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Adrenocorticotropic Hormone (ACTH, Corticotropin), plasma/serum

Clinical Significance:
Adrenocorticotropic Hormone (ACTH) is secreted by the anterior pituitary gland. The major effects of ACTH are the regulation of the adrenal gland to release glucocorticoids primarily cortisol, mineralocorticoids including aldosterone, and sex steroids to supplement those produced by the gonads. ACTH secretion is controlled by corticotropin releasing factor from the hypothalamus and by negative feedback control by the glucocorticoids. Increased levels of ACTH lead to hypercortisolism, hypertension, edema and increased pigmentation. Elevated levels of ACTH are seen in Cushing's syndrome, ectopic ACTH tumors, adrenal atrophy, adrenal adenoma or carcinoma, congenital adrenal hyperplasia, and stress. Decreased levels occur in Addison's disease, secondary adrenal hyperplasia, hypopituitarism, hypothalamic failure and in patients on glucocorticoid therapy. Urine ACTH measurements integrate ACTH secretion over a 24 hour period minimizing the effect of diurnal variation found in plasma or serum levels.

Reference Range:
10 - 75 pg/mL

Procedure:
ACTH is measured by radioimmunoassay.

Patient Preparation:
Patient should be fasting 10-12 hours, if possible, prior to the collection of specimen. Cortrosyn, dexamethasone, corticosteroids, and other medications that may affect pituitary secretion should be discontinued, if possible, for at least 48 hours prior to collection of specimen. Morning specimens are preferred.

Specimen Collection:
5ml of serum, EDTA plasma or heparinzed plasma should be collected and separated as soon as possible and frozen prior to shipping. No special preservatives are required. Specimens should be frozen.

Shipping Instructions:
ACTH specimens should be shipped frozen in dry ice.

References:
1. H Hohtari, K Salminen-Lappalainen, and T Laatikainen. Response of Plasma Endorphins, Corticotropin, Cortisol, and Luteinizing Hormone in the Corticotropin-Releasing Hormone Stimulation Test in Eumenorrheic and Amenorrheic Athletes. Fertility and Sterility 55: 276-280, 1991.

2. E Carmina, JH Levin, G Malizia, and RA Lobo. Ovine Corticotropin-Releasing Factor and Dexamethasone Responses in Hyperandrogenic Women. Fertility and Sterility 54: 251-254, 1990.

 

Adrenocorticotropic Hormone(ACTH, Corticotropin), urine

Clinical Significance:
Adrenocorticotropic Hormone (ACTH)  is secreted by the anterior pituitary gland.    The major effects of ACTH are the regulation of the adrenal gland to release glucocorticoids primarily cortisol, mineralocorticoids including aldosterone, and sex steroids to supplement those produced by the gonads.  ACTH secretion is controlled by corticotropin releasing factor from the hypothalamus and by negative feedback control by the glucocorticoids.  Increased levels of ACTH lead to hypercortisolism, hypertension, edema and increased pigmentation.  Elevated levels of ACTH are seen in Cushing's syndrome, ectopic ACTH tumors, adrenal atrophy, adrenal adenoma or carcinoma, congenital adrenal hyperplasia, and stress.  Decreased levels occur in Addison's disease, secondary adrenal hyperplasia, hypopituitarism, hypothalamic failure and in patients on glucocorticoid therapy.  Urine ACTH measurements integrate ACTH secretion over a 24 hour period minimizing the effect of diurnal variation found in plasma or serum levels.

Reference Range:
Up to 25 ng/24 hours

Procedure:
ACTH is measured by radioimmunoassay following extraction of ACTH from the specimen.

Patient Preparation:
Cortrosyn, dexamethasone, corticosteroids, and other medications that may affect pituitary secretion should be discontinued, if possible, for at least 48 hours prior to collection of specimen.

Specimen Collection:
10 ml of a 24 hour urine collection should be submitted for analysis. No special preservatives are required. Store specimen refrigerated during collection. Specimens should be frozen prior to shipping. Minimum specimen size is 5 ml.

Shipping Instructions:
Ship specimens frozen in dry ice. Provide the total volume per 24 hours.

References:
1. H Hohtari, K Salminen-Lappalainen, and T Laatikainen.   Response of Plasma Endorphins, Corticotropin, Cortisol, and Luteinizing Hormone in the Corticotropin-Releasing Hormone Stimulation Test in Eumenorrheic and Amenorrheic Athletes.  Fertility and Sterility 55: 276-280, 1991.

2. E Carmina, JH Levin, G Malizia, and RA Lobo.  Ovine Corticotropin-Releasing Factor and Dexamethasone Responses in Hyperandrogenic Women.  Fertility and Sterility 54: 251-254, 1990.

 

Aldosterone, urine*

* Test available on a research basis only. Contact ISI for details.

 

Aldosterone-18-Glucuronide, urine*

* Test available on a research basis only. Contact ISI for details.

 

Amylin*

* Test available on a research basis only. Contact ISI for details.

 

Amyloid ß-Protein

Clinical Significance:
Amyloid B-Protein is a peptide that ranges in size from 28-43 amino acids. Most fragments have the same biological activity as the whole molecule. Amyloid B-Protein causes vascular and cerebral plaque formation. Insoluble fibrils of Amyloid B-Protein accumulate in adrenal blood vessels and un neutritic plaques. Occurrence of plaques are present in normal brain but in a much less dense degree as in Alzheimer's disease patients. Amyloid B-Protein is also found in elevated levels in patients with Down's Syndrome. Substance P has been found to counteract the effects of Amyloid B-Protein.

Reference Range:
20- 80 pg/mL

Procedure:
Amyloid Protein is measured by a specific radioimmunoassay procedure that measures all fragments from 1-40 amino acids.

Patient Preparation:
No specific patient preparation is required as Amyloid B-Protein is increased by the quantity and density of plaques.

Specimen Collection:
3mL EDTA plasma should be collected and separated as soon as possible. Freeze EDTA plasma immediately after separation. Minimum specimen size is 1 ml.

Special Specimens:
For tumor/tissue and various fluids (i.e. CSF, peritoneal, synovial, etc.) contact the Institute for requirements and special handling.

Shipping Instructions:
Ship specimens frozen in dry ice.

References:
1. Whitson JS, Selkoe DJ and Cotman CW. Amyloid B-Protein enhances the survival of hippocampal neurons in vitro. Science 243: 1488-1490, 1989.

2. Yankner BA, Mesulam M-M. Beta-Amyloid and the pathogenesis of alzheimer's disease. N Eng J Med 325: 1849-1857, 1991.

 

Androstenedione, urine (D-4 Androstenedione)

* Test available on a research basis only. Contact ISI for details.

Androstenediol* (Δ-5 Androstenediol)

* Test available on a research basis only. Contact ISI for details.

Androstenedione* (Δ-4 Androstenedione)

* Test available on a research basis only. Contact ISI for details.

Androsterone*

* Test available on a research basis only. Contact ISI for details.

Androsterone, urine*

* Test available on a research basis only. Contact ISI for details.

Angiotensin I

Clinical Significance
Angiotensin I is a ten amino acid peptide formed by Renin cleavage of Angiotensinogen (Renin Substrate) I.   Angiotensin I has little biological activity except that high levels can stimulate Catecholamine production. It is metabolized to its biologically active byproduct Angiotensin II by Angiotensin Coverting Enzyme (ACE). The formation of Angiotensin I is controlled by negative feedback of Angiotensin II and III on Renin release and by Aldosterone concentration. Levels of Angiotensin I are increased in many types of hypertension. Angiotensin I levels are used to determine Renin Activity. Angiotensin I is excreted directly into the urine.

Reference Range
Up to 25 pg/mL.

Procedure
Angiotensin I is measured by direct radioimmunoassay.

Patient Preparation
Patient should be on a normal sodium diet, 110 mEq. sodium.  Patient should be in a recumbent posture for at least 30 minutes prior to collection of specimen.  Diuretics, mineralocorticoids, glucocorticoids, estrogens, oral contraceptives, and ACTH medications and sodium, potassium, and posture all affect Angiotensin levels.

Specimen Collection
3 ml EDTA plasma should be collected and separated as soon as possible.  Freeze plasma immediately after separation.  Minimum specimen size is 1 ml.

Special Specimens
For tumor/tissue and various fluids (i.e. CSF, peritoneal, synovial, etc.), contact the Institute for requirements and special handling.

Shipping Instructions
Ship specimens frozen in dry ice.

References:
1. van Hooft IMS, Grobbee DE, Derkx FHM, et al.  Renal Hemodynamics and the Renin-Angiotensin-Aldosterone System in Normotensive Subjects with Hypertensive and Normotensive Patients.  N Engl J Med 324:1305-1311, 1991.

2. Oparia S and Haber E. The Renin-Angiotensin System. N Engl J Med 291:389, 1974.

CPT Code: 
Unspecified
Quantitative

Immunoassay  83519

Angiotensin I, urine*

* Test available on a research basis only. Contact ISI for details.

 

Angiotensin II

Clinical Significance
Angiotensin II is an eight amino acid peptide formed by Angiotensin Converting Enzyme (ACE) cleavage of Angiotensin I.   Angiotensin II is metabolized further to Angiotensin III.  Angiotensin II release is controlled by Renin, blood pressure, blood volume, sodium balance and by Aldosterone concentration.  Levels of Angiotensin II are increased in many types of hypertension.  Angiotensin II stimulates the release of Anti-Diuretic Hormone, ACTH, Prolactin, Luteinizing Hormone, Oxytocin and Aldosterone.  Angiotensin II increases vasoconstriction and inhibits tubular resorption of sodium, and can increase endothelial cell growth.

Reference Range
10 - 60 pg/ml.

Procedure:
Angiotensin II is measured by direct radioimmunoassay.

Patient Preparation
Patient should be on a normal sodium diet, 110 mEq. sodium.  Patient should be in a recumbent posture for at least 30 minutes prior to collection of specimen.  Diuretics, mineralocorticoids, glucocorticoids, estrogens, oral contraceptives, and ACTH medications and sodium, potassium, and posture all affect Angiotensin levels.

Specimen Collection
3 ml EDTA plasma should be collected and separated as soon as possible.  Freeze plasma immediately after separation.  Minimum specimen size is 1 ml.

Special Specimens
For tumor/tissue and various fluids (i.e. CSF, peritoneal, synovial, etc.), contact the Institute for requirements and special handling.

Shipping Instructions
Ship specimens frozen in dry ice.

References
1. van Hooft IMS, Grobbee DE, Derkx FHM, et al.  Renal Hemodynamics and the Renin-Angiotensin-Aldosterone System in Normotensive Subjects with Hypertensive and Normotensive Patients.  N Engl J Med 324:1305-1311, 1991.

2. Kosunin KJ and Pakarinen A.  Correlations Between Plasma Renin Activity, Angiotensin II, and Aldosterone.  J Clin Endocrinol Metab. 47:665,1978.

CPT Code: 

Angiotensin II 82163

Angiotensinogen*

* Test available on a research basis only. Contact ISI for details.

Anti-Diuretic Hormone (ADH, Vasopressin)

Clinical Significance
Anti-Diuretic Hormone is a hormone released by the neurohypophysis.  It has potent anti-diuretic and vasopressor activities.  It is released with its carrier protein Neurophysin.  Anti-Diuretic Hormone measurement gives a good indicator of posterior pituitary function and activity.  Secretion of Anti-Diuretic Hormone is primarily controlled by the osmotic pressure of the plasma.  Blood pressure, blood volume, nausea, hypoglycemia, and Angiotensin are other factors regulating Anti-Diuretic Hormone secretion.  The most important function of Anti-Diuretic Hormone is the reduction of the rate of urine output. 

Reference Range
Up to 7 pg/ml

Procedure
Anti-Diuretic Hormone is measured by direct radioimmunoassay.

Patient Preparation
Patient should not be on diuretics, hypertension, or blood pressure medication, if possible, for at least 48 hours prior to collection of specimen.

Specimen Collection
3 ml serum or plasma EDTA should be collected and separated as soon as possible.  Store specimens frozen.  Minimum specimen size is 1 ml. Whole blood not acceptable specimen type.

Special Specimens
For tumor/tissue and various fluids (i.e., CSF, peritoneal, synovial, etc.), contact the Institute for requirements and special handling.

Shipping Instructions
Ship specimens frozen in dry ice.

References
1. Gavras H.  Role of Vasopressin in Clinical Hypertension and Congestive Cardiac Failure:  Interaction with the Sympathetic Nervous System.  Clin Chem 37:1828-1830, 1991.

2. H Gavras, I Gavras.  Salt-Induced Hypertension: The Interactive Role of Vasopressin and of the Sympathetic Nervous System.  J Hypertens 7: 601-606,1989.

CPT Code: 
Unspecified
Quantitative
Immunoassay  83519

 

Anti-Diuretic Hormone (ADH, Vasopressin), urine

Clinical Significance:
Anti-Diuretic Hormone is a hormone released by the neurohypophysis.  It has potent anti-diuretic and vasopressor activities.  It is released with its carrier protein Neurophysin.  Anti-Diuretic Hormone measurement gives a good indicator of posterior pituitary function and activity.  Secretion of Anti-Diuretic Hormone is primarily controlled by the osmotic pressure of the plasma.  Blood pressure, blood volume, nausea, hypoglycemia, and Angiotensin are other factors regulating Anti-Diuretic Hormone secretion.  Urinary Anti-Diuretic Hormone levels are increased by water deprivation and increased by hydration.  Urinary Anti-Diuretic Hormone levels are often increased in patients with essential hypertension, Kwashiorkor disease and edema.

Reference Range:
Hydrated:                                        10 -  50 ng/24 hours
Dehydrated:                                  100 - 450 ng/24 hours

Procedure:
Anti-Diuretic Hormone is measured by direct radioimmunoassay.
 
Patient Preparation:
Patient should not be on diuretics, hypertension, or blood pressure medication, if possible, for at least 48 hours prior to collection of specimen.

Specimen Collection:
10 ml of a 24 hour urine collection should be submitted for analysis. No special preservatives are required. Store specimen refrigerated during collection. Specimens should be frozen prior to shipping. Minimum specimen size is 5 ml.

Shipping Instructions:
Ship specimens frozen in dry ice. Provide the total volume per 24 hours.

References:
1. H Gavras.  Role of Vasopressin in Clinical Hypertension and Congestive Cardiac Failure:  Interaction with the Sympathetic Nervous System.  Clinical Chemistry 37: 1828-1830, 1991.

2. SG Srikantia and M Monanram.  Antidiuretic Hormone Values in Plasma and Urine of Malnourished Children.  Journal of Clinical Endocrinology and Metabolism 31: 312, 1970.

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