Hypopituitarism laboratory findings: Difference between revisions
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==== ACTH reserve: ==== | ==== ACTH reserve: ==== | ||
Patients with intermediate cortisol levels need to be tested for ACTH reserve. There are several tests to check the ACTH reserve. Metyrapone | Patients with intermediate cortisol levels need to be tested for ACTH reserve. There are several tests to check the ACTH reserve. Metyrapone test is preferred over others as it is applicable to all adults with no age restriction and has good correlation with stress related cortisol response. It has a drawback that it needs inpatient observation for blood pressure and pulse monitoring to prevent postural hypotension. | ||
*Laboratory findings consistent with the diagnosis of hypopituitarism include: | *Laboratory findings consistent with the diagnosis of hypopituitarism include: | ||
Revision as of 17:57, 5 September 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: {IQ}
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Overview
- An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
- Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
- [Test] is usually normal among patients with [disease name].
- Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
OR
- There are no diagnostic laboratory findings associated with [disease name].
Laboratory Findings
- A subnormal/reduced concentration of pituitary hormones is diagnostic of hypopituitarism.[1]
- Any history of a lesion causing hypopituitarism or a symptom suggestive of hypopituitarism is an indication for testing for hypopituitarism.
Corticotopin:
Basal ACTH secretion:
Normal range of serum cortisol is 5 to 25 mcg/dL (138 to 690 nmol/L). Serum cortisol levels are measured at 8 to 9 am and results are interpreted as follows:
| Serum cortisol | Basal ACTH |
|---|---|
| Low: ≤3 mcg/dL (83 nmol/L) | Cortisol deficiency |
| High: ≥18 mcg/dL (497 nmol/L) | No cortisol deficiency even in times of stress |
| Intermediate: >3 mcg/dL (83 nmol/L)
but <18 mcg/dL (497 nmol/L) |
Needs evaluation for ACTH reserve |
ACTH reserve:
Patients with intermediate cortisol levels need to be tested for ACTH reserve. There are several tests to check the ACTH reserve. Metyrapone test is preferred over others as it is applicable to all adults with no age restriction and has good correlation with stress related cortisol response. It has a drawback that it needs inpatient observation for blood pressure and pulse monitoring to prevent postural hypotension.
- Laboratory findings consistent with the diagnosis of hypopituitarism include:
| Hormonal deficiency | Lab finding |
|---|---|
| ACTH | |
| TSH | |
| Gonadotropins | |
| Growth hormone | |
| Prolactin | |
| ADH | |
| Oxytocin |
References
- ↑ Fleseriu M, Hashim IA, Karavitaki N, Melmed S, Murad MH, Salvatori R, Samuels MH (2016). "Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline". J. Clin. Endocrinol. Metab. 101 (11): 3888–3921. doi:10.1210/jc.2016-2118. PMID 27736313.