Endocrine and Metabolic Disorders: Clinical Lab Testing Manual, Fourth Edition

Endocrine and Metabolic Disorders: Clinical Lab Testing Manual (Fourth Edition)......Page 2
Contents......Page 5
Preface......Page 19
The Authors......Page 20
Laboratory Test Interpretation Principles......Page 22
Analytical Performance Characteristics of Lab Tests......Page 24
Diagnostic Specificity......Page 28
Post- Test Probability of Disease......Page 29
Efficiency......Page 30
Area under the Curve ( AUC) from a Receiver– Operator Characteristic ( ROC) Curve Analysis......Page 31
Reference Change Value ( RCV)......Page 32
Suggested Reading......Page 34
Contents......Page 0
1.1.1 Thyroid- Stimulating Hormone ( Sensitive or Highly Sensitive TSH) as a Test for Hypothyroidism*......Page 35
1.1.2 TSH as a Screening Test for Hypothyroidism in Adults and Neonates......Page 44
1.1.3 Free T4 ( Free Thyroxine) as a Test for Hypothyroidism......Page 46
1.1.4 Antimicrosomal ( Anti- M) or Antithyroid Peroxidase ( Anti- TPO) and Antithyroglobulin ( Anti- Tg) Antibodies in Hypothyroidism......Page 48
1.1.5 Thyrotropin- Binding Inhibitory Immunoglobulins ( TBIIs) in Hypothyroidism......Page 50
1.1.6 Thyroid Scanning Scintigraphy Using 99mTc-Pertechnetate or [123I]Na in Hypothyroidism......Page 51
1.1.7 T3 Resin Uptake ( RU) and Thyroid Hormone Binding Ratio ( THBR) as Tests to Estimate Thyroid- Hormone- Binding Proteins ( TBPs) in Hypothyroidism......Page 52
1.1.8 Free Thyroxine Index ( FTI or FT4I) and Total Thyroxine ( Total T4 or TT4) in Hypothyroidism......Page 54
1.1.9 Thyroid- Binding Globulin ( TBG) and Thyroxine- Binding Prealbumin ( TBPA) as Tests in the Event of a False- Normal TT4 in Hypothyroidism......Page 55
1.1.10 Triiodothyronine ( T3), Total T3 ( TT3), Free T3 ( FT3), and Reverse T3 ( rT3) for Determination of Thyroid Status, Especially in Critical Illness or Low T3 Syndrome......Page 56
1.2.1 Thyroid- Stimulating Hormone as a Test for Hyperthyroidism......Page 57
1.2.2 Free Thyroxine ( Free T4, FT4) as a Test for Hyperthyroidism......Page 59
1.2.3 Free Thyroxine Index Derived from Total T4 ( TT4) and T3 Resin Uptake ( T3 RU) as a Test for Hyperthyroidism......Page 60
1.2.4 Total T3 to Total T4 Ratio ( TT3/ TT4 Ratio) in Hyperthyroidism......Page 61
1.2.5 Thyroid Autoantibodies: Antimicrosomal ( Anti- M), Antithyroid Peroxidase ( Anti- TPO), and Antithyroglobulin ( Anti- Tg) Antibody Testing in Hyperthyroidism......Page 62
1.2.6 Thyroid- Stimulating Immunoglobulin ( TSI) or Thyroid- Stimulating Antibody ( TS- Ab) Testing in Graves\' Disease ( GD)......Page 63
1.2.7 Thyroid Scan with Radioactive Iodine and Measurement of Its Uptake ( RAIU) in Hyperthyroidism......Page 64
1.2.8 Thyroid Scan with Technetium- 99m (99mTc) Methoxyisobutyl Isonitrile (Sestamibi) Scintigraphy in Hyperthyroidism......Page 65
1.2.9 Ultrasonograph ( USG) Imaging of the Thyroid in Hyperthyroidism......Page 67
1.2.10 Thyroglobulin ( Tg) Testing in Thyroiditis and Hyperthyroidism......Page 68
1.2.11 Exophthalmometry in Graves\' Disease: Measurement of Ocular Protrusion by Hertel\'s Method......Page 69
1.2.12 Criteria for the Objective Diagnosis of Thyroid Storm......Page 71
1.3.1 Fine- Needle Aspiration Biopsy ( FNAB) of Thyroid Nodules ( TNs)......Page 74
1.3.2 Thyroglobulin ( Tg) Testing in Patients with Known Thyroid Carcinoma after Administration of Recombinant Human Thyrotropin ( rhTSH) or Discontinuation of Thyroxine Replacement Therapy......Page 76
1.3.3 Antithyroglobulin ( Anti- Tg) Antibody as a Marker for Thyroid Carcinoma......Page 79
1.3.4 Imaging of Anatomic Abnormalities of the Thyroid Gland and Neck Region Using Ultrasound ( USG), Multislice Computed Tomography ( M- CT), or Magnetic Resonance Imaging ( MRI)......Page 80
1.3.5 Thyroid Scanning with 131I, 123I, or 99mTc-MIBI after Administration of rhTSH or Discontinuation of Thyroxine Replacement Therapy in Patients with or at Risk for Thyroid Cancer Recurrence......Page 83
1.3.6 Thyroid Scan, Thallium- 201 Whole- Body Scan (201Tl-WBS) in Patients with Thyroid Carcinoma, Particularly Onchyocytic (Hürthle Cell) and Medullary Types......Page 85
1.3.7 Positron Emission Tomography ( PET) Scan and Fusion with MR or M- CT Images in Metastatic Thyroid Carcinoma......Page 87
1.3.8 Calcitonin Testing: Serum Screening and Follow- Up in Patients with Medullary Thyroid Carcinoma ( MTC)......Page 89
1.3.9 RET Protooncogene Testing in Medullary Thyroid Carcinoma (MTC)......Page 90
2.1.1 Cortisol and Adrenocorticotropic Hormone ( ACTH) Testing in the Morning: Test Panel for Adrenal Insufficiency Secondary to Central or Isolated ACTH Deficiency......Page 93
2.1.2 Cosyntropin Stimulation Test: Short or Rapid ( 1 Hour) with Low- Dose ( 1 mcg) Cosyntropin in Central Adrenal Insufficiency or Secondary Hypoadrenalism......Page 95
2.2.1 Cortisol and Adrenocorticotropic Hormone ( ACTH) Testing in the Morning: Test Panel for Cushing\'s Syndrome......Page 97
2.2.2 Imaging to Find ACTH- Secreting Tumors by High- Resolution Multislice Magnetic Resonance ( MR) and Computed Tomographic ( M- CT) Scanning......Page 98
2.3.1 Insulin- Like Growth Factor 1 ( IGF- 1) Screening Prior to Use of Growth Hormone Stimulation Testing in Suspected Growth Hormone Deficiency ( GHD)......Page 99
2.3.2 Total and Free Insulin- Like Growth Factor 1 ( IGF- 1 or Somatomedin C) Testing for Growth Hormone Deficiency ( GHD) in Fasted Adults......Page 103
2.3.3 Free Insulin- Like Growth Factor 1 ( Free IGF- 1) and Insulin- Like Growth Factor Binding Protein 3 ( IGFBP- 3) Testing in Growth Hormone Deficiency ( GHD) of Children......Page 105
2.3.4 Arginine– GHRH ( ARG– Geref) Infusion for Stimulation of GH in Growth Hormone Deficiency ( GHD)......Page 107
2.3.5 Insulin- Like Growth Factor Binding Protein 3 ( IGFBP- 3) Test in GHD Patients with Growth Hormone Receptor Defects ( GHRD or Laron Syndrome) and/ or Hepatic Disorders......Page 110
2.3.6 Pituitary Imaging by M- CT and MR in GH Deficiency ( GHD)......Page 111
2.4.1 Basal GH, IGF- 1, and IGFBP- 3 Testing in Acromegaly......Page 113
2.4.2 Oral Glucose Tolerance Test ( oGTT) for GH Secretory Dynamics in Acromegaly......Page 115
2.4.3 Growth- Hormone- Releasing Hormone ( GHRH): Basal Level in Acromegaly......Page 116
2.4.4 Imaging of Somatotropin- Secreting Pituitary Tumors by M- CT and MR in Acromegaly......Page 117
2.4.5 Imaging of the Skull, Mandible, and Pituitary Sella by Conventional Radiography and Multislice CT ( M- CT) Scanning in Acromegaly......Page 119
2.5.1 Follicle- Stimulating Hormone ( FSH) and Luteinizing Hormone ( LH) Testing: Basal Levels in Central Gonadotropin Deficiency......Page 120
2.5.2 Olfactory Function Testing in Gonadotropin Deficiency......Page 123
2.6.1 Luteinizing Hormone ( LH) and Follicle- Stimulating Hormone ( FSH) Testing for Gonadotropin Hypersecretion......Page 125
2.6.2 Thyrotropin- Releasing Hormone ( TRH) Stimulation of LH Alpha- and Beta- Subunits in Pituitary Tumors......Page 126
2.6.3 Imaging of Nonfunctional and Nonsecreting Pituitary– Hypothalamic Tumors ( PHTs) by High- Resolution Multislice Magnetic Resonance ( MR) and Computed Tomographic ( M- CT) Scanning......Page 128
2.7.1 TSH Testing in Central Hypothyroidism ( CH)......Page 129
2.7.2 Thyrotropin ( TSH) Surge Test for Diagnosis of Central Hypothyroidism ( CH)......Page 131
2.8.1 TSH Testing in Screening for Thyrotrope Hypersecretion......Page 132
2.8.2 TSH Alpha- Subunit and Intact TSH Testing in TSH- Secreting Pituitary Tumors......Page 134
2.8.3 Imaging of TSH- Secreting Central Nervous System ( CNS) Tumors by High- Resolution Multislice Magnetic Resonance ( MR) and Computed Tomographic ( M- CT) Scanning......Page 135
2.9.1 Prolactin ( PRL) and Growth Hormone ( GH) Testing in Lactation Failure in Prolactotroph and Somatotroph Insufficiency......Page 137
2.9.2 Prolactin ( PRL) Testing: Monitoring after Treatment of a Prolactinoma......Page 138
2.10.1 Monomeric Prolactin ( PRL) and Multimeric Macroprolactin ( MPRL) Testing in Apparent States of Hyperprolactinemia......Page 139
2.10.3 Imaging of Prolactin- Secreting Pituitary Tumor by High- Resolution Multislice Magnetic Resonance ( MR) and Computed Tomographic ( M- CT) Scanning......Page 141
2.11.1 Measurement of Serum and Urine Osmolality Followed by Determination of Plasma or Urine AVP in Diabetes Insipidus ( DI)......Page 142
2.11.2 Water Deprivation Test ( WDT) for Adult Diabetes Insipidus ( DI)......Page 145
2.11.3 Water Deprivation Test ( WDT) Using Urinary [ AVP] as a Test for Diabetes Insipidus in Pediatric Patients......Page 148
2.11.4 Imaging of the Pituitary and Hypothalamus in Diabetes Insipidus ( DI)......Page 149
2.12.1 Sodium [ Na+] Testing in Syndrome of Inappropriate Antidiuresis ( SIAD)......Page 150
2.12.2 Arginine Vasopressin ( AVP) with Serum and Urine Osmolality Tests for Syndrome of Inappropriate Anti- Diuresis ( SIAD)......Page 153
2.13.1 Beta- 2 Transferrin and Beta- 2 Microglobulin Testing in Nasal Secretions of Patients with a Possible CSF Leak......Page 155
2.13.2 Imaging Studies to Localize Site of CSF Leakage Following Pituitary Surgery......Page 156
3.1.1 Random or Casual Plasma Glucose ( RPG or CPG) Concentration in Reactive Hypoglycemia and Neuroglycopenia......Page 159
3.1.2 Mixed Meal Tolerance Test in Idiopathic or Postprandial Reactive Hypoglycemia and Postprandial Syndrome......Page 161
3.1.3 Imaging of the Pancreas and Abdomen in a Patient with Suspected Tumor- Associated Hypoglycemia......Page 163
3.2.1 Insulin/ Glucose ( I/ G) Ratio and the I/ G Amended Ratio in the Hypoglycemic Patient......Page 164
3.2.2 Extended Fasting and Monitoring of Glucose in the Hypoglycemic Patient......Page 166
3.2.3 C- Peptide Suppression with Low- Dose Insulin as a Test for Abnormal Endogenous Insulin Secretion in the Hypoglycemic Patient......Page 168
3.2.4 Proinsulin ( PI) Level Test for Insulinoma......Page 171
3.2.5 Provocative Insulin Secretagog Tests for Insulinomas Using Infusion of Calcium, Tolbutamide, Glucagon, or Secretin to Stimulate Insulin......Page 172
3.2.6 Human Chorionic Gonadotropin ( hCG) and Its Subunits as Tumor Markers in Insulinoma Patients......Page 176
3.2.7 Insulin- Like Growth Factor 2 ( IGF- 2) and IGF- 1 ( Somatomedin C) as Tests for Non- Insulin Causes of Hypoglycemia......Page 177
3.3.1 Pediatric Hypoglycemia: Routine Serum and Urine Testing ( Glucose, Electrolytes, Ketones, and Lactate)......Page 178
3.3.2 Pediatric Hypoglycemia: Nonroutine Testing ( Arterial Blood Gases, Blood Alcohol, Sulfonylureas, Ammonia, Uric Acid, and Lipids)......Page 180
3.3.3 Extended Fasting and Monitoring of Glucose in Pediatric Patients......Page 182
3.3.4 Beta- Hydroxybutyrate ( BHB) Testing in Hypoglycemic Pediatric Patients......Page 184
3.3.5 Organic Acids: Urine Testing in Hypoglycemic Pediatric Patients......Page 185
3.3.6 Free Fatty Acid ( FFA) Testing in Hypoglycemic Pediatric Patients......Page 187
3.3.7 Carnitine/ Acylcarnitine Ratio in Hypoglycemic Pediatric Patients......Page 189
3.3.8 Quantitative Amino Acid ( AA), Alanine, and Branched- Chain AA Levels in Plasma and Urine in Hypoglycemic Pediatric Patients......Page 191
3.3.9 Testing for Reducing Substances in Urine in Screening for Galactosemia and Hereditary Fructose Intolerance ( HFI) in Hypoglycemic Pediatric Patients......Page 192
3.4.1 C- Peptide: Basal Level as a Test for Insulin Deficiency and Type 1 Diabetes Mellitus ( T1DM)......Page 194
3.4.2 Glucagon- Stimulated C- Peptide Levels in Testing for Insulin Deficiency and Type 1 Diabetes ( T1DM)......Page 195
3.4.3 First- Phase Insulin Response ( FPIR) to Intravenous Glucose as a Test for Pancreatic Beta- Cell Function......Page 197
3.5.1 Glucose Testing: Fasting Plasma Glucose ( FPG) in the Detection of Diabetes Mellitus ( DM)......Page 199
3.5.2 Glucose Testing: Random Plasma Glucose ( RPG) in the Detection of DM and Beta- Hydroxybutyrate ( BHB) for Detection of Diabetic Ketoacidosis ( DKA)......Page 200
3.5.3 Oral Glucose Tolerance Tests ( oGTTs) in the Diagnosis of Gestational Diabetes Mellitus ( GDM): 50- g and 100- g Glucose Load......Page 202
3.5.4 Hemoglobin A1c ( HbA1c) Testing and A1c- Derived Average Glucose ( ADAG) in Monitoring Patients with Diabetes Mellitus......Page 205
3.5.5 Fructosamine ( Glycosylated Albumin) Testing in Patients with Diabetes Mellitus......Page 210
3.5.6 Glucose Monitoring by Devices for Use at Home and Work in Patients with Diabetes Mellitus......Page 211
3.5.7 Glucose Monitoring During Intravenous Insulin Therapy for Postoperative and Post- Myocardial Infarction ( MI) Glycemic Control: The Van den Berghe and Diabetes Mellitus Insulin– Glucose Infusion in Acute Myocardial Infarction ( DIGAMI) Study Protocols......Page 213
3.5.8 Serum 1,5- Anhydro-D-Glucitol (1,5-ADG) as a Test for Degree of Postprandial Hyperglycemia......Page 217
3.5.9 Autoantibody Screening Tests for Type 1 Diabetes Mellitus: Insulin Autoantibodies ( IAAs), Protein Tyrosine Phosphatase- Like Protein ( IA- 2) Autoantibodies, and Glutamic Acid Decarboxylase Autoantibodies ( GADAs)......Page 219
3.6.1 Five Criteria for Identification of Insulin Resistance or Early Diabetes Mellitus ( EDM)......Page 222
3.6.2 Insulin Sensitivity Index ( ISI) in Gestational Diabetes Mellitus ( GDM)......Page 224
3.6.3 Fasting Glucose/ Fasting Insulin ( Glu/ Ins) Ratio as an Estimate of Insulin Sensitivity or Deficiency......Page 225
4.1.1 Uric Acid ( UA) as a Risk Factor for Cardiovascular Disease......Page 229
4.1.2 High- Sensitivity C- Reactive Protein ( hsCRP) as a Risk Factor for CVD......Page 231
4.1.3 Homocysteine ( Hcy) as a Risk Factor for CVD......Page 233
4.1.4 B- Type Natriuretic Peptide ( BNP) and N- Terminal proBNP ( NT- proBNP): Tests for Congestive Heart Failure ( CHF) or Risk for CHF in DM Patients Treated with Oral Hypoglycemic Agents......Page 235
4.1.5 Measurement of Blood Pressure ( BP) and Calculation of Mean Arterial Pressure ( MAP) and Pulse Pressure ( PP) in Diabetes Mellitus ( DM) and Non- DM Patients......Page 239
4.1.6 Ankle– Brachial Index ( ABI) Using Segmental Blood Pressures as a Measure of Blood Flow to the Extremities and the Degree of Peripheral Artery Disease ( PAD)......Page 242
4.1.7 Transcutaneous Oxygen Tension ( TC pO2) Measurement with 100% O2 Challenge for Prediction of Wound Healing in Lower Extremity Ulcers of Diabetes Mellitus ( DM) Patients*......Page 244
4.1.8 Coronary Artery Imaging Using Electron Beam Tomography ( EBT) or Multidetector ( 16- to 64- Slice) Computerized Tomography ( M- CT) as a Test for Coronary Artery Disease ( CAD)......Page 249
4.2.1 Lipid Screening: Conventional Lipid Profile* as a Predictor of Cardiovascular Disease ( CVD) in DM Patients......Page 252
4.2.2 Total Cholesterol ( TC) Fasting Test......Page 257
4.2.3 Triglyceride ( TG) Fasting and Nonfasting Tests......Page 258
4.2.4 Very- Low- Density Lipoprotein ( VLDL): VLDL Cholesterol ( VLDL- C) and VLDL Particles ( VLDL- p)......Page 260
4.2.5 Non- High- Density Lipoprotein Cholesterol ( Non- HDL- C) as an Index of Atherogenic Hyperlipidemia......Page 261
4.2.6 High- Density Lipoprotein Cholesterol ( HDL- C), Non- HDL- C, Total Cholesterol ( TC)/ HDL- C Ratio, and the Risk for Coronary Artery Disease ( CAD) in Diabetes Mellitus ( DM) Patients......Page 263
4.2.7 Low- Density Lipoprotein Cholesterol ( LDL- C) and LDL Particle ( LDL- p) Testing......Page 265
4.3.1 Apolipoprotein B ( ApoB)......Page 269
4.3.2 ApoCII and ApoCIII......Page 270
4.3.3 ApoE Phenotype......Page 272
4.3.4 Lipoprotein Little a......Page 273
5.1.1 Indirect Ophthalmoscopy and Stereoscopic Slit- Lamp Biomicroscopy of the Retina with Multi- Field Stereophotography of the Fundus for Detection and Monitoring of Diabetic Retinopathy ( DR) and Macular Edema ( ME)*......Page 276
5.2.1 Glomerular Filtration Rate ( GFR) Estimation by Creatinine Clearance ( Clcr), the Modification of Diet in Renal Disease ( MDRD) Equations, and the Cockcroft– Gault Formula......Page 279
5.2.2 Microalbumin ( MicroAlb) in the Diagnosis of Nephropathy of DM Patients......Page 283
5.2.3 Fractional Excretion of Sodium ( FENa) for Differentiation of Prerenal Azotemia from Acute Tubular Necrosis ( ATN) in the Diagnosis of Hyperosmolar Nonketotic Hyperglycemia in DM Patients......Page 286
5.3.1 Semmes– Weinstein Monofilament ( S- WMF) Semiquantitative Test for Neurosensory Deficits in Diabetes Mellitus ( DM) Patients......Page 288
5.3.2 Vibratory Sensation Testing in the Screening and Diagnosis of Peripheral Neuropathy in DM Patients......Page 291
5.3.3 Calculation of Gastric Emptying Rate by Conventional Radioscintigraphic Measurement of the Clearance of 99mTc-Albumin from the Stomach in DM Patients......Page 294
5.3.4 Assessment of Erectile Function ( EF) in Male DM Patients with Possible Neuropathy, Vasculopathy, and/ or Hypogonadism......Page 297
5.4.1 Ketone Testing for Diabetic Ketoacidosis ( DKA) in Patients with Type 1 Diabetes Mellitus ( T1DM)......Page 301
5.4.2 Blood pH in Diabetic Ketoacidosis ( DKA) and Hyperglycemic Hyperosmolar Nonketoacidosis ( HHNK) Syndrome......Page 303
5.5.1 Aspartate Aminotransferase ( AST) and Alanine Aminotransferase ( ALT) in Screening for Hepatic Steatosis, Nonalcoholic Fatty Liver Disease ( NAFLD), and Nonalcoholic Steatohepatitis or Steatohepatopathy ( NASH) in the Obese Diabetes Mellitus ( DM) Patient*......Page 304
5.5.2 Liver Ultrasonography ( USG), Computed Tomography ( CT) Scanning, and Proton Magnetic Resonance ( PMR) Spectroscopy in Diagnosis of Nonalcoholic Fatty Liver Disease ( NAFLD) and Nonalcoholic Steatohepatitis or Steatohepatopathy ( NASH) in the Overweight Diabetes Mellitus ( DM) Patient......Page 308
6.1.1 Cosyntropin Stimulation Test ( CST): Short or Rapid with High- Dose ( 250- mcg) Cosyntropin in Primary Adrenal Insufficiency ( 1 ° AD) and in Critical Illness......Page 311
6.1.2 Cortisol and ACTH Testing: Early- Morning ( 9 a. m.) Test Panel for Primary Adrenal Insufficiency ( 1 ° AD)......Page 313
6.1.3 24- Hour Urinary Free Cortisol ( UFC) Excretion Test to Monitor the Treatment of Hypoadrenalism......Page 315
6.1.4 Very- Long- Chain Fatty Acids ( VLCFAs) Testing in Adrenoleukodystrophy ( ALD)......Page 316
6.1.5 Adrenocortical Antibody ( ACA) Screening for Autoimmune Adrenal Disease with Reflexive Immunoprecipitation Assay ( IPA) for Antibodies to the 21- Hydroxylase Enzyme ( 21OH- Abs)......Page 319
6.1.6 Steroid- Producing Cell Autoantibodies ( StCAs) in Evaluation of Risk of Primary Hypoadrenalism or Addison\'s Disease ( 1 ° AD)......Page 321
6.2.1 Cortisol Testing: Diurnal Variation of Salivary vs. Serum Cortisol Concentration in Cushing\'s Syndrome ( CS)......Page 322
6.2.2 Urinary Free Cortisol ( UFC) 24- Hour Excretion Rate and UFC/ Urine Creatinine ( UCr) Ratio in Cushing\'s Syndrome ( CS)......Page 324
6.3.1 ACTH Testing in the Differential Diagnosis of Causes for Cushing\'s Syndrome ( CS)......Page 327
6.3.2 Bilateral Inferior Petrosal Sinus Sampling ( BIPSS) after Administration of Ovine Corticotropin- Releasing Hormone ( oCRH) to Exclude Ectopic ACTH Syndrome......Page 328
6.4.1 Potassium Testing: Screening Test for Hypoaldosteronism......Page 331
6.5.1 Potassium Testing: Screening Test for Hyperaldosteronism......Page 332
6.5.2 Plasma Aldosterone Concentration ( PAC)/ Renin ( R) Ratio as a Screening Test for Primary Hyperaldosteronism ( PHA)......Page 333
6.5.3 18- Hydroxycorticosterone ( 18OH- B) Testing to Differentiate Idiopathic Hyperaldosteronism ( IHA) from Aldosterone- Producing Adenoma ( APA)......Page 336
6.5.4 18- Hydroxycorticosterone/ Cortisol Ratio after Saline Infusion in Hyperaldosteronism......Page 337
6.5.5 Adrenal Vein Sampling ( AVS) Protocol for Localization of Adrenal Source of an Elevated Aldosterone Concentration......Page 338
6.5.6 Imaging of Adrenal Glands Using Cholesterol Analogs ( NP- 59, 131l-or 75 Se-6b-Methyl-19-Norcholesterol) as an
Adjunct to Multislice Computerized Tomography (M-CT)......Page 342
6.6.1 Free Metanephrines ( FMNs): Screening Test in Plasma ( PFMN) and Random Urine Samples......Page 344
6.6.2 Metaiodobenzylguanidine ( MIBG) Scan as an Adjunct to Magnetic Resonance ( MR) or Multislice Computerized Tomography ( M- CT) Imaging for Neuroendocrine Tissue......Page 345
6.7.1 Cosyntropin Stimulation Test ( CST) in Hirsutism and Possible Late- Onset Congenital Adrenal Hyperplasia ( CAH)......Page 347
7.1.1 Measurement of Bone Mineral Density ( BMD) by Dual- Energy X- Ray Absorptiometry ( DXA) of Hip and Lumbar Spine......Page 351
7.1.2 Imaging of the Vertebral Spine to Determine Presence of and Risk for Fractures......Page 354
7.1.3 Stadiometry for Assessment of Height Loss and Knemometry for Assessment of Height Velocity......Page 357
7.2.1 Cross- Linked C- Terminal ( CTx) and N- Terminal ( NTx) Telopeptides of Type 1 Bone Collagen as Markers of Accelerated Bone Turnover......Page 359
7.2.2 Alkaline Phosphatase ( AP), Bone- Specific Alkaline Phosphatase ( BSAP), and Osteocalcin as Serum Markers of Bone Formation in Conditions Associated with Accelerated Bone Turnover......Page 362
7.3.1 Calcium, Phosphorus, and Albumin Test Panel......Page 364
7.3.2 Calcium Concentration Corrected for [ Albumin] in Serum......Page 366
7.3.3 Calcium Concentration in 24- Hour Urine Collections......Page 367
7.3.4 Fractional Excretion of Calcium ( FECa)......Page 370
7.3.5 Calcium Load Test for Suspected or Mild Hyperparathyroidism......Page 371
7.3.6 Intact* Parathyroid Hormone ( PTH) Testing......Page 373
7.3.7 Parathyroid Hormone- Related Protein ( PTHrP) Testing......Page 375
7.3.8 Aluminum, [ Al], and Parathyroid Hormone, [ PTH]: Test Panel in Renal Osteodystrophy......Page 376
7.4.1 Dual- Phase 99mTc-Sestamibi (99mTc-MIBI) Scan for Parathyroid Adenoma Localization......Page 377
7.4.2 Parathyroid Imaging Techniques: Multislice Computed Tomography ( M- CT), Magnetic Resonance ( MR), and Ultrasonography ( USG) Imaging as Adjuncts to Dual- Phase Sestamibi (......Page 380
7.4.3 Selective Venous Sampling for Localization of Hyperfunctioning Parathyroid Glands......Page 381
7.4.4 Rapid Parathyroid Hormone ( PTH) Testing and Use of the Radioisotopic Gamma Probe ( GP) in the Intraoperative Localization and Removal of Parathyroid Adenomas......Page 383
7.5.1 Bone Biopsy Labeling Technique......Page 386
7.5.2 Vitamin D Testing......Page 388
7.5.3 Anion Gap ( AG), Serum Anion Gap ( SAG), and Urine Anion Gap ( UAG): Test for Differential Diagnosis of Renal Tubular Acidosis ( RTA) and Prediction of Bone Disease of Chronic RTA......Page 390
7.5.4 Citrate: 24- Hour Urine in Nephrolithiasis and Renal Tubular Acidosis ( RTA)......Page 394
8.1.1 Orchidometry in the Assessment of Hypogonadism and Pubertal Development in Males......Page 397
8.1.2 Human Chorionic Gonadotropin ( hCG): Single- Injection hCG Stimulation Test for Hypothalamic Hypogonadism ( Kallmann\'s Syndrome)......Page 399
8.1.3 Sperm Count in Evaluation of the Testes......Page 401
8.1.4 Testosterone: Total, Free, Weakly Bound, and Bioavailable Testosterone Testing for Male Hypogonadism......Page 403
8.1.5 Sex Hormone Binding Globulin ( SHBG) and Androgen Testing, Including Dihydrotestosterone ( DHT), in Males......Page 407
8.1.6 Hypogonadism in Potentially Androgen- Deficient Aging Males ( ADAM): Screening Questionnaires ( ADAM and Daily Assessment of Mood Score)......Page 409
8.2.1 Semen Analysis: Complete Analysis in Male Infertility......Page 412
8.2.2 Luteinizing Hormone ( LH) and Follicle- Stimulating Hormone ( FSH) Testing in Male Infertility......Page 414
8.2.3 Antisperm Antibody ( ASA) Testing in Male Infertility......Page 415
8.3.1 Imaging of Testicles, Epididymis, and Anatomic Abnormalities of the Male Reproductive Apparatus Using Scrotal ( SUS) and Transrectal ( TRUS) Ultrasound......Page 417
8.3.2 Human Chorionic Gonadotropin ( hCG) and Alpha- Fetoprotein ( AFP) Testing in Testicular Tumor Patients......Page 418
8.3.3 Male Estrogens: Estrone ( E1) and Total Estradiol ( E2) Testing to Determine the Origin of Estrogens from Testicular Tissue, Nontesticular Tumors, or Exogenous Sources......Page 421
8.3.4 Prostate- Specific Antigen ( PSA) as a Test to Screen for and Monitor Prostate Cancer ( PCa)......Page 422
8.4.1 Anogenital ( AG) Ratio in the Evaluation of Ambiguous Genitalia of Neonates......Page 424
8.4.2 Determination of Secondary Sexual Characteristics and Pubertal ( Tanner) Stage of Development in Boys and Girls......Page 425
8.4.3 Karyotype of Cells from Peripheral Circulation and Amniotic Fluid in Evaluation of Disorders of Sex Differentiation......Page 428
8.4.4 Imaging of Pelvic Structures with Ultrasonography ( USG) in the Evaluation of Disorders of Sexual Differentiation......Page 429
8.4.5 Sex Hormone Binding Globulin ( SHBG) Suppression Test in the Evaluation of Androgen Insensitivity Syndrome ( AIS)......Page 430
9.1.1 Progestin and Premarin®/Provera®
(Conjugated Estrogen/Medroxyprogesterone) Challenge Tests for Amenorrhea......Page 433
9.1.2 Ovulation Determination by Colorimetric ( Dipstick) Test for Luteinizing Hormone ( LH) in Urine......Page 435
9.1.3 Premenstrual Dysphoric Disorder ( PMDD): Use of a Diagnostic Questionnaire Based on Criteria for the Diagnosis of PMDD from the Diagnostic Statistical Manual of Mental Disorders ( DSM- IV)......Page 436
9.2.1 Progesterone, Luteinizing Hormone ( LH), and Follicle- Stimulating Hormone ( FSH) Testing in Female Infertility and Menopause......Page 437
9.2.2 Female Estrogens— Estrone ( E1), Estradiol ( E2), and Estriol ( E3)— in the Evaluation of Fertility and Ovarian Function......Page 440
9.2.3 The LH, FSH, LH/ FSH Ratio, and Androgens in the Evaluation of Female Infertility and Diagnosis of Polycystic Ovary Syndrome ( PCOS)......Page 442
9.2.4 GnRH Agonist ( Buserelin) Stimulation Test ( BST) for Diagnosis of PCOS......Page 443
9.2.5 Anti- Müllerian Hormone ( AMH) in the Determination of Ovarian Reserve and the Status of the Menopause Transition......Page 444
9.3.1 Human Chorionic Gonadotropin ( hCG) and Alpha- Fetoprotein ( AFP) in Pregnancy and Trophoblastic Diseases......Page 448
9.4.1 Androgen Excess in Females: Tests for Total ( TT), Free ( FT), and Bioavailable ( BioT) Testosterone; Androstenedione; Sex Hormone Binding Globulin ( SHBG); Dehydroepiandrosterone ( DHEA); and DHEA Sulfate ( DHEAS)......Page 450
9.4.2 Androgen Deficiency in Females: Tests for Total ( TT), Free ( FT), and Bioavailable ( BioT) Testosterone; Androstenedione; Sex Hormone Binding Globulin ( SHBG); Dehydroepiandrosterone ( DHEA); and DHEA Sulfate ( DHEAS)......Page 453
9.5.1 CA- 125 Testing in Ovarian Cancer......Page 455
9.5.2 Imaging of the Ovaries with Transvaginal Ultrasound ( TVUS)......Page 457
9.5.3 Transvaginal Ultrasound ( TVUS) Imaging of the Uterus for Endometrial Stripe Measurement and Assessment of Endocrine- Related Anatomic Abnormalities......Page 458
10.1.1 Gastrin: Basal Level as Screening Test for Gastrinoma or Zöllinger– Ellison Syndrome ( ZES)......Page 461
10.1.2 Secretin Stimulation of Gastrin Test in the Event of Elevated Basal Gastrin Levels......Page 464
10.2.1 5- Hydroxyindoleacetic Acid ( 5- HIAA): Random Urine, Timed Urine, and Blood Test for Carcinoid Syndrome......Page 465
10.2.2 Chromogranin A ( CgA) Testing in Carcinoid Tumor Patients......Page 467
10.3.1 Glucagon: A Test for the Presence of a Glucagonoma......Page 469
10.3.2 Somatostatin: A Test for the Presence of a Somatostatinoma......Page 471
10.3.3 Vasoactive Intestinal Peptide ( VIP): A Test for the Presence of a VIP- Secreting Non- Beta, Islet- Cell Tumor ( VIPoma)......Page 473
10.3.4 Pancreatic Polypeptide ( PP): A Test for the Presence of a Gastrointestinal or PP- Secreting Tumor ( PPoma)......Page 474
10.4.1 Somatostatin Receptor Scintigraphy ( SRS) Imaging with Somatostatin Analogs......Page 476
10.4.2 Ultrasonography ( USG), Multislice Computed Tomography ( M- CT), Magnetic Resonance ( MR), and Venous Sampling for Imaging and Localization of Gastroenteropancreatic Endocrine Tumors Including Insulinomas......Page 478
10.5.2 Chromogranin A ( CgA) Testing in Patients with Neuroendocrine Tumors Other than Carcinoid......Page 480
11.1.1 Measurement of Oxygen Consumption ( VO2) and Resting Metabolic Rate ( RMR) by Indirect Calorimetry and Calculation of Total Energy Expenditure ( TEE)......Page 483
11.1.2 Body Composition Analysis ( BCA): Lean Body Mass and Percent Body Fat (% BF) by Bioelectrical Impedance Absorptiometry ( BIA) and Dual- Energy X- Ray Absorptiometry ( DXA); Determination of Body Surface Area ( BSA)......Page 488
11.1.3 Body Mass Index ( BMI) Calculations......Page 490
11.1.4 Waist- to- Hip Circumference Ratio ( WHCR) and Waist Circumference ( WC) or Girth as Measurements of Obesity and Cardiovascular Disease ( CVD) Risk......Page 492
11.1.5 Ideal Body Weight ( IBW) and Lean Body Mass ( LBM) Determinations for Nutritional Assessment......Page 494
11.2.1 Albumin ( ALB), Total Protein ( TP), and Prealbumin ( PAB)......Page 497
11.2.2 Lymphocyte Count......Page 499
11.2.3 Serum Creatinine ( Creat) and Blood or Urine Urea Nitrogen ( BUN)......Page 500
11.2.4 Carotene......Page 502
11.2.5 25- Hydroxyvitamin D [ 25( OH) D3 Plus 25( OH) D2]......Page 504
11.2.6 Cyanocobalamin ( Vitamin B12), Methylmalonic Acid ( MMA), and Transcobalamin II ( TC- II)......Page 505
11.2.7 Magnesium: Testing for Total [ Mg] in Serum and Intracellular Red Blood Cell Ionized [ Mg2+]......Page 507
11.2.8 Magnesium [ Mg] Retention Test......Page 509
11.2.9 Folate: Testing in Serum and Red Blood Cells ( RBCs)......Page 511
11.2.10 Thiamine ( Vitamin B1), Riboflavin ( Vitamin B2), and Pyridoxine ( Vitamin B6)......Page 513
11.2.11 Potassium ( K+)......Page 515
11.2.12 Urinary Iodide ( or Iodine) Excretion......Page 517
11.2.13 Iron: Testing for Serum Iron Concentration ( SIC), Total Iron Binding Capacity ( TIBC), and Ferritin......Page 518
11.2.14 Red Cell Indices......Page 521
11.3.1 SCOFF Questionnaire for Anorexia Nervosa ( AN) and Bulimic or Binge Eating Disorders ( BEDs)......Page 523
11.3.2 Dietary CAGE Questionnaire for Assessment of Saturated Fat and Cholesterol Intake......Page 524
11.3.3 Three- Factor Eating Questionnaire ( TFEQ) for Identification of Patients with Eating Behaviors Characterized by Dietary Restraint, Dietary Disinhibition, or Susceptibility to Hunger......Page 525
11.3.4 Antigliadin Endomysial ( EMA IgG and IgA) and Tissue Antitransglutaminase ( TTG) IgA Antibody Testing in Diagnosis of Celiac Disease......Page 527
Introduction......Page 531
12.1.1 Thyrotropin- Releasing Hormone ( TRH) Stimulation Test in Hypothyroidism......Page 532
12.1.2 Gentle Hair-Pull Test for Alopecia of Autoimmune, Endocrine, and Non-Endocrine Causes, Including Telogen Effluvium Following Stressful Events......Page 534
12.1.3 Thyrotropin-Releasing Hormone (TRH) Stimulation Test in Thyroid Malignancies......Page 536
12.2.1 TRH Stimulation Test of Pituitary Gonadotropins in Pituitary Tumor Patients......Page 537
12.2.2 Clomiphene Stimulation Test in Diagnosis of Gonadotropin Deficiency......Page 539
12.3.1 Oral Glucose Tolerance Test ( oGTT) and the Hypoglycemic Index ( HGI) for Diagnosis of Reactive Hypoglycemia ( RH)......Page 540
12.3.2 75-Gram oGTT in the Research-Oriented Diagnosis of Nonpregnant Type 2 Diabetes Mellitus (T2DM) Patients......Page 542
12.3.3 Fasting Glucose/ Insulin ( Glu/ Ins) Ratio vs. Homeostasis Model Assessment ( HOMA) Formulas for Estimation of Insulin Sensitivity and Pancreatic Beta- Cell Function......Page 543
12.3.4 Determination of Glucagon-Like Peptide 1 (GLP-1) Deficiency......Page 546
12.4.1 Lipoprotein- Associated Phospholipase A2 ( Lp- PLA2) as a Marker for Inflammation and Risk for Cardiovascular Disease ( CVD)......Page 548
12.4.2 Tumor Necrosis Factor Alpha (TNFα) as a Marker
of Intravascular Inflammation and Adiponectin Effects......Page 550
12.4.3 Plasminogen Activator Inhibitor-1 (PAI-1) as Serine Proteinase Inhibitor (SERPIN) in Patients with Thrombotic Vascular Disease......Page 551
12.4.4 Mean Platelet Volume (MPV) and Measures of Platelet Activation as Indicators of Risk for Cardiovascular Disease (CVD) in Diabetes Mellitus (DM) Patients......Page 553
12.4.5 Measurement of Carotid Artery Intima–Media Thickness (CIMT) as a Test for Atherosclerotic Disease and Risk of CVD......Page 555
12.4.6 Pulse-Wave Analysis as a Measure of Arterial Wall Stiffness in Patients with Atherosclerosis......Page 556
12.4.7 Lipid Analyses by Proton Nuclear Magnetic Resonance (NMR) Spectroscopy (NMR LipoProfile®) or Vertical-Spin Density-Gradient Ultracentrifugation (VAP®) as Tests Predictive of Cardiovascular Disease (CVD) in Diabetes Mellitus (DM) Patients......Page 558
12.4.8 Apolipoprotein A (ApoA) and ApoA-I/ApoB Ratio Testing......Page 563
12.5.1 Heart Rate Variability ( HRV) Tests for Diabetic Autonomic Neuropathy ( DAN)......Page 565
12.6.1 Low- Dose Dexamethasone Suppression Test ( DST) in Combination with the Ovine Corticotropin- Releasing Hormone ( oCRH) Stimulation Test in the Differential Diagnosis of Cushing\'s Syndrome ( CS)......Page 574
12.6.2 Metyrapone Test for Central Hypoadrenalism (CH)......Page 576
12.7.1 Radiographic Absorptiometry ( RA) of Hand Bones......Page 577
12.8.1 Human Chorionic Gonadotropin ( hCG): 15- Day Multiple- Injection hCG Stimulation Test in Boys with Intraabdominal Testes......Page 578
12.9.1 Dexamethasone Suppression Test ( DST) Combined with Gonadotropin- Releasing Hormone ( GnRH) Agonist Stimulation for Determination of the Source of Androgen Production in Females......Page 580
12.9.2 Clomiphene Challenge Test (CCT) for Ovulatory Failure......Page 583
12.9.3 Assessment of Female Sexuality in the Menopause Transition: Use of the Short Personal Experiences Questionnaire ( SPEQ)......Page 584
12.10.1 Serotonin ( 5- Hydroxytryptamine) in Urine and Platelets: Tests in Carcinoid Tumor Patients......Page 585
Appendix 1. Questionnaires......Page 587
Q1.1......Page 588
Q5.1......Page 590
Q5.3......Page 591
Q5.4......Page 592
Q8.1......Page 593
Q8.2......Page 594
Q 9.1......Page 595
Q11.1......Page 596
Q12.1......Page 599
SCP-1. Urine Sample Collection: Patient Instructions......Page 601
SCP-2. Saliva Sample Collection: Patient Instructions......Page 602
SCP-4. Blood Sample Collection Protocol: Growth Hormone (GH) Testing......Page 603
SCP-5. Blood Sample Collection Protocol: Bilateral Inferior Petrosal Sinus Sampling (BIPSS)......Page 604
SCP-7. Blood Sample Collection Protocol and Report Form: Adrenal Vein Sampling......Page 605
SCP-9. Blood Sample Collection Protocol: Measurement of Testosterone in Blood......Page 607