[醫如往常] Senior Clerkship Day 96: Lab Medicine: Diagnostic Endocrinology

Diagnostic Endocrinology

邱醫師

Growth hormone

先跑兩圈再抽血

增加測到的機率

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Cortisol 用米彩頭 agar tube

ACTH 用EDTA管+冰浴

IPSS (Inferior petrosal sinus sampling) 管子不要弄錯

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Cortisol

早上0800: 1

下午1600: 1/2

晚上2000: 1/4

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Midnight salivary cortisol 國外才有

只能測Hypercortisolism

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Package insert

看檢驗有哪些干擾

Dexamethasone 不會干擾cortisol測定

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Urinary free cortisol 只能篩檢 cushing

Serum >25 ug/dl 才會漏到尿中

24 hours

50-100ug borderline

>100ug positive

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Overnight dexamethasone suppression test

Cutoff: 2 ug/dl

Borderline: 2-5 µg/dL

CYP3A4 inducer

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現在只做High dose

Pituitary or ectopic

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Adrenal insufficiency

Cortisol <5  µg/dL

5-10 borderline

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Cushing

Loss of diurnal pattern

Pituitary MRI

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Ectopic

• Small cell lung cancer
• Parathyroid
• Thymic cancer
• Pancreas NET
• Carcinoid

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Adrenal medulla

24hr urinary VMA(vanillylmandelic acid) HPLChigh-performance liquid chromotography (HPLC) >7.0 mg/24h

24-hour Urinary catecholamines:100 g/24h

• Epi>20g/24hr
• NE>80g/24hr

24hr urinary metanephrines 要在基因醫學部免費驗mass

>2 mg/24h

(metanephrine >0.4 mg/24h, normetanephrine >0.9 mg/24h)

Plasma metanephrines

• NMN <112 ng/L and MN <61 ng/L: exclude pheo
• NMN >400 ng/L or MN >236 ng/L: high probability of pheo

Clonidine suppression test

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Catecholamine axis: ARB ACEi不會影響

Mineral axis: 只有alpha blocker不會影響

也可以直接自費CT 避免風險