Laboratory Tests For Endocrinology

Adrenocorticotrophic Hormone (ACTH, Corticotropin)
Normal Findings
Adult/Elderly:
Female: 19 years and older: 6-58 pg/mL
Male: 19 years and older: 7-69 pg/mL
Children:
Male and Female: 10-18 years: 6-55 pg/mL
Male and Female: 1 week-9 years: 5-46 pg/mL
INDICATIONS
The serum ACTH study is a test of anterior pituitary gland function that affords the greatest insight into
the causes of either Cushing syndrome (overproduction of cortisol) or Addison disease (underproduction of
cortisol)
INTERFERRING FACTORS
Increase levels of cortisol through elevated ACTH
• Stress
• Menses
• Pregnancy
• Recently administered radioisotope scans can affect levels measured by radioimmunoassay or
immunoradiometry
• Drugs – aminoglutethimide, amphetamines, estrogens, ethanol, insulin, levodopa, metyrapone,
spironolactone, and vasopressin.
• Exogenously administered corticosteroids decrease ACTH.
PROCEDURE AND PATIENT CARE

Before
• Explain the procedure to the patient
• Nothing by mouth status after midnight the day of the test
• Evaluate the patient for stress factors that could invalidate the results
• Evaluate the patients for sleep pattern abnormalities
• Assess patient for self-administration of drugs that could affect test results
During
• Collect a venous blood sample in a lavender (EDTA) or pink top (K2 EDTA) tube or as required by your
reference laboratory
• Chill the blood tube to prevent enzymatic degradation of ACTH.
After
• Place the specimen in ice water and send it to the chem lab ASAP. ACTH is a very unstable peptide in
plasma and should be stored at -20 degrees Celsius to prevent artificially low values.
• Apply pressure to venipuncture site and assess for bleeding.
TEST RESULTS AND CLINICAL SIGNIFICANCE

Increased Levels Decreased Levels
Addison disease Secondary adrenal insufficiency
Adrenogenital syndrome (congenital Hypopituitarism

adrenal hyperplasia)
Adrenal Adenoma or Carcinoma
Cushing disease (pituitary
Cushing syndrome
dependent adrenal hyperplasia)
Exogenous steroid administration
Ectopic ACTH syndrome
Stress
Estrogen Fraction (Estriol Excretion, Estradiol, Estrone)
Normal Findings
Serum Urine mcg/24 hr

Estradiol <15pg/mL 0-6
Child 10-50 pg/mL 0-6
Adult male
Adult female
Follicular phase 20-350 pg/mL 0-13
Midcycle peak 150-750pg/mL 4-14
Luteal phase 30-450 pg/mL 4-10
Postmenopausal <20pg/mL 0-4
Estriol
Male or child N/A 1-11
Adult female
Follicular phase N/A 0-14
Ovulatory phase N/A 13-54
Luteal phase N/A 8-60
Postmenopausal N/A 0-11
Pregnant
1ST trimester <38 ng/mL 0-800
nd
2 trimester 38-140 ng/mL 800-12000
3rd trimester 31-460 ng/mL 5000-12000
Total Estrogen
Male or Child <10 years N/A 4-25
Female not pregnant N/A 4-60
Female pregnant
1ST trimester N/A 0-800
2nd trimester N/A 800-5000
rd
3 trimester N/A 5000-50000
*rising estriol levels indicate normal fetal growth
INDICATIONS
Estrogen measurements are used to evaluate sexual maturity, menstrual problems, and fertility problems in
females. This test is also used in the evaluation of males with gynecomastia or feminization syndromes. in
pregnant women it is used to indicate Fetal-placental health. In patients with estrogen producing tumors it can be
used as a tumor marker.
• Recent administration od radioisotopes may alter test results if RIA methods are used.
• Glycosuria and urinary tract infections can increase urine estriol levels
• Drugs that may increase levels include adrenocorticosteroids, ampicillin, estrogen containing drugs,
phenothiazines, and tetracyclines
• Drugs that may decrease levels include clomiphene

Before
• If the patient is going to collect the 24-hour urine specimen at home, give her the collection bottle
(with a preservative, usually boric acid) and instruct to keep the urine refrigerated
• Tell the patient that no food or fluid restrictions are needed
During
Blood
• Collect a venous blood sample in red top tube
24-Hour Urine
o instruct the patient to begin the 24-hour urine collection after voiding. Discard the initial
specimen and start the 24-hour collection at that point
o collect all urine passed during the next 24 hours, make sure the patient knows where to store the
urine container.
o keep the specimen on ice or refrigerated during the 24-hour collection period
o indicate the starting time on the urine container
o instruct the patient to void before defecating so that the urine is not contaminated by feces.
o encourage the patient to drink fluids during the 24 hours
After
• Transport the specimen promptly

Increased Levels
Feminization syndromes
Precocious puberty
Ovarian tumor
Testicular tumor
Adrenal tumor (Gonadal tumors)
Normal pregnancy
Hepatic Cirrhosis
Liver Necrosis
Hyperthyroidism
Decreased Levels
Turner syndrome
Hypopituitary syndrome
Primary and Secondary hypogonadism
Stein-Leventhal syndrome
Menopause
Anorexia nervosa
Glucagon
Normal Findings
50-100 pg/mL or 50-100 ng/L (SI units)
INDICATIONS
This is a direct measurement of glucagon in the blood. It is used to diagnose a gucagonoma. It is also useful in the
evaluation of some diabetic patients. Finally, pancreatic function can be investigated with the use of this test.
• this test result may be invalidated if a patient has undergone a radioactive scan within the previous 48
hours and glucagon is measured by RIA. Administration of radionuclides can affect the results.
• Levels may be elevated after prolonged fasting, stress or moderate to intense exercise
• Drugs that may cause increased levels: Amino acids (arginine), cholecystokinin, danazol, gastrin,
glucocorticoids, insulin, and nefedipines
• drugs that may cause decreased levels: atenolol, propranolol, and secretin

Before
• Fasting is necessary for 10-12 hours before the test. Only water is permitted
During
Blood
• Collect a venous blood sample in lavender top tube
After
• Transport the specimen promptly on ice

Increased Levels
Familial hyperglucagonemia
Glucagonoma
Dabetes Mellitus
Chronic Renal Failure
Sever stress, including infection, burns, surgery, and acute hypoglycemia
Acromegaly
Hyperlipidemia
Acute pancreatitis
Pheochromocytoma
Decreased Levels
Idiopathic glucagon deficiency

DM
Cystic fibrosis
Chronic Pancreatitis
Post-pancreatectomy
Cancer of pancreas
Growth Hormone (GH, HGH, SH)
Normal Findings
Men: <5ng/mL or<5 mcg/L (SI Units)
Women: <10ng/mL or <10mcg/L
Children:
Newborn: 5-23ng/mL
1 week: 2-27 ng/mL
1-12 mos: 2-10ng/mL
>1 year female: 0-10 ng/mL
>1 year male: 0-6 ng/mL
INDICATIONS
This test is used to identify GH deficiency in adolescent with short stature, delayed sexual maturity or other
growth deficiencies. it is also used to document the diagnosis of GH excess in patients with gigantism or
acromegaly. GH is used to identify and follow patients with ectopic growth hormone produced by neoplasms.
Finally it is often used as a screening test for pituitary hypofunction.
• GH secretion is increased by stress, exercise, diet, and low blood glucose levels
• Drugs that may cause increased levels: amphetamines, arginine, dopamine, estrogens, glucagon,
histamine, insulin, levodopa, methyldopa and nicotinic acid
• Drugs that may cause decreased levels: corticosteroids and phenothiazines

Before
• The patient should not be physically or emotionally stressed, because this can increase GH levels
• it is preferred that patients are rested and are kept on NPO status after midnight the morning of the
test. Water is permitted
During
Growth Hormone
• Collect a venous blood sample in red top tube
Growth Hormone Suppression Test
• Obtain peripheral venous access with NSS
• Obtain baseline GH and glucose levels as described above
• Administer the prescribed glucose dose
• Obtain GH and Glucose levels at 10,60 and 120 minutes after glucose ingestion
After
• Indicate the patients fasting status and time of blood collection. sed to lab ASAP due to 20-25 min
half-life

Increased Levels
Gigantism Hypoglycemia
Acromegaly Starvation
Anorexia nervosa Deep sleep state
Stress Exercise
Major surgery Hypoglycemia
Decreased Levels
GH defieciency Hyperglycemia
Pituitary Insufficiency Failure to thrive
Dwarfism Delayed Sexual maturity
Growth Hormone Stimulation (GH Provocation, Insulin tolerance, Arginie)
Normal Findings
GH levels >10 ng/mL or >10 mcg/L (SI unit)
INDICATIONS
The GH stimulation test is used to identify patients who are suspected of having a GH deficiency. A normal patient
can have low GH levels, but if GH is still low after GH stimulation, the diagnosis can be more accurately made.
CONTRAINDICATIONS
• Epileptic patients, cause seizures can be induced by hypoglycemia
• patients with cerebrovascular disease
• patients with MI
POTENTIAL COMPLICATIONS
• Hypoglycemia may be so significant and severe as to cause ketosis, acidosis and shock.

Before
• it is preferred that patients are kept on NPO status after midnight the morning of the test.
During
Note the following procedural steps
• A saline lock IV line is inserted for the administration of medications and withdrawal of frequent
blood samples.
• Baseline blood levels are obtained for GH, glucose and cortisol
• Venous samples for GH are obtained 0, 60 and 90 minutes after injection of arginine and or
insulin/glucagon
• Blood glucose levels are monitored at 15-30 minute intervals with the glucometer The blood
sugar should drop to less than 40 mg/dL for effective measurement of GH reserve
• Ice chips are often given during the test for patient comfort
After
• after the test give the patient cookies and punch or an IV glucose infusion
Decreased Levels
GH defieciency
Pituitary Deficiency

Laboratory Tests For Endocrinology

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Adrenocorticotrophic Hormone (ACTH, Corticotropin)

PROCEDURE AND PATIENT CARE

TEST RESULTS AND CLINICAL SIGNIFICANCE

Addison disease Secondary adrenal insufficiency

Adrenogenital syndrome (congenital Hypopituitarism

Serum Urine mcg/24 hr

PROCEDURE AND PATIENT CARE

TEST RESULTS AND CLINICAL SIGNIFICANCE

PROCEDURE AND PATIENT CARE

TEST RESULTS AND CLINICAL SIGNIFICANCE

Idiopathic glucagon deficiency

PROCEDURE AND PATIENT CARE

TEST RESULTS AND CLINICAL SIGNIFICANCE

PROCEDURE AND PATIENT CARE

TEST RESULTS AND CLINICAL SIGNIFICANCE

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