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Profiles

Commonly Ordered Profiles from C.U.R.E.® handbook
Adrenal Challenge Protocol: ACTH Stimulation (Rapid and Prolonged)
Androgenic Screen *
Estrogenic Profile: General Screen
Estrogenic Profile: Comprehensive Screen
Gastrin Challenge Protocol: Secretin Stimulation

Congenital Adrenal Hyperplasia (CAH) Profiles
3β-Hydroxysteroid Dehydrogenase Deficiency *
11β-Hydroxylase Deficiency *
17α-Hydroxylase Deficiency *
21&alpha- Hydroxylase Deficiency *

Profiles from NET Handbook 3rd Edition
Adenocarcinoma of the Pancreas
Bronchospasm Profile
Carcinoid Follow-Up Profile
Diabetes Type 1 Screen
Diabetes Type 2 Screen
Assessment for Risk Factors for Atherosclerotic Vascular Disease
Diabetes Complications
Pseudogastrinoma Syndrome (Atrophic Gastritis With Loss of Acid Inhibition of Gastrin)
Diarrhea Syndrome Tests
Dumping Syndrome
Flushing Syndrome Tests
Gastrinoma (Zollinger-Ellison) Screen
Generic Follow-Up Profiles
Genetic Studies
GI-Neuroendocrine Tests
Hypoglycemia/Insulinoma
Interleukins Individually and as a Profile (IL-1 through IL-18)
Lipoprotein Profile(Total Cholesterol, HDL-C, LDL-C, Particle Size, and Triglycerides)
MEN Syndrome Screen
Metabolic Syndrome Profile
Oxidative/Nitrosative Stress Profile
Pancreatic Function Screen
Polycystic Ovary Syndrome (PCOS) Screen

Adenocarcinoma of the Pancreas

Ductal adenocarcinoma of the pancreas accounts for 90% of pancreatic cancers. Imaging investigation using CT, with or without fine needle aspiration and assays for tumor and genetic markers, is the primary approach in evaluating patients with symptoms suggestive of pancreatic cancer. Most tumor markers have limited sensitivity and specificity.

BLOOD

  • CA 19-9
  • CEA

OTHER RELATED TESTS

  • Islet amyloid polypeptide (IAPP)
  • Glucose
  • Glucose tolerance test
  • KRAS mutation in pancreatic juice

Patient Preparation

None for blood test.

Specimen Collection

BLOOD
Collect 10 mL serum or EDTA plasma and separate as soon as possible. Freeze serum or plasma immediately after separation. Minimum specimen size is 2 mL.

Shipping Instructions

Specimens should be shipped frozen in dry ice.

References

  1. Sawabu N, Watanabe H, Yamaguchi Y, et al. Serum tumor markers and molecular biological diagnosis in pancreatic cancer.
    Pancreas. Apr;28(3):263-7, 2004.
  2. Saisho H, Yamaguchi T. Diagnostic imaging for pancreatic cancer: computed tomography, magnetic resonance imaging, and positron emission tomography. Pancreas. Apr;28(3):273-8, 2004.
  3. Chari ST, Klee GG, Miller LJ, et al. Islet amyloid polypeptide is not a satisfactory marker for detecting pancreatic cancer.
    Gastroenterology. Sep;121(3):640-5, 2001.
  4. Rosty C, Goggins M. Early detection of pancreatic carcinoma. Hematol Oncol Clin North Am. Feb;16(1):37-52, 2002.

Bronchospasm Profile

This profile is useful for ruling out a neuroendocrine tumor cause of bronchospasm.

BLOOD

  • Prostaglandin D2
  • Histamine
  • Serotonin
  • Substance P
  • VIP
  • CGA
  • Pancreastatin
  • Serum protein immunoelectrophoresis, IgE

URINE

  • 5-HIAA
  • 5-HTP
  • VMA
  • Tryptase

Patient Preparation

The patient should fast for 10 to 12 hours prior to collection of specimen. Alkali antacid medications should be discontinued, if possible, for at least 24 hours prior to collection. PPIs and H2 blockers should be discontinued for 72 hours or more prior to collection and patients monitored closely. For 48 hours prior to sample collection, patients should not be treated with the following medications, if possible:

  • Insulin or oral medications that influence insulin production or secretion
  • Aspirin, indomethacin, or anti-inflammatory medications
  • Antacids or medications affecting intestinal motility

Patients should not partake of the following foods for 48 hours prior to collection of urine for measurement of 5-HIAA and 5-HTP:

  • Red wine
  • Cheese
  • Hot dogs
  • Chocolates
  • Vanilla-containing foods (e.g., ice cream)
  • Custard
  • Pineapple, kiwi, bananas, or cassava
  • Specimen Requirements

BLOOD

Collect 10 mL EDTA plasma in special tube containing the Z-tubeTM Preservative and separate as soon as possible. Freeze plasma immediately after separation. Special Z-tubeTM Preservative is available from ISI. Minimum specimen size is 5 mL.

URINE

See complete urine collection instructions in the introduction to Chapter 3.

Shipping Instructions

Specimens should be shipped frozen in dry ice.

Further Diagnosis

Refer patient for allergy testing.

Reference

  1. Chughtai TS, Morin JE, Sheiner NM, et al. Bronchial Carcinoid-20 years experience defines a selective surgical approach. Surgery. Oct;122(4):801-8, 1997. ©2006 Inter Science Institute. This profi

Carcinoid Follow-Up Profile

BLOOD

Measure every 3 months or immediately following a therapeutic intervention.

  • CGA
  • Serotonin
  • Pancreastatin

If on Sandostatin LAR® for at least three months, consider (measure immediately prior to the LAR® injection):

  • Octreotide

For increase in tumor growth or rise in biomarkers, consider other amines, peptides, and markers found to be elevated in the screening evaluation profile, including the following:

  • Substance P
  • NKA

URINE

Measure every 3 months or immediately following a therapeutic intervention.

  • 5-HIAA (or 5-HTP if 5-HIAA is negative and 5-HTP is positive at initial screening)

Patient Preparation

Patient should fast overnight prior to collection of blood specimens. Because of the diurnal variation of serotonin secretion, morning specimens are preferred. For the pancreastatin assay, patients should be advised to discontinue medications that affect insulin levels, if possible, for 48 hours prior to collection. Patients should not partake of the following foods for 48 hours prior to collection of urine for measurement of 5-HIAA and 5-HTP:

  • Red wine
  • Cheese
  • Hot dogs
  • Chocolates
  • Vanilla-containing foods (e.g., ice cream)
  • Custard
  • Pineapple, kiwi, bananas, cassava

Specimen Requirements

BLOOD

Collect 10 mL EDTA plasma in special tube containing the Z-tubeTM Preservative and separate as soon as possible. Freeze plasma immediately after separation. Special Ztube TM Preservative is available from ISI. Minimum specimen size is 5 mL. For serotonin analysis, use a yellow-topped tube containing 75 mg ascorbic acid (vitamin C). Separate and freeze plasma immediately.

URINE

See complete urine collection instructions in the introduction to Chapter 3.

Important Precaution

For serotonin measurements, avoid hemolysis. Do not use a tourniquet. Handle specimens gently. Use 20-gauge needle. Hemolysis results in spuriously high results.

Shipping Instructions

Specimens should be shipped frozen in dry ice.

References

  1. Oberg K, Kvols L, Caplin M, et al. Consensus report of the use of somatostatin analogs for the management of neuroendocrine tumors of the gastroenteropancreatic system. Ann Oncol. Jun;15(6):966-73, 2004.
  2. Please refer to www.nccn.org, The National Comprehensive Cancer Network clinical practice guidelines in oncology.
    ©2006 Inter Science

Diabetes Type 1 Screen

General Screen

General screen tests may be ordered from the local laboratory in each physician's area.

BLOOD

  • Glucose
  • Fasting
  • Postprandial
  • Glucose tolerance test

Specific Screening

Specific screening tests are available from ISI.

BLOOD

  • Insulin
  • C-peptide
  • Anti-insulin antibody
  • Islet cell antibody
  • GAD antibodies (GAD 65, GAD 67)

Patient Preparation

Patient should fast for 10 to 12 hours prior to collection of specimen. Patient should not be on any insulin therapy or taking medications that influence insulin levels, if possible, for at least 48 hours prior to collection of specimen.

Specimen Collection

Collect 10 mL serum or EDTA plasma and separate as soon as possible. Freeze serum or plasma immediately after separation. Minimum specimen size is 2 mL.

Shipping Instructions

Specimens should be shipped frozen in dry ice.

References

  1. Skyler JS. New diabetes criteria and clinical implications. Drugs. 58 Suppl 1:1-2, discussion 75-82, 1999.
  2. Barker JM, Goehrig SH, Barriga K, et al. DAISY study. Clinical characteristics of children diagnosed with type 1 diabetes through intensive screening and follow-up. Diabetes Care. Jun;27(6):1399-404, 2004.
  3. Devendra D, Liu E, Eisenbarth GS. Type 1 diabetes: recent developments. BMJ. 27 Mar;328(7442):750-4, 2004.
  4. Eisenbarth GS. Prediction of type 1 diabetes: the natural history of the prediabetic period. Adv Exp Med Biol. 552:268-90, 2004.
  5. Pugliese A, Eisenbarth GS. Type 1 diabetes mellitus of man: genetic susceptibility and resistance. Adv Exp Med Biol. 552:170-203, 2004.
  6. Krischer JP, Cuthbertson DD, Yu L, et al. Screening strategies for the identification of multiple antibody-positive relative of individuals with type 1 diabetes. J Clin Endocrinol Metab. Jan;88(1):103-8, 2003.
  7. Atkinson MA, Eisenbarth GS. Type 1 diabetes: new perspectives on disease pathogenesis and treatment. Lancet. 21 Jul;358(9277):221-9, 2001.
  8. Bingley PJ, Bonifacio E, Ziegler AG, et al. Proposed guidelines on screening for risk of type 1 diabetes. Diabetes Care.
    Feb;24(2):398, 2001.

©2006 Inter Science Institute. This profile of assays for diagnosis and monitoring of diabetes has been copyrighted.

Diabetes Type 2 Screen

Predictors of the Development of Type 2 Diabetes

BLOOD

  • Lipoprotein profile (either VAPTM or nuclear magnetic resonance [NMR] method)
  • Triglycerides
  • Total cholesterol
  • HDL-C
  • Low-density lipoprotein (LDL)-C
  • LDL-C particle size
  • Peptides and cytokines
  • Insulin
  • IL-6
  • C-peptide
  • C-reactive protein (highly sensitive for macrovascular disease)

Patient Preparation

Patient should fast for 10 to 12 hours prior to collection of specimen. Patient should not be on aspirin, pain killers, corticosteroids, indomethacin, or anti-inflammatory medications for at least 48 hours prior to collection of specimen.

Specimen Collection

Collect 10 mL serum or EDTA plasma and separate as soon as possible. Freeze plasma immediately after separation. Specimens should not be thawed. Minimum specimen size is 6 mL.

Shipping Instructions

Specimens should be shipped frozen in dry ice.

Assessment for Risk Factors for Atherosclerotic Vascular Disease

BLOOD

  • Lipoprotein profile (either VAPTM or NMR method)
  • Triglycerides
  • Total cholesterol
  • HDL-C
  • LDL-C
  • LDL-C particle size
  • Arachidonic acid/EPA ratio
  • Glucose
  • HBA1c
  • Fibrinogen
  • PAI-1
  • Thromboglobulin
  • Homocysteine
  • C-reactive protein
  • IL-6
  • Thromboxane B2

Patient Preparation

Patient should not be on aspirin, pain killers, corticosteroids, indomethacin, or anti-inflammatory medications for at least 48 hours prior to collection of specimens. Fasting patients may have elevated levels of thromboxane B2.

Specimen Collection

BLOOD

Collect 10 mL serum or EDTA plasma and separate as soon as possible. Freeze plasma immediately after separation. Specimens should not be thawed. Minimum specimen size is 6 mL.

Shipping Instructions

Specimens should be shipped frozen in dry ice.

References

  1. Schriger DL, Lorber B. Lowering the cut off point for impaired fasting glucose: where is the evidence? Where is the logic? Diabetes Care. Feb; 27(2):592-601, 2004.
  2. Genuth S, Alberti KG, Bennett P, et al. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care. Nov;26(11):3160-7, 2003.
    VAPTM Atherotech, Birmingham, AL 35211

©2006 Inter Science Institute. This profi le of assays for diagnosing risk factors for atherosclerotic vascular disease assessment has been copyrighted.

Diabetes Complications

Gastroparesis or Brittle Diabetes

BLOOD

  • Gastrin
  • B12
  • Gastric parietal cell antibody
  • Pancreatic polypeptide (consider meal-stimulated PP measurements or insulinstimulated

PP measurements; see Chapter 5, Meal (Sham Feeding) Stimulation for Vagal Integrity)

  • TSH (thyrotoxicosis)
  • GH (anorexia nervosa)
  • Cortisol (anorexia nervosa, Addison's disease)
  • IGF-1 (anorexia nervosa)
  • Catecholamines, VMA, and metanephrines (i.e., pheochromocytoma panel)

Patient Preparation

Patient should fast for 10 to 12 hours prior to collection of specimen.

Specimen Collection

Collect 10 mL serum or EDTA plasma and separate as soon as possible. Freeze serum or plasma immediately after separation. Minimum specimen size is 1 mL.

Shipping Instructions

Specimens should be shipped frozen in dry ice.

References

  1. Johnson DA, Vinik AI. Gastrointestinal Disturbances. In: Lebovitz HE, ed. Therapy for Diabetes Mellitus and Related Disorders, 4th ed. Alexandria, VA: American Diabetes Association, Inc.; 2004:388-405.
  2. Zimmet P, Alberti KG, Shaw J. Global and societal implications of the diabetes epidemic. Nature. 414:782-7, 2004.
  3. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA. 287:356-9, 2002.
  4. Carey VJ, Walters EE, Colditz GA, Solomon CG, Willett WC, Rosner BA, Speizer FE, Manson JE. Body fat distribution and risk of non-insulin-dependent diabetes mellitus in women. The Nurses' Health Study. Am J Epidemiol. 1 Apr;145(7):614-9, 1997.
  5. Assmann G, Carmena R, Cullen P, Fruchart JC, Jossa F, Lewis B, Mancini M, Paoletti R. Coronary heart disease: a worldwide view. International Task Force for the Prevention of Coronary Heart Disease. Circulation. 2 Nov;100(18):1930-8, 1999.
  6. Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 348:383-93, 2003.
  7. Vinik A, Flemmer M. Diabetes and macrovascular disease. J Diabetes Complications. 16:235-45, 2002.
  8. National Diabetes Data Group. Diabetes in America, 2nd ed. NIH Publication No. 95-1468. Bethesda, MD: National Diabetes Data Group of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health; 1995.
  9. National Eye Institute. Facts about diabetic retinopathy. Available at: http://www.nei.nih.gov/health/diabetic/retinopathy.asp. Accessed 7 June 2005.
  10. American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care. 25:213-29, 2002.
  11. American Diabetes Association. Diabetic retinopathy. Diabetes Care Suppl. 25:S90-3, 2002.
  12. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulindependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med. 30 Sep;329(14):977-86, 1993.
  13. Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, Hadden D, Turner RC, Holman RR. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 321:405-12, 2000.
  14. Vinik AI, Park TS, Stansberry KB, Pittenger GL. Diabetic neuropathies. Diabetologia. 43:957-73, 2000.
  15. Vinik AI, Erbas T. Recognizing and treating diabetic autonomic neuropathy. Cleve Clin J Med. 68:928-44, 2001.

©2006 Inter Science Institute. This profile of assays for diagnosis and monitoring of diabetes complications has been copyrighted.

Pseudogastrinoma Syndrome (Atrophic Gastritis With Loss of Acid Inhibition of Gastrin)

BLOOD

  • Gastrin (elevated)
  • Secretin stimulation test of gastrin

If fasting gastrin level is above 100 pg/mL, order a secretin stimulation test. An increase in gastrin level greater than 100 pg/mL above the normal range denotes a gastrinoma.

  • Chromogranin A (not due to a neuroendocrine tumor)

May be suspected with mean corpuscular volume greater than 100 µm3

  • B12
  • Pepsinogen I and II

Important Precaution

Patients submitted to dynamic challenge should be under the direct and constant supervision of their physician at all times. The doses listed are intended as a guideline only. The actual dose and collection schedule must be approved by the patients physician.

Specimen Collection

Collect 10 mL serum or EDTA plasma and separate as soon as possible. Freeze serum or plasma immediately after separation. Minimum specimen size is 2 mL.

GASTRIC PH

Patient Preparation

Patient should fast 10 to 12 hours prior to collection of specimen. Alkali antacid medications should be discontinued, if possible, for at least 24 hours prior to collection. PPIs and H2 blockers should be discontinued for 72 hours or more prior to collection and patients monitored closely.

Shipping Instructions

Specimens should be shipped frozen in dry ice.

References

  1. Owyang C, Vinik AI. Diabetic pseudo Zollinger-Ellison syndrome. Gastroenterol. 82(5):1144, 1982.
  2. DuFour DR, Gaskin JH, Jubiz WA. Dynamic procedures in endocrinology. In: Becker KL, ed. Principles and Practice of Endocrinology and Metabolism. Philadelphia: JB Lippincott Company; 1990:1762-75.
  3. Alsever RN, Gotlin RW. Handbook of Endocrine Tests in Adults and Children. Chicago: Year Book Medical Publishers, Inc.; 1978.
  4. Feldman M, Schiller LR, Walsh JH, et al. Positive intravenous secretin test in patients with achlorhydria-related hypergastrinemia. Gastroenterol. 93:59-62, 1987.

©2006 Inter Science Institute. This profile of assays for diagnosis and monitoring of pseudogastrinoma syndrome has been copyrighted.

Diarrhea Syndrome Tests

BLOOD

  • VIP
  • Gastrin
  • Gastrin-releasing peptide (bombesin)
  • Calcitonin (MCT)
  • PGD2
  • Histamine
  • CGA
  • Pancreastatin
  • Pancreatic polypeptide
  • PTH and PTHRP if hypercalcemic
  • CGRP and substance P if flushing

URINE

  • 5-HIAA
  • 5-HTP
  • VMA and catecholamines if hypertensive

STOOL

Measurement of stool electrolytes and osmolarity should be done early in the diagnostic evaluation. The presence of an osmolar gap suggests factitious diarrhea. A 72-hour supervised fast with intravenous fluid administration may also help determine if the diarrhea is secretory or infectious.

Patient Preparation

Patient should fast for 10 to 12 hours prior to collection of blood specimen. Antacid medications, antihistamine medications, aspirin, indomethacin, anti-inflammatory medications, and medications affecting motility or pancreatic function should be discontinued, if possible, for at least 48 hours prior to collection. Patients should not partake of the following foods for 48 hours prior to collection of urine for measurement of 5-HIAA and 5-HT:

  • Red wine
  • Cheese
  • Hot dogs
  • Chocolates
  • Vanilla-containing foods (e.g., ice cream)
  • Custard
  • Pineapple, kiwi, bananas, cassava

Specimen Requirements

BLOOD

Collect 10 mL EDTA plasma in a special tube containing the GI Preservative and separate as soon as possible. Freeze plasma immediately after separation. Special GI Preservative tubes are available from ISI. Minimum specimen size is 1 mL. For other assays

URINE

See complete urine collection instructions in the introduction to (Chapter 3).

Shipping Instructions

Specimens should be shipped frozen in dry ice.

References

  1. Vinik AI, Tsai ST, Moattari AR, et al. Somatostatin analogue (SMS 201-995) in the management of gastroenteropancreatic tumors and diarrhea syndromes. Am J Med. 81(6B):23-40, 1986.
  2. Verner JV, Morrison AB. Islet cell tumor and a syndrome of refractory watery diarrhea and hypokalemia. Am J Med. 25(3):374-80, 1958.
  3. Murray JS, Paton RR, Pope CE. Pancreatic tumor associated with flushing and diarrhea. Report of a case. N Engl J Med. 264:436-9, 1961.
  4. Arnold R, Lankisch PG. Somatostatin and the gastrointestinal tract. Clin Gastroenterol. 9(3):733-53, 1980.
  5. Stockmann F, Richter G, Lembeke B, Conlon JM, Creutzfeldt W. Long-term treatment of patients with endocrine gastrointestinal tumors with the somatostatin analogue SMS 201-995. Scand J Gastroenterol. 21:230, 1986.
  6. Hengl G, Prager J, Pointner H. The influence of somatostatin on the absorption of triglycerides in partially gastrectomized subjects. Acta Hepatogastroenterol (Stuttg). Oct;26(5):392-5, 1979.
  7. Vinik A, Moattari AR. Use of somatostatin analog in management of carcinoid syndrome. Dig Dis Sci; 34(3 Suppl):14S-27S, 1989.

©2006 Inter Science Institute. This profile of assays for diagnosing diarrhea syndrome has been copyrighted.

Dumping Syndrome

BASAL/FASTING TESTS

Following an overnight fast, patients should have blood drawn for the following tests:

  • Pancreatic polypeptide
  • Glucagon
  • GLP-1
  • Insulin
  • Motilin
  • GIP

FECAL MEASUREMENTS

  • Fecal fat measurement
  • Fecal chymotrypsin measurement
  • Fecal EL1 measurement

Patient Preparation

Patients should fast for 10 to 12 hours prior to collection of specimens. Patients should discontinue medications that affect insulin production or secretion, antacid medications, or medications affecting intestinal motility, if possible, for 48 hours prior to collection.

Specimen Collection

BLOOD

For the glucagon and GIP analyses, collect 3 mL EDTA plasma in a special tube containing the GI Preservative and separate as soon as possible. Freeze plasma immediately after separation. Special GI Preservative tubes are available from ISI. Minimum specimen size is 1 mL.

STOOL

Collect 100 mg of formed stool and store at -20°C. Stool specimens are stable for 7 days at refrigerated temperatures. Minimum specimen size is 20 mg of formed stool. Note on request slip if sample has watery diarrhea consistency, as concentration levels of EL1 may be decreased due to dilution factor.

Shipping Instructions

Specimen should be shipped frozen in dry ice.

References

  1. Harris AG, O'Dorisio TM, Woltering EA, et al. Consensus statement: octreotide dose titration in secretory diarrhea. Diarrhea Management Consensus Development Panel. Dig Dis Sci. Jul;40(7):1464-73, 1995.
  2. Mozell EJ, Woltering EA, O'Dorisio TM. Non-endocrine applications of somatostatin and octreotide acetate: facts and flights of fancy. Dis Mon. Dec;37(12):749-848, 1991.
  3. Richards WO, Geer R, O'Dorisio TM, et al. Octreotide acetate induces fasting small bowel motility in patients with dumping syndrome. J Surg Res. Dec;49(6):483-7, 1990.
  4. Geer RJ, Richards WO, O'Dorisio TM, et al. Efficacy of octreotide acetate in treatment of severe postgastrectomy dumping syndrome. Ann Surg. Dec;212(6):678-87, 1990.
  5. Woltering EA, O'Dorisio TM, Williams ST, et al. Treatment of nonendocrine gastrointestinal disorders with octreotide acetate. Metabolism. Sep;39(9 Suppl 2):176-9, 1990.

©2006 Inter Science Institute. This profile of assays for diagnosing dumping syndrome has been copyrighted.

Flushing Syndrome Tests

Tests to Identify Causes of Flushing in Different Clinical Syndromes

BLOOD

  • CGA
  • Pancreastatin
  • Substance P
  • VIP
  • Gastrin
  • Neurotensin
  • Serotonin
  • CGRP
  • Calcitonin
  • FSH
  • Histamine

URINE

For all 24-hour urine collections, measure creatinine.

  • 5-HIAA
  • 5-HTP
  • VMA if hypertensive
  • Tryptase

CONSIDER

  • Plasma catecholamines if hypertensive
  • Dopamine
  • Epinephrine
  • Norepinephrine
  • PTH and PTHRP if hypercalcemic
  • MEN screen (gastrin, prolactin, pancreatic polypeptide, and ionized Ca++)
  • MEN-I gene and RET protooncogene
  • Calcitonin, gastrin, and ACTH for degree of tumor aggression
  • CA 19-1
  • BNP, otherwise known as atrial natriuretic factor, if echocardiogram abnormal

ADDITIONAL TESTING IN PATIENTS WITH UNUSUAL CLINICAL SYNDROMES

  • GHRH
  • Bombesin
  • Ghrelin
  • IGF-1, IGF-2
  • Corticotropin-releasing factor (CRF)

TISSUE STAINS

  • K167
  • CGA
  • Synaptophysin
  • NSE
  • Somatostatin receptor type 2

CONSIDER

  • Factor VIII, CD 31, AE1/AE3
  • Somatostatin receptor subtypes other than type 2

Patient Preparation

Patient should fast overnight prior to collection of blood specimens. Antacid medications and medications affecting motility should be discontinued, if possible for at least 48 hours prior to collection of specimens. Patients should not partake of the following foods for 48 hours prior to collection of urine for measurement of 5-HIAA and 5-HTP measurements:

  • Red wine
  • Cheese
  • Hot dogs
  • Chocolates
  • Vanilla-containing foods (e.g., ice cream)
  • Custard
  • Pineapple, kiwi, bananas, cassava

Specimen Requirements

BLOOD

Collect 20 mL of blood in a green-topped EDTA tube. For serotonin analysis, use a yellow-topped tube containing 75 mg ascorbic acid (vitamin C). Separate and freeze plasma immediately. For bombesin and VIP analyses, collect 5 mL EDTA plasma in a special tube containing the GI Preservative and separate as soon as possible. Freeze plasma immediately after separation. Special GI Preservative tubes are available from ISI. Minimum specimen size is 1 mL.

TISSUE

Consult specialist for tissue staining requirements.

URINE

See complete urine collection instructions in the introduction to Chapter 3.

Shipping Instructions

Specimens should be shipped frozen in dry ice.

References

  1. Vinik AI, Tsai ST, Moattari AR, et al. Somatostatin analogue (SMS 201-995) in the management of gastroenteropancreatic tumors and diarrhea syndromes. Am J Med. 81(6B):23-40, 1988.
  2. Verner JV, Morrison AB. Islet cell tumor and a syndrome of refractory watery diarrhea and hypokalemia. Am J Med. 25(3):374-80, 1958. 3. Murray JS, Paton RR, Pope CE. Pancreatic tumor associated with flushing and diarrhea. Report of a case. N Engl J Med. 264:436-9, 1961.
  3. Arnold R, Lankisch PG. Somatostatin and the gastrointestinal tract. Clin Gastroenterol. 9(3):733-53, 1980.
  4. Stockmann F, Richter G, Lembeke B, et al. Long-term treatment of patients with endocrine gastrointestinal tumors with the somatostatin analogue SMS 201-995. Scand J Gastroenterol. 2:230, 1986.
  5. Hengl G, Prager J, Pointner H. The influence of somatostatin on the absorption of triglycerides in partially gastrectomized subjects. Acta Hepatogastroenterol (Stuttg). 26(5):392-5, 1979.
  6. Vinik A, Moattari AR. Use of somatostatin analog in management of carcinoid syndrome. Dig Dis Sci. 34(3 Suppl): 14S-27S, 1989.

©2006 Inter Science Institute. This profile of assays to identify causes of flushing has been copyrighted.

Gastrinoma (Zollinger-Ellison) Screen

BASAL/FASTING TESTS

  • Fasting gastrin concentration
  • Gastric pH

CONSIDER

  • Pancreatic polypeptide for pancreatic location and suspected MEN-I
  • MEN-I screen
  • ACTH if rapid tumor growth, history of hypertension, diabetes, bruising, etc.
  • OctreoScan and CT or MRI

Patient Preparation

Patient should fast for 10 to 12 hours prior to collection of specimen. Alkali antacid medications should be discontinued, if possible, for at least 24 hours prior to collection. PPIs and H2 blockers should be discontinued for 72 hours prior to collection and patients monitored closely.

Specimen Collection

Collect 10 mL serum or EDTA plasma and separate as soon as possible. Freeze serum or plasma immediately after separation. Minimum specimen size is 1 mL.

Shipping Instructions

Specimens should be shipped frozen in dry ice.

References

  1. Trudeau WI, McGuigan JE. Effects of calcium on serum gastrin levels in the Zollinger-Ellison syndrome. N Engl J Med. 16 Oct;281(16):862-6, 1969.
  2. Mozell EJ, Woltering EA, O'Dorisio TM, et al. Effect of somatostatin analog on peptide release and tumor growth in the Zollinger-Ellison syndrome. Surg Gynecol Obstet. Jun;170(6):476-84, 1990.
  3. Mozell EJ, Cramer AJ, O'Dorisio TM, et al. Long-term efficacy of octreotide in the treatment of Zollinger-Ellison syndrome. Arch Surg. Sep;127(9):1019-24, discussion 1024-6, 1992.
  4. Mignon, M. Diagnostic and therapeutic strategies in Zollinger-Ellison syndrome associated with multiple endocrine neoplasia type I (MEN-I): experience of the Zollinger-Ellison Syndrome Research Group: Bichat 1958-1999. Bull Acad Nat Med. 187(7):1249-58, 2003.
  5. Mozell EJ, Woltering EA, O'Dorisio TM, et al. Effect of somatostatin analog on peptide release and tumor growth in the Zollinger-Ellison syndrome. Surg Gynecol Obstet. Jun;170(6):476-84, 1990.
  6. Owyang C, Vinik AI. Diabetic pseudo Zollinger-Ellison syndrome. Gastroenterol. 82(5):1144, 1982.

©2006 Inter Science Institute. This profile of assays for the gastrinoma screen has been copyrighted.

Generic Follow-Up Profiles

Pancreas and MEN Tests

BLOOD

  • Ca++ corrected for albumin concentrations
  • Every 3 months, measure specific peptides found to be elevated on screening profile
  • Check other components of MEN syndrome screen for MEN measurements (see previous page)

CONSIDER

  • Octreotide suppression test, a predictive test for responsiveness to somatostatin analog therapy
  • Octreotide levels for patients on drug, if patient symptoms, tumor, and biochemical markers are not responding
  • RET protooncogene and MEN-I gene (MENIN) if not tested previously

Patient Preparation

Patient should fast for 10 to 12 hours prior to collection of specimen. Alkali antacid medications should be discontinued, if possible, for at least 24 hours prior to collection. PPIs and H2 blockers should be discontinued for 72 hours prior to collection and patients monitored closely.

Specimen Requirements:

For plasma peptides, collect 10 mL whole blood in an EDTA plasma tube. Separate and freeze plasma immediately. For the isolation of DNA for genetic testing, send 10 mL of whole blood in green-topped tube. Do not separate, do not freeze.

Shipping Instructions

Specimens should be shipped frozen in dry ice.

References

  1. Mozell EJ, Woltering EA, O'Dorisio TM, et al. Effect of somatostatin analog on peptide release and tumor growth in the Zollinger-Ellison syndrome. Surg Gynecol Obstet. Jun;170(6):476-84, 1990.
  2. Mozell EJ, Woltering EA, O'Dorisio TM, et al. Adult onset nesidioblastosis: response of glucose, insulin, and secondary peptides to therapy with Sandostatin. Am J Gastroenterol. Feb;85(2):181-8, 1990.
  3. Please refer to http://www.endotext.org.

©2006 Inter Science Institute. This profile of assays for pancreas/MEN follow-up has been copyrighted.

Genetic Studies

Neuroendocrine Tumors

BLOOD

  • MEN-I (MENIN gene)
  • RET protooncogene (MEN-II)

Type 1 Diabetes

BLOOD

  • HLA
  • DR3
  • DR4
  • A2

Risk Factors for Diabetic Complications

  • Superoxide dismutase gene polymorphism
  • Toll receptor polymorphism
  • ApoE gene polymorphism
  • Angiotensin receptor gene polymorphism
  • Glut 4 abnormalities
  • Hepatic nuclear transcription factor 1 and 4 (MODY)
  • Aldose reductase gene polymorphism (Z2 allele)
  • Cytochrome P450 polymorphism
  • TNFa gene polymorphism
  • 5' Lipoxygenase gene polymorphism
  • Mitochondrial DNA mutations
  • Glucokinase gene abnormalities
  • Mitochondrial DNA

Patient Preparation

Consult specialist for patient preparation.

Specimen Requirements

Consult specialist for specimen requirements.

Shipping Instructions

Consult specialist for shipping instructions.

Reference

©2006 Inter Science Institute. This profile of assays for diagnosing genetic risk factors for diabetes, neuroendocrine tumors, and diabetic complications has been copyrighted.

GI-Neuroendocrine Tests

BLOOD

  • Neurotensin
  • Ghrelin
  • PTH
  • PTHRP
  • Prolactin
  • Glucagon
  • Insulin (if history of hypoglycemia) IGF I and IGF II
  • C-Peptide (if history of hypoglycemia)
  • Somatostatin
  • Calcitonin
  • VIP
  • Gastrin
  • Catecholamines (dopamine, epinephrine and norepinephrine if hypertensive)

Patient Preparation

Patient should be fasting 10 to 12 hours prior to collection of specimen. Antacid medication, Corticosteroid, ACTH, Thyroid, Estrogen or Gonadotropin medications and medications affecting motility, gastrointestinal or pancreatic function should be discontinued, if possible, for at least 48 hours prior to collection.

URINE

  • VMA if hypertensive
  • Catecholamines [dopamine, epinephrine, (metaepinephrine) norepinephrine (normetanephrine) if hypertensive]

Specimen Requirements

BLOOD

Collect 10 mL EDTA plasma in a special tube containing the GI Preservative and separate as soon as possible. Freeze plasma immediately after separation. Minimum specimen size is 2 mL. Special GI Preservative tubes are available from ISI for these assays: glucagon, somatostatin, and VIP. Submit 10 mL serum or EDTA plasma for other assays not requiring the GI Preservative.

URINE (FOR CATECHOLAMINES ONLY)

Measure 10 mL of 24-hour urine collection. Minimum specimen size is 2 mL. Random urine samples are acceptable if 24-hour total volume is not available.

Important Precaution

Specimens for assays specified must be collected using the GI Preservative tube. No other specimens are acceptable for these assays.

Shipping Instructions

Specimens should be shipped frozen in dry ice.

References

©2006 Inter Science Institute. This profile of assays for GI-Neuroendocrine tests has been copyrighted.

Hypoglycemia/Insulinoma

Screening Test

Patient Preparation

Patients should be advised to discontinue medications that affect insulin levels, if possible, for 48 hours prior to collection. After an overnight fast, basal blood samples are collected to measure the following:

  • Insulin
  • Proinsulin
  • C-peptide
  • IGF-1 and IGF-2

Specimen Requirements

Collect 6 mL of serum or EDTA plasma and separate as soon as possible. Freeze serum or plasma immediately after separation. Minimum specimen size is 4 mL.

Shipping Instructions

Specimen should be shipped frozen in dry ice.

Reference

  1. Fajans SS, Vinik AI. Diagnosis and treatment of "insulinoma." In: Santen RJ, Manni A, eds. Diagnosis and Management of Endocrine-Related Tumors. Boston, MA: Martinus Nijhoff Publishers; 1984:235.

©2006 Inter Science Institute. This profile of assays for the hypoglycemia insulinoma screening has been copyrighted.

Interleukins Individually and as a Profile (IL-1 through IL-18)

Reference Range

See individual assays in Chapter 3.

Procedure

Interleukins are measured by enzyme immunoassay.

Patient Preparation

Patient should not be on any corticosteroids, anti-inflammatory medications, or pain killers, if possible, for at least 48 hours prior to collection.

Specimen Collection

Collect 3 mL serum or EDTA plasma and separate as soon as possible. Freeze specimen immediately after separation. Minimum specimen size is 1 mL.

Important Precaution

The interleukins are unstable in freeze-thaw cycles. Do not thaw prior to shipping; specimens must remain frozen from immediately after collection until assayed.

Special Specimens

For tumor/tissue and various fluids (e.g., CSF, peritoneal fluid, synovial fluid) contact ISI for requirements and special handling instructions.

Shipping Instructions

Specimens should be shipped frozen in dry ice.

References

  1. Whicher JT, Evans SW. Cytokines in disease. Clin Chem. 36:1269-81, 1990.
  2. Bevilacqua MP, Pober JS, Majeau GR, et al. Recombinant tumor necrosis factor induces procoagulant activity in cultured human vascular endothelium: characterization and comparison with the actions of interleukin 1. Proc Natl Acad Sci USA. Jun;83(12):4533-7, 1986.
  3. Huang CM, Elin RJ, Ruddel M, et al. Changes in laboratory results for cancer patients treated with interleukin-2. Clin Chem. Mar;36(3):431-4, 1990.
  4. Ihle JN. The molecular and cellular biology of interleukin-3. Year Immunol. 5:59-102, 1989.
  5. Galizzi JP, Castle B, Djossou O, et al. Purification of a 130-kDa T cell glycoprotein that binds human interleukin 4 with high affinity. J Biol Chem. Jan 5;265(1):439-44, 1990.
  6. Bischoff SC, Brunner T, De Weck AL, et al. Interleukin 5 modifies histamine release and leukotriene generation by human basophils in response to diverse agonists. J Exp Med. 1 Dec;172(6):1577-82, 1990.
  7. Spangelo BL, Jarvis WD, Judd AM, et al. Induction of interleukin-6 release by interleukin-1 in rat anterior pituitary cells in vitro: evidence for an eicosanoid-dependent mechanism. Endocrinology. Dec;129(6):2886-94, 1991.
  8. Hunt P, Robertson D, Weiss D, et al. A single bone marrow-derived stromal cell type supports the in vitro growth of early lymphoid and myeloid cells. Cell. 27 Mar;48(6):997-1007, 1987.
  9. Matsushima K, Oppenheim JJ. Interleukin 8 and MCAF: novel inflammatory cytokines inducible by IL 1 and TNF. Cytokine. Nov;1(1):2-13, 1989.

©2006 Inter Science Institute. This profile of assays for the interleukins has been copyrighted.

Lipoprotein Profile(Total Cholesterol, HDL-C, LDL-C, Particle Size, and Triglycerides)

Lipoprotein profile (either VAPTM or NMR method)

  • Triglycerides
  • Total cholesterol
  • HDL-C
  • LDL-C
  • LDL-C particle size

Patient Preparation

Consult local laboratory for patient preparation.

Specimen Requirements

Consult local laboratory for specimen requirements.

Shipping Instructions

Consult local laboratory for shipping instructions.

Reference

  1. Please refer to http://www.endotext.org.

©2006 Inter Science Institute. This lipoprotein profile has been copyrighted.

MEN Syndrome Screen

BLOOD

  • Pituitary (MEN-I)
  • Prolactin
  • Growth hormone if features of acromegaly
  • Parathyroid (MEN-I and -II)
  • PTH
  • PTHRP
  • Ionized Ca++ or Ca++ corrected for serum albumin
  • 24-Hour urine collection for Ca++ and PO4
  • Pancreas (MEN-I)
  • Pancreatic polypeptide
  • Gastrin
  • Insulin/C-peptide if patient hypoglycemic
  • CGA
  • Thyroid C cells (MEN-II)
  • Calcitonin
  • CEA
  • Adrenal (MEN-II)
  • Catecholamines (plasma and urine determinations)

URINE

  • VMA
  • Catecholamines if hypertensive or VMA is positive
  • 5-HIAA
  • 5-HTP

TISSUE IMMUNOHISTOCHEMISTRY (FORMALIN-FIXED 2-mm3 SPECIMENS)

  • CGA
  • NSE
  • Synaptophysin
  • Ki-67, AE1, and AE3
  • Glucagon
  • Gastrin
  • Insulin
  • Somatostatin
  • PP
  • Consider factor VIII, CD31, and somatostatin receptors

GENETIC SCREENING

  • RET protooncogene
  • MEN-I gene

Patient Preparation

Patient should fast overnight prior to collection of blood specimens. Antacid medications and medications affecting intestinal motility should be discontinued, if possible, for at least 48 hours prior to collection of specimens. Patients should not partake of the following foods for 48 hours prior to collection of urine for

  • Red wine
  • Cheese
  • Hot dogs
  • Chocolates
  • Vanilla-containing foods (e.g., ice cream)
  • Custard
  • Pineapple, kiwi, bananas, cassava

Specimen Requirements

BLOOD

Collect 20 mL of blood in a green-topped EDTA tube. For serotonin analysis, use a yellow-topped tube containing 75 mg ascorbic acid (vitamin C) for the blood collection. Separate and freeze plasma immediately. For bombesin and VIP analyses, collect 5 mL EDTA plasma in a special tube containing the GI Preservative and separate as soon as possible. Freeze plasma immediately after separation. Special GI Preservative tubes are available from ISI. Minimum specimen size is 1 mL.

TISSUE

Consult specialist for tissue staining requirements.

URINE

See complete urine collection instructions in the introduction to Chapter 3.

Shipping Instructions

Specimens should be shipped frozen in dry ice.

References

  1. Please refer to http://www.endotext.org.
  2. Please refer to Roger R. Perry in http://www.endotext.org/guthormones/index.htm.

©2006 Inter Science Institute. This profile for MEN syndrome screen has been copyrighted.

Metabolic Syndrome Profile

  • Insulin (1 test)
  • Fasting glucose (1 test)
  • HOMA index

HOMA IR = Fasting Insulin (µU/mL) x Fasting Glucose (mmol/L)/22.5
HOMA B = Fasting Insulin (µU/mL)/[Fasting Glucose (mmol/L) - 3.5]

  • Insulin secretory index

Insulin Secretory Index = [Insulin 30 min (pmol/L) - Insulin 0 min (pmol/L)]/
[Glucose 30 min (mmol/L) - Glucose 0 min (mmol/L)]

  • HBA1c (1 test)
  • C-peptide (2 tests)
  • Free fatty acids (FFAs; 2 tests)
  • Highly sensitive C-reactive protein (HS CRP; 1 test)
  • PAI-1 (1 test)
  • Fibrinogen (1 test)
  • Adiponectin (1 test)
  • IL-6 (1 test)
  • Free and total testosterone (free index; 2 tests)
  • Sex steroid-binding globulin (2 tests)
  • Uric acid (2 tests)
  • Lipoprotein profile (VAPTM; 1 test)
  • Apolipoproteins (2 test)
  • Microalbumin (spot/g creatinine; 1 test)
  • Angiotensin I and II
  • Endothelin I

Patient Preparation

Patient should fast for 10 to 12 hours prior to collection of specimen. Patient should be on a normal-sodium diet (110 mEq sodium) and recumbent for at least 30 minutes prior to draw. Patient should not be on ACTH, corticosteroid, diuretics, mineralocorticoids, glucocorticoids, estrogens, oral contraceptives, or hypertension medications, if possible, for 48 hours prior to collection.

Specimen Collection

Collect 20 mL EDTA plasma and separate as soon as possible. Freeze plasma immediately after separation. Minimum specimen size is 10 mL.

Shipping Instructions

Specimens should be shipped frozen in dry ice.

References

  1. Goodman E, Daniels SR, Morrison JA, et al. Contrasting prevalence of and demographic disparities in the World Health Organization and National Cholesterol Education Program Adult Treatment Panel III definitions of metabolic syndrome among adolescents. J Pediatr. Oct;145(4):445-51, 2004.
  2. Grundy SM, Brewer HB Jr, Cleeman JI, et al. Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Arterioscler Thromb Vasc Biol. Feb;24(2):13-8, 2004.
  3. Mathews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 28:412-9, 1985.

©2006 Inter Science Institute. This profile for metabolic syndrome has been copyrighted.

Oxidative/Nitrosative Stress Profile

NFkB

  • CML
  • ROS
  • NOX nitrotyrosine
  • TBARS
  • 8-Keto PGF2a
  • 8-OH, guanosine

TEST PROTOCOL

  • Vitamin E
  • Vitamin C
  • Plasma antioxidant capacity
  • Superoxide anion

Patient Preparation

Patient should fast for 10 to 12 hours prior to collection of specimen. Patient should not be on any medications that influence insulin production or secretion, if possible.

Specimen Collection

After a 12-hour fast, collect blood by venipuncture into 10-mL sampling vials containing NH4 and 2.7-mL vials containing EDTA (final concentration 0.1%). Obtain plasma by centrifugation at 1500g at room temperature for 10 minutes. Immediately store samples of plasma from EDTA vials at -850°C for subsequent analysis (vitamins and antioxidant capacity). For F2 isoprostane analysis, aliquots (1 jl) of plasma from vials containing NH4 are combined with 10 µL of chain-breaking antioxidant butylated hydroxytoluene at a final concentration of 25 µmol/L and stored at -850°C until analysis.

Special Specimens

For tumor/tissue and various fluids (e.g., CSF, peritoneal fluid, synovial fluid) contact ISI for requirements and special handling instructions.

Shipping Instructions

Specimens should be shipped frozen in dry ice.

References

  1. Ziegler D, Sohr C, Nourooz-Zadeh J. Oxidative stress and antioxidant defense in relation to the severity of diabetic polyneuropathy and cardiovascular autonomic neuropathy. Diabetes Care. Sep;27(9):2178-83, 2004
  2. Tripathy D, Mohanty P, Dhindsa S, et al. Elevation of free fatty acids induces inflammation and impairs vascular reactivity in healthy subjects. Diabetes. Dec;52(12):2882-7, 2003.
  3. Dhindsa S, Tripathy D, Mohanty P, et al. Differential effects of glucose and alcohol on reactive oxygen species generation and intranuclear nuclear factor-kappaB in mononuclear cells. Metabolism. Mar;53(3):330-4, 2004.

©2006 Inter Science Institute. This profile for oxidative/nitrosative stress screen has been copyrighted.

Pancreatic Function Screen

BLOOD

  • Trypsin
  • Amylase
  • Lipase
  • Elastase

SERUM

  • Amylase
  • Lipase
  • Trypsin

STOOL

  • Fat
  • Chymotrypsin
  • Elastase-1

Patient Preparation

Patient should fast for 10 to 12 hours prior to collection of specimen. Antacid medications and medications affecting intestinal motility or pancreatic function should be discontinued, if possible, for at least 48 hours prior to collection.

Specimen Requirements

BLOOD

Collect 10 mL serum or EDTA plasma and separate as soon as possible. Freeze plasma immediately after separation. Minimum specimen size is 3 mL.

STOOL

See complete fecal collection instructions in the introduction to Chapter 3.

Shipping Instructions

Specimens should be shipped frozen in dry ice.

References

  1. Hahn JU, Bochnig S, Kerner W, et al. A new fecal elastase 1 test using polyclonal antibodies for the detection of exocrine pancreatic insufficiency. Pancreas. Mar;30(2):189-91, 2005.
  2. Luth S, Teyssen S, Forssmann K, et al. Fecal elastase-1 determination: 'gold standard' of indirect pancreatic function tests? Scand J Gastroenterol. Oct;36(10):1092-9, 2001.
  3. Gullo L, Ventrucci M, Tomassetti P, et al. Fecal elastase 1 determination in chronic pancreatitis. Dig Dis Sci. Jan;44(1):210-3, 1999.

©2006 Inter Science Institute. This profile for pancreatic function screen has been copyrighted.

Polycystic Ovary Syndrome (PCOS) Screen

The following measurements are required for the diagnosis of polycystic ovary disease:

BLOOD

  • Total and free testosterone
  • SHBG
  • Dehydroepiandrosterone sulfate (DHEA-S)
  • Prolactin
  • LH/FSH (frequent but not required)
  • TSH
  • 17a-Hydroxy progesterone
  • Glucose (fasting)
  • Insulin
  • C-peptide

Patient Preparation

Patient should fast for 10 to 12 hours prior to collection of specimen. Patient should not be on any medications that influence insulin production or secretion or any corticosteroid, ACTH, thyroid, estrogen, or gonadotropin medications, if possible, for at least 48 hours prior to collection.

Specimen Requirements

Collect 10 mL serum or EDTA plasma and separate as soon as possible. Freeze serum or plasma immediately after separation. Minimum specimen size is 4 mL.

Shipping Instructions

Specimens should be shipped frozen in dry ice.

References

  1. Zawadzski JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. In: Dunaif A, Givens J, Haseltine F, Merriam G, eds. Polycystic Ovary Syndrome. Boston: Blackwell Scientific; 1992:377-84.

Adrenal Challenge Protocol ACTH (Cortrosyn) Infusion Stimulation
(Rapid and Prolonged)

In this Challenge Protocol, synthetic ACTH (Cortrosyn) is given to the patient and the Aldosterone and Cortisol responses are measured at specified time points.

Test(s) Measured for the Rapid Challenge Protocol:
Aldosterone and Cortisol

Time(s) of Collection:
Baseline, 30 and 60 minutes.

Test(s) Measured for the Prolonged Challenge Protocol:
Cortisol

Time(s) of Collection:
Baseline, and 6-8 hours.

Stimulus/Challenge:
Rapid: Following an overnight fast, subject is given 250 μg synthetic ACTH (Cortrosyn) as an I.V. bolus.
Prolonged: Following an overnight fast, 250 μg synthetic ACTH (Cortrosyn) is infused over a 6-8 hour period.

Expected Response:
Rapid: Aldosterone levels should increase at least 2 times the baseline. Cortisol levels should increase at 7 μg /dL.
Prolonged: Cortisol levels should increase 30-45 μg /dL.

Interpretation:
Responses are greater in morning specimens. There is an inverse relationship between response and basal Cortisol levels. Secondary Aldosteronism subjects have a significantly greater stimulation than primary Aldosteronism subjects. There is a diminished or no response from subjects with primary adrenal insufficiency and patients who have recently been on glucocorticoids. Subjects with Cushing's disease have exaggerated responses. Subjects with Adrenal Carcinoma and Ectopic ACTH tumors do not respond. 50% of subjects with Adrenal Adenomas do not respond.

Patient Preparation:
Patient should be fasting overnight.

Specimen Collection
Collect 10 mL serum or EDTA plasma and separate as soon as possible. Freeze 3-5mL serum or plasma immediately after separation and label each tube with time of collection. Minimum specimen size is 2 mL.

Shipping Instructions
Specimens should be shipped frozen in dry ice.

Contraindications, Interferences and Drug Effects:
Decreased responses are seen in patients on Glucocorticoids and Verapamil. Estrogens produce an increased response.

References:

  1. DuFour DR ,Gaskin JH and Jubiz WA. Dynamic procedures in endocrinology. In Principles and Practice of Endocrinology and Metabolism. Ed. Becker KL. JB Lippincott Co, Philadelphia; 1762-1775, 1990.
  2. May ME and Carey RM. Rapid adrenocorticotropic hormone test in practice. Am J Med 79; 679-684, 1985.

Androgenic Screen, blood testing *

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

 

Estrogenic Profile, blood testing
General Screen

Test(s) included in this plasma/serum Profile:

  • Estrone (E1)
  • Estradiol (E2)
  • Estriol (E3)

Patient Preparation:
Patient should not be on any ACTH, Corticosteroid, Estrogens, Steroid or Gonadotropin medications if possible, for 48 hours prior to collection.

Specimen Collection
Collect one to two10mL vials of serum or EDTA plasma and separate as soon as possible. Aliquot into 4-5 separate 1mL vials per test, if possible. Minimum specimen size is 0.5mL per test.

Shipping Instructions
Specimens should be shipped frozen in dry ice.

Estrogenic Profile, blood testing
Comprehensive Screen

Test(s) included in this plasma/serum Profile:

  • Estrone (E1)
  • Estradiol (E2)
  • "Free" Estradiol (Free E2)
  • Estriol (E3)
  • Estrogen Binding Globulin Index (EBG-I)

Patient Preparation:
Patient should not be on any ACTH, Corticosteroid, Estrogens, Steroid or Gonadotropin medications if possible, for 48 hours prior to collection.

Specimen Collection
Collect one to two10mL vials of serum or EDTA plasma and separate as soon as possible. Aliquot into 4-5 separate 1mL vials per test, if possible. Minimum specimen size is 0.5mL per test.

Shipping Instructions
Specimens should be shipped frozen in dry ice.

Gastrin Challenge Protocol
Secretin Stimulation

In this Challenge Protocol, Secretin is given to the patient and the Gastrin response is measured at specified time points.

Test(s) Measured:
Gastrin

Time(s) of Collection:
Fasting, 2, 5, 10, 15 and 30 minutes.

Stimulus/Challenge:
Following an overnight absolute fast, subject should be given 2 units per kilogram Secretin I.V. bolus.

Expected Response:
Gastrin response should increase no more than 50% over baseline levels.

Interpretation:
Subjects with Gastrinoma exhibit elevated baseline levels and an exaggerated response greater than double the baseline level to Secretin. Subjects with Achlorhydria exhibit no response. Subjects with active peptic ulcers show a 30-50% increase over baseline levels. Normal subjects frequently exhibit suppression in Gastrin levels following Secretin administration. Response is often greater in women than in men.

Patient Preparation:
Patient should be fasting overnight.

Specimen Collection
Collect 10 mL serum and separate as soon as possible. Freeze 3-5mL serum immediately after separation and label each tube with time of collection. Minimum specimen size is 2 mL.

Shipping Instructions
Specimens should be shipped frozen in dry ice.

Contraindications, Interferences and Drug Effects:
Cimetidine, Ranitidine, Catecholamines, Insulin, and Haloperidol may increase the response. Atropine may decrease the response.

References

  1. DuFour DR ,Gaskin JH and Jubiz WA. Dynamic procedures in endocrinology. In Principles and Practice of Endocrinology and Metabolism. Ed. Becker KL. JB Lippincott Co, Philadelphia; 1762-1775, 1990.
  2. Alsever RN, Gotlin RW. In Handbook of Endocrine Tests in Adults and Children. Year Book Medical Publishers, Inc. Chicago, 1978.
  3. Feldman M, Schiller LR, Walsh JH et al. Positive intravenous secretin test in patients with Achlorhydria-related hypergastrinemia. Gastroenterology 93: 59-62, 1987.

Of Note:
If the physician wants to measure the Secretin levels following the Secretin I.V. bolus administration, contact ISI at (800)255-2873 or supplies@interscienceinstitute.com to obtain the proper G.I. Preservative collection tubes required, as neither serum nor EDTA plasma is acceptable for the Secretin blood test.

3β-Hydroxysteroid Dehydrogenase Deficiency Profile, blood testing
Diagnosing Congenital Adrenal Hyperplasia (CAH) *

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

 

11β-Hydroxylase Deficiency Profile, blood testing
Diagnosing Congenital Adrenal Hyperplasia (CAH) *

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

 

17α-Hydroxylase Deficiency Profile, blood testing
Diagnosing Congenital Adrenal Hyperplasia (CAH) *

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

 

21α-Hydroxylase Deficiency Profile, blood testing
Diagnosing Congenital Adrenal Hyperplasia (CAH) *

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

 

©2006 Inter Science Institute. This profile for polycystic ovary screen has been copyrighted.

 
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