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16Th July 2001 AUSTRALASIAN ASSOCIATION OF CLINICAL BIOCHEMISTS INC 5/85 Bourke Rd, Alexandria NSW, 2015 Telephone: +61 2 9669 6600 Facsimile: +61 2 9669 6607 Email: [email protected] Draft Guideline Title Harmonisation of Endocrine Dynamic Testing (HEDT) Document Number: 2018 DGD02 Publication date: Draft for comment September 2018 Next review date: Owner: ESA/AACB/RCPA HEDT Working Party This draft manual for Harmonisation of Endocrine Dynamic Testing is a joint initiative from ESA/AACB/RCPA and is now open for comment and feedback for 90 days. Information provided is a guide only and needs to be verified and modified according to local procedures (e.g. patient consent, sample type, name of test set). A separate paediatric endocrine dynamic testing protocol is in progress with the HDET-P working party. Please direct comments to the chair of the HEDT working party: Dr Cherie Chiang ([email protected]) with the subject heading " HEDT feedback" 2018 DGD02 Harmonisation of Endocrine Dynamic Testing (HEDT) This manual is a joint initiative from ESA/AACB/RCPA and is freely available as a resource for Endocrinologists and Biochemists. Information provided is a guide only and needs to be verified and modified according to local procedures (e.g. patient consent, sample type, name of test set). Queries can be directed to the chair of the HEDT working party. A separate paediatric endocrine dynamic testing protocol is in progress with the HDET-P working party. 2018 DGD02 Page 1 Table of Contents HEDT Working Group Members: ...........................................................................................................4 Endocrine Analyte Reporting Unit and Sample Tube .............................................................................5 1 Adrenal ............................................................................................................................................8 1.1 SHORT SYNACTHEN TEST .........................................................................................................8 1.2 PRIMARY ALDOSTERONISM INVESTIGATION ....................................................................... 10 1.3 SALINE SUPPRESSION TEST ................................................................................................... 12 1.4 FLUDROCORTISONE SUPPRESSION TEST .............................................................................. 13 1.5 ORAL SODIUM LOADING TEST .............................................................................................. 15 1.6 ADRENAL VENOUS SAMPLING.............................................................................................. 16 2 Cushing Overview ......................................................................................................................... 20 2.1 OVERNIGHT DEXAMETHASONE SUPPRESSION TEST (1 mg DST) ......................................... 21 2.2 LATE NIGHT SALIVARY CORTISOL ......................................................................................... 21 2.3 24 HOUR URINARY FREE CORTISOL (UFC) ............................................................................ 23 2.4 2-DAY LOW DOSE DEXAMETHASONE SUPPRESSION TEST (LDDST) ..................................... 24 2.5 DEXAMETHASONE-CRH TEST ............................................................................................... 26 2.6 IV 4 mg DEXAMETHASONE SUPPRESSION TEST ................................................................... 28 2.7 ACTH Dependent Cushing’s Syndrome ................................................................................ 29 2.7.1 HIGH DOSE DEXAMETHASONE SUPPRESSION TEST (HDDST)........................................... 29 2.7.2 PERIPHERAL CRH TEST ...................................................................................................... 30 2.7.3 BILATERAL INFERIOR PETROSAL SINUS SAMPLING .......................................................... 31 3 Hypopituitarism ............................................................................................................................ 34 3.1 INSULIN TOLERANCE TEST .................................................................................................... 34 3.2 OVERNIGHT METYRAPONE TEST .......................................................................................... 38 3.3 GLUCAGON STIMULATION TEST ........................................................................................... 40 3.4 GONADOTROPHIN RELEASING HORMONE STIMULATION TEST .......................................... 42 4 Acromegaly .................................................................................................................................. 43 4.1 GROWTH HORMONE SUPPRESSION TEST ............................................................................ 43 5 Hyperglycaemia investigation ...................................................................................................... 44 5.1 ORAL GLUCOSE TOLERANCE TEST (OGTT) ............................................................................ 44 6 Hypoglycaemia investigation ....................................................................................................... 47 6.1 MIXED MEAL TEST ................................................................................................................ 47 6.2 PROLONGED OGTT ............................................................................................................... 51 6.3 72 HOUR FAST ...................................................................................................................... 52 6.4 CALCIUM STIMULATION TEST FOR INSULINOMA ................................................................ 55 2018 DGD02 Page 2 7 Diabetes Insipidus ........................................................................................................................ 57 7.1 WATER DEPRIVATION TEST .................................................................................................. 57 8 Thyroid .......................................................................................................................................... 61 8.1 TRH TEST ............................................................................................................................... 61 8.2 T3 SUPPRESSION TEST .......................................................................................................... 62 8.3 CALCIUM STIMULATION TEST FOR MEDULLARY THYROID CANCER .................................... 63 9 Phaeochromocytoma .................................................................................................................... 65 9.1 CLONIDINE SUPPRESSION TEST ............................................................................................ 65 Acknowledgements: ............................................................................................................................. 67 Amendment history: ............................................................................................................................. 68 2018 DGD02 Page 3 HEDT Working Group Members: Members Site Affiliations Stream email Dr Cherie Chiang (chair) VIC ESA, AACB, Adult [email protected] RCPA Assoc Prof Warrick Inder QLD ESA Adult [email protected] Prof Mathis Grossmann VIC ESA Adult [email protected] Assoc Prof Rory Clifton-Bligh NSW ESA Adult [email protected] Dr Penny Coates SA ESA, AACB, Adult [email protected] RCPA Dr Ee Mun Lim WA ESA, AACB, Adult [email protected] RCPA Mr Peter Ward NSW AACB Adult [email protected] Dr Phoebe Stanford NSW ESA, AACB, Adult [email protected] RCPA Assoc Prof Chris Florkowski NZ AACB, RCPA Adult [email protected] Dr James Doery VIC AACB, RCPA Paediatric [email protected] 2018 DGD02 Page 4 Endocrine Analyte Reporting Unit and Sample Tube The following table is provided as a guide, check with local laboratory for sample type. Test Standard Alternate Conversion Collection Collection comment unit unit to alternate tube unit ACTH pmol/L pg/mL 4.54 EDTA Collect on ice ng/L Aldosterone pmol/L ng/dL 0.036 EDTA State erect (seated for 10 mins) or supine (for 30 mins) on request slip Aldosterone- pmol/L ng/dL 0.036 plain Urine 24 h Urine container Keep the container refrigerated during the collection period AVP / ADH pmol/L pg/mL 0.923 2 x 4 ml Collect on ice EDTA Androstenedione nmol/L ng/dL 28.65 Li heparin βHCG IU/L mIU/mL 1 Li heparin C-peptide nmol/L ng/mL 0.331 Li heparin Fasting Calcitonin pmol/L pg/mL 0.292 Li heparin Fasting specimen is or serum preferred. tube Collect on ice. NOT EDTA. Chromogranin A ug/L Serum Fasting specimen preferred. Collect on ice. Copeptin pmol/L Li heparin Cortisol nmol/L µg/dL 27.588 Li heparin/ Morning 8 – 9 am sample serum Cortisol - Saliva nmol/L µg/dL 27.588 Salivette 11 pm to midnight collection. Nil by mouth/ no teeth brushing 30 mins prior. DHEAS µmol/L µg/dL 0.027 Serum Estradiol pmol/L pg/mL 0.272 Serum Free T3 pmol/L pg/dL 64.9 Li heparin/ serum Free T4 pmol/L ng/dL 0.0775 Li heparin/ serum FSH IU/L mIU/mL 1 Li heparin Gastrin pmol/L pg/mL 0.481 Serum Fasting, collect on ice. Proton pump inhibitors elevate result. 2018 DGD02 Page 5 Glucagon ng/L pg/mL 1 EDTA & Fasting. Collect on ice trasylol containing GLASS tube (Use 6 mg Na EDTA + 2,500 KIU trasylol per 5 ml blood) Glucose mmol/L mg/dL 18 Fluoride Li heparin/ serum if rapid oxalate transport to laboratory GH µg/L mU/L 3 Li heparin
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