol >550 Nmol/L)
					Falsely Non-stimulable (“Insufficient,” i.e., Serum Cortisol <550 Nmol/L)
				Adverse Events of Synacthen
			3.1.1.2	 Low-Dose Synacthen Stimulation Test (1 mcg)
				Principle
				Aim
				Indications
				Preparation
				Shelf Life
				Interpretation
				Pitfalls
			3.1.1.3	 Acton Prolongatum Stimulation Test
				Principle
				Aim, Indications, and Contraindications
				Procedure
				Dose Preparation
				Interpretation
				Unit Conversion
		3.1.2	 Tests for Primary Hyperaldosteronism
			3.1.2.1	 Assessment of Plasma Aldosterone Concentration (PAC) and Plasma Renin Activity (PRA)
				Aim
				Indications
				Contraindication
				Preparation/Prerequisite
				Procedure
				Interpretation
		3.1.3	 Confirmatory Tests for Primary Aldosteronism
			3.1.3.1	 Intravenous Saline Suppression Test
				Principle
				Aim
				Indication
				Contraindications
				Prerequisite
				Preparation
				Procedure
				Troubleshooting
			3.1.3.2	 Oral Sodium Loading Test
				Aim
				Principle
				Indication
				Contraindications
				Heart Failure
				Prerequisite
				Procedure
			3.1.3.3	 Fludrocortisone Suppression Test
				Aim
				Principle
				Indication
				Contraindication
				Prerequisites
				Procedure
			3.1.3.4	 Adrenal Venous Sampling
				Aim
				Principle
				Indication
			3.1.3.5	 Not Required/Indicated in the Following Cases
				Contraindication
				Preparation/Prerequisite
				Procedure
				Interpretations
				Troubleshooting
				Complications
			3.1.3.6	 Dexamethasone Androgen Suppression Test (DAST)
				Aim
				Principle
				Indication
				Contraindication
				Preparation
				Prerequisite
				Procedure
					Short DAST
					Long DAST
				Unit conversion
		3.1.4	 Tests to Differentiate Pseudo-Cushing’s from Cushing’s Syndrome
			3.1.4.1	 Loperamide Challenge (Suppression) Test
				Aim
				Principle
				Contraindications
				Preparation and Prerequisite
				Procedure
				Interpretation
				Complications
			3.1.4.2	 16 mg Loperamide Challenge Test
				Interpretation
			3.1.4.3	 Low-Dose Dexamethasone Suppression Test (LDDST) Followed by CRH or Vasopressin Stimulation
				Aim
				Principle
				Indication
				Contraindication
				Preparation
				Prerequisite
				Procedure
			3.1.4.4	 Interpretation
				Complications
			3.1.4.5	 Insulin-Induced Hypoglycemia (Discussed Earlier in the Chapter for GH Stimulation Test)
				Aim
				Principle
				Indication
				Contraindications
				Prerequisite/Procedure
				Interpretation
		3.1.5	 Test for ACTH-Independent Macronodular Adrenal Hyperplasia (AIMAH)
			3.1.5.1	 Lacroix Protocol
			3.1.5.2	 Procedure
			3.1.5.3	 On Day 1
		3.1.6	 Mixed-Meal Stimulation Test (Details Have Been Mentioned Earlier in the Chapter)
			3.1.6.1	 Mixed-Meal Stimulation Test
				Procedure
				Day 2
			3.1.6.2	 GnRH Agonist Stimulation Test
				Procedure
			3.1.6.3	 Short Synacthen Test (Details Have Been Discussed Earlier)
				Procedure
				Day 3
			3.1.6.4	 Vasopressin Stimulation Test (Discussed Earlier in Detail)
				Prerequisite
				Procedure
			3.1.6.5	 Metoclopramide Stimulation Test
				Procedure
				Interpretation
					Partial Response
					Positive Response
	Suggested Reading
4: Endocrinology Evaluation Protocol: Gonads
	4.1	 Gonadotropin-Releasing Hormone Agonist (GnRHa) Test
		4.1.1	 Aim
		4.1.2	 Indications
		4.1.3	 Preparation/Prerequisite
		4.1.4	 Triptorelin Stimulation Test
			4.1.4.1	 Procedure
		4.1.5	 Leuprolide Stimulation Test
			4.1.5.1	 Procedure
			4.1.5.2	 Side Effects
	4.2	 hCG (Human Chorionic Gonadotropin) Stimulation Test
		4.2.1	 Aim
		4.2.2	 Indications
		4.2.3	 Contraindications
		4.2.4	 Procedure
			4.2.4.1	 Protocol 1
			4.2.4.2	 Protocol 2 (4-Day Test)
			4.2.4.3	 Protocol 3 (7-Day Test)
		4.2.5	 Side Effects
		4.2.6	 Conversion Factor
	4.3	 Congenital Adrenal Hyperplasia
		4.3.1	 Cosyntropin (Synacthen) Stimulation Test (ACTH [1–24])
		4.3.2	 Aim
		4.3.3	 Indications
		4.3.4	 Prerequisite
		4.3.5	 Precautions/Contraindications
			4.3.5.1	 Adverse Reactions
		4.3.6	 Preparation
		4.3.7	 Procedure
		4.3.8	 11β-Hydroxylase Deficiency
		4.3.9	 Interpretation
		4.3.10	 3β-HSD Deficiency
		4.3.11	 Older Criteria
		4.3.12	 Newer Criteria
	Suggested Reading
5: Endocrinology Evaluation Protocol: Bone and Mineral Disorders
	5.1	 Renal Tubular Acidosis
		5.1.1	 Ammonium Chloride Loading Test
			5.1.1.1	 Principle
			5.1.1.2	 Indication
			5.1.1.3	 Contraindications
			5.1.1.4	 Patient Preparation and Prerequisite
			5.1.1.5	 Protocol
			5.1.1.6	 Interpretation
			5.1.1.7	 Comments
	5.2	 Bicarbonate Loading Test
		5.2.1	 Principle
		5.2.2	 Indication
		5.2.3	 Patient Preparation
		5.2.4	 Protocol
		5.2.5	 Interpretation
			5.2.5.1	 Fractional Excretion of Bicarbonate (FEHCO3−)
			5.2.5.2	Urine-to-blood (U-B) pCO2 gradient
	5.3	 Measurement of TmP/GFR
		5.3.1	 Principle
		5.3.2	 Indications
		5.3.3	 Protocol
		5.3.4	 Calculation
		5.3.5	 Interpretation
	Suggested Reading
6: Endocrinology Evaluation Protocol: Special Situations
	6.1	 Diagnosis of Endocrine Disorders in Special Circumstances
		6.1.1	 Cushing’s Syndrome
			6.1.1.1	 Pregnancy
				Diagnostic Challenges
				Diagnosis
				Instructions for Urinary Free Cortisol Sample Collection
				Tumour Localisation
			6.1.1.2	 Chronic Kidney Disease
				Diagnostic Challenges
				Diagnosis
				Tumour Localisation
		6.1.2	 Pheochromocytoma
			6.1.2.1	 Pregnancy
				Diagnostic Challenges
				Diagnosis
				False-Positive Result
				False-Negative Result
				Tumour Localisation
			6.1.2.2	 Chronic Kidney Disease
				Diagnostic Challenges
				Diagnosis
				Tumour Localisation
		6.1.3	 Primary Hyperparathyroidism
			6.1.3.1	 Pregnancy
				Diagnostic Challenges
				Diagnosis
				Tumour Localisation
			6.1.3.2	 Chronic Kidney Disease
				Diagnostic Challenges
				Diagnosis
				Tumour Localisation
		6.1.4	 Acromegaly
			6.1.4.1	 Pregnancy
				Diagnostic Challenges
				Diagnosis
				Tumour Localisation
			6.1.4.2	 Chronic Kidney Disease
				Diagnostic Challenges
				Diagnosis
				Tumour Localisation