Handbook of Endocrine Protocols Simon Rajaratnam, Anulekha Mary John
INDEX
A
Acarbose 46, 66
Acetazolamide 57
Acidosis, metabolic 52
Acromegaly 9, 15
Adrenal gland 6, 25
Adrenal hyperplasia, congenital 18, 26
Adrenal insufficiency 36, 41
primary 26
secondary 26
Adrenaline 72
Adrenocorticotropic hormone, assessment of 11
Adrogue formula 32
Aldosterone receptor blockers 49
Alendronate 70
Alpha glucosidase inhibitors 46
Amiloride 64
Amitriptyline 70
Amlodipine 64
Anastrazole 67
Androgen excess 7
Angiotensin converting enzyme inhibitors 51
Anion gap 57
metabolic acidosis 57
Anterior pituitary function, assessment of 11
Antibody titers 45
Anticoagulation 43
Anticonvulsants 51
Antidepressants 51
Anxiety 42
Arrhythmias 42
cardiac 27
Arteritis, temporal 43
Atenolol 64
Atropine 72
B
Basal bolus insulin 48
Basal energy expenditure 57
Basal metabolic rate 57
Bethesda system 61
Bicarbonate 52, 53, 58
fractional excretion of 59
Biguanides 46
Bijovet index 59
Biopsy proven malignancy 60
Bisoprolol 64
Blood
glucose 52
pressure 46, 52
sugar 45, 52
Body mass index 56
Body surface area 56
Bone profile 1, 40
Bradycardia 39
Broad spectrum antibiotic cover 39
Burch-Wartofsky score 37
C
Cabergoline 43
Calcitonin 70
Calcitriol 70
Calcium 70
correction 58
infusion test 23
interpretation 24
preparation 23
procedures 23
Canagliflozin 46, 66
Candesartan 64
Carbamazepine 63
Carbimazole 38
Carcinoid tumors 28
Cardiovascular dysfunction 37
Caruncle, inflammation of 62
Carvedilol 64
Cavernous sinus thrombosis 43
Central nervous system disturbance 38
Central venous pressure 53
Cerebral edema
signs of 53
treatment of 54
Cerebrovascular
accidents 42
seizures 42
Charcot's arthropathy 50
Chemosis 62
Chemotherapy 41
Chromogranin A 28
Chronic kidney disease, classification of 49
Cilnidipine 64
Cinacalcet 70
Clinical biochemistry, reference ranges 1
Clomiphene 67
Clonidine 64
dose 14
test 14
indication 14
interpretation 14
precaution 14
procedures 14
Common calculations and scoring systems 56
Conjunctival redness 62
Corticosteroids 47
Cortisol day curve 21
indication 21
interpretation 21
preparation 21
procedure 21
Creatinine 40, 43
CRH stimulation test 19
indication 19
procedures 19
Cushing's disease 9, 17, 20, 21
Cushing's syndrome 17, 19
D
Dapagliflozin 46, 66
Deflazacort 68
Dehydration 23
Denosumab 70
Desmopressin 68
test 20, 22
indication 20
interpretation 21
procedures 21
DEXA-CRH test 19
indication 19
interpretations 19
procedures 19
Dexamethasone 68, 69
Diabetes
duration of 50
insipidus 10, 43
mellitus 5, 45
gestational 47, 51
protocols 45
secondary 47
type 1 47
type 2 47
Diabetic cardiovascular disease, management of 48
Diabetic foot 50
Diabetic kidney disease, management of 49
Diarrhea 38, 57
Diazoxide 71
Dihydrotestosterone 28
Diltiazem 64
Dipeptidyl peptidase IV inhibitors 46
Dobutamine 72
Dopamine 72
Drugs 6372
Dulaglutide 67
Duloxetine 51
Dyslipidemia 48, 50
E
Edema
pedal 38
pulmonary 38, 42
Empagliflozin 46, 67
Enalapril 65
Encephalopathy, hypertensive 43
Endocrine
disorders, evaluation of 4
emergencies 37
test protocols 11
Enoxaparin 71
Epilepsy 11
Eplerenone 65
Estradiol 15
Ethylene glycol 57
Exenetide 67
Eyelid
erythema 62
swelling 62
F
Fasting glucose 45
Fludrocortisone 68
Follicle-stimulating hormone 15
Fondaparinux 71
Forty eight or seventy two hour fast 24
indications 24
interpretations 25
preparation 24
procedures 24
Furosemide 65
G
Gabapentin 51, 63
Gastrointestinal dysfunction 38
Gaze evoked orbital pain 61
Glibenclamide 46, 67
Gliclazide 46, 67
Glimiperide 46, 67
Glipizide 46, 67
Glucagon dose 13
Glucagon test 13
contraindications 13
indications 13
procedures 13
Glucocorticoid excess 6
Glucose 58
Glyburide 51
Glycemic criteria 46
Glyceryl trinitrate 72
Gonadal function 15
Gonadotroph adenomas 10
Gonadotropin releasing hormone
analog dose 15
therapy 43
Gonadotropin releasing hormone analog test 15
indications 15
interpretations 15
procedures 15
Goserelin 68
Graves’ ophthalmopathy 61
Growth hormone 16, 60
reserve, assessment of 11
status after surgery, assessment of 16
H
Head injury 43
Headache 42
Heart
disease, ischemic 11
failure, congestive 38
Hemorrhage
cerebral 43
subarachnoid 43
Heparin 71
High-dose dexamethasone suppression test 19
contraindications 19
interpretations 20
procedures 20
Hormone 67
assays 2
replacement therapy 17
Hounsfield units 60
Human chorionic gonadotropin 68
stimulation test 27
indications 27
interpretations 28
procedures 28
Hungry bone syndrome 41
Hydralazine 65
Hydrochlorothiazide 65
Hydrocortisone 39, 69
replacement 36
Hydroxylase deficiency, partial 18
Hyperaldosteronism 27, 60
Hypercalcemia 35, 40
classification 35
treatment 35
Hypercortisolemic state, establishing 17
Hyperglycemia 48
sodium correction for 58
symptoms of 45
Hyperkalemia 33
classification 33
treatment 33
Hypernatremia 32
calculation 32
classification 32, 33
treatment 33
Hyperosmolar hyperglycemic state 47, 54
Hyperphosphatemia 41
Hypertension 48, 50
uncontrolled 27
Hypertensive crises, treatment of 42
Hypocalcemia 34, 41
classification 34
mild 34
severe 34
Hypoglycemia 39, 52
classification of 46
correction of 39
Hypokalemia 33, 35
classification 33
mild to moderate 33
severe 27
treatment 33
Hypomagnesemia 35, 41
grading 35
treatment 35
Hyponatremia 31, 39
asymptomatic 32
calculation 31
classification 31
postoperative 10
severe 39
treatment 32
Hypoparathyroidism 41
Hypopituitarism 11
Hypotension 39
treatment of 39
Hypothermia 39
Hypothyroidism, severe 11, 13
Hypoventilation 39
I
Ibandronate 70
Impaired fasting glucose 45
Impaired glucose tolerance 45
Infection 37
Inferior petrosal sinus sampling 20
indication 20
interpretations 20
procedures 20
Insulin 58
classification of 47
infusion 55
tolerance test 11, 13
contraindications 11
indications 11
Insulinoma 13
Intravenous fluids, sodium content of 32
Irbesartan 65
Isoniazid 57
J
Jaundice 38
K
Ketoacidosis
alcoholic 57
diabetic 37, 47, 52, 57
L
Labetalol 65
Lactic acidosis 57
Lamotrigine 63
Laser photocoagulation 50
Letrozole 69
Leuprorelin 69
Levetiracetam 63
Linagliptin 46, 67
Liraglutide 67
Lisinopril 65
Liver
disease, chronic 13
function tests 1
Lixisenatide 67
Losartan 65
Low-dose dexamethasone suppression test 18
contraindications 18
indications 18
interpretations 18
procedures 18
Luteinizing hormone 15
M
Magnesium sulfate 42
Mean arterial pressure 56
Mean growth hormone 16
Medullary thyroid carcinoma 23
Meglitinides 46
Meningitis 43
Metformin 46, 47, 51, 67
Methanol 57
Methylcobalamin 71
Methyldopa 65
Methyl-prednisolone 69
Metoprolol 65
Microalbuminuria 4850
Monotherapy 46
Mosteller formula 56
Myxedema coma 39
N
Nateglinide 46, 67
Nausea 38, 42
Nebivolol 65
Nephropathy 49
Neuropathy
diabetic peripheral 51
severe 47
Nifedipine 65
Night-time salivary cortisol 17
Non-anion gap acidosis 57
Noradrenaline 72
O
Obesity, central 57
Octreotide lar 69
Olmesartan 66
Ophthalmoplegia 42
Opiate analgesics 51
Oral antidiabetic drugs 46
Oral glucose tolerance test 15, 16, 51
for assessment of diabetic status 24
interpretation 24
preparations 24
procedure 24
indication 15
interpretation 16
precaution 15
procedures 15
Oral iodine 39
Orbital pain, spontaneous 61
Osteopenia 60
Osteoporosis 60
classification of 60
severe 60
Ovary 8
Overnight dexamethasone suppression test 17
contraindications 17
interpretation 18
procedures 18
indication 17, 18
Oxcarbazepine 63
P
Pain 38
Pamidronate 70
Pancreas 5, 24
Pancreatic neuroendocrine tumors 28
Pancreatitis 41, 47
Paraldehyde 57
Parathyroid 5
hormone 40
Paresthesia 41
Peak postprandial capillary plasma glucose 45
Peptide analogs, glucagon-like 47
Phenobarbitone 63
Phenoxybenzamine 66
Phenytoin 63
Pheochromocytoma 7, 13, 42
Phosphate 53
renal tubular reabsorption of 59
Pioglitazone 46, 67
Pitressin 69
Pituitary apoplexy 42
Plasma
creatinine 59
sodium 59
Polycystic ovary syndrome 18, 58
Poor glycemic control 50
Potassium, fractional excretion of 59
Pramlintide 67
Prazosin 66
Prediabetes 45
Prednisolone 69
Pregabalin 51, 64
Pregnancy, toxemia of 37
Preprandial capillary plasma glucose 45
Prolactinomas 9
Propranolol 66
Propylthiouracil 38
Proteinuria 50
Pseudo-Cushing's syndrome 19
Puberty
central precocious 15
disorders of 15
peripheral precocious 15
R
Radioiodine therapy 37
Ramipril 66
Random plasma glucose 45
Rapid-acting insulin 47
Renal tubular acidosis 57
Repaglinide 46
Retinopathy
diabetic 50
progressive 47
S
Salbutamol 71
Salicylates 57
Saline infusion test 27
contraindications 27
indication 27
interpretations 27
preparations 27
procedures 27
Saxagliptin 46, 67
Seizures 41
Serum electrolytes 40, 43
creatinine 41
Short synacthen test 25
indications 25
interpretations 26
preparations 25
procedures 26
Sildenafil 71
Sitagliptin 46, 67
Sliding scale 55
Small fiber function 51
Sodium
bicarbonate 72
fractional excretion of 59
glucose cotransporter 2 46
nitroprusside 66
infusion 42
total body deficit of 31
valproate 64
Spironolactone 57, 66
Stress situations 47
Sulfonylurea 46, 47
Sweating 42
T
Tachycardia 37
Tadalafil 71
Tamoxifen 69
Telmisartan 66
Teneligliptin 67
Teriparatide 70
Testis 8, 27
Testosterone 15, 28, 69
Tetany 41
Thermoregulatory dysfunction 37
Thiamine 71
Thiazolidinedione 46, 47
Third nerve palsy, diabetic 43
Thyroid 4
cytopathology 61
gland, normal 60
image reporting and data system 60
malignancy 4
profile 38
storm 37
Thyroxine 39
Topiramate 64
Torsemide 66
Total parenteral nutrition 48
Trauma 37
Triglycerides 46
Triple therapy 47
Tube feeds 48
Twenty-four hour urinary free cortisol 17
U
Uremia 57
Ureteropelvic shunt 57
Urine
creatinine 59
osmolality 43
sodium 59
V
Valsartan 66
Vasopressin 72
Venlafaxine 51
Verapamil 66
Vertigo 42
Vildagliptin 46, 67
Visual acuity 42
Vitamin D 40, 70
deficiency 41
Voglibose 46, 67
Vomiting 38, 42
W
Waist
circumference 57
hip ratio 57
Water deprivation test 21, 22
interpretation 23
preparations 21
procedure 22
Z
Zinc transporter 8 islet antibody 45
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Chapter Notes

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Clinical Biochemistry: Reference RangesCHAPTER 1

Renal Parameters
Lipid Profile
Sodium
135–145 mmol/L
Total cholesterol
<200 mg/dL
Potassium
3.5–5 mmol/L
Triglyceride
<150 mg/dL
Bicarbonate
22–29 mmol/L
LDL cholesterol
<100 mg/dL
Chloride
95–105 mmol/L
HDL cholesterol
>60 mg/dL
Urea
15–40 mg/dL
Creatinine
0.7–1.4 mg/dL (males)
0.5–1.1 mg/dL (females)
Bone Profile
Liver Function Tests (LFTs)
Calcium
8.3–10.4 mg/dL
Bilirubin total
0.5–1 mg/dL
Albumin
3.5–5.0 g/dL
Bilirubin direct
0.1–0.5 mg/dL
Phosphate
2.5–4.6 mg/dL
Protein
6.0–8.5 g/dL
Alkaline phosphatase
40–125 U/L
Albumin
3.5–5.0 g/dL
Vitamin D (25 OHD3)
>30 ng/mL
Alanine amino-transferase
(ALT or SGPT)
5–35 U/L
Parathyroid hormone
8–74 pg/mL
Aspartate amino transferase
(AST or SGOT)
8–40 U/L
24-hr urinary calcium
50–300 mg/24 hr
Alkaline phosphatase
40–125 U/L
DIABETES
Glucose
Fasting (AC)
Normal
<100 mg/dL
Impaired fasting glucose
100–125 mg/dL
Diabetes mellitus
≥126 mg/dL
2 hr postmeal (PC)
Normal
<140 mg/dL
Impaired glucose tolerance
140–199 mg/dL2
Diabetes mellitus
≥200 mg/dL
HbA1c
Normal
<5.7%
Prediabetes
5.7–6.4%
Diabetes
≥6.5%
C-Peptide
1.1–5.0 ng/mL
Antiglutamic acid decarboxylase (GAD) antibody
<5.0 U/mL
Anti-islet cell antibody
<7.5 U/mL
Insulin (fasting)
0–30 µU/mL
Urine microalbumin
<30 mg/g creatinine
Urine protein/creatinine
<0.21 mg/mg
24-hr urine protein
50–150 mg/24-hr
HORMONE ASSAYS
Thyroid
Total thyroxine (TT4)
4.5–12.5 µg/dL
Free thyroxine (FT4)
0.8–2.0 ng/dL
Gonadal hormones
Total T3
90–190 ng/dL
Follicle stimulating hormone (FSH) (Women)
Thyroid stimulating hormone (TSH)
0.3–4.5 mIU/L
Follicular phase
2.8–11.3 mIU/mL
Thyroid antibodies -
Mid-cycle
5.8–21 mIU/mL
Antimicrosomal (TPO) antibodies
<50 IU/mL
Luteal phase
1.2–9 mIU/mL
Antithyroglobulin antibodies
<100 IU/mL
Postmenopausal
21.7–153 mIU/mL
Thyroglobulin (Post-thyroidectomy)
<1 ng/mL
(Men)
0.7–11.1 mIU/mL
Calcitonin
0–50 pg/mL
Luteinizing hormone (LH) (Women)
Adrenal
Follicular phase
1.1–11.6 mIU/mL
17 OH-progesterone
Mid-cycle
17–77 mIU/mL
Men
0.4–3.3 ng/mL
Luteal phase
0.0–14.7 mIU/mL
Women (Follicular phase)
0.1–1.2 ng/mL
Postmenopausal
11.3–39.8 mIU/mL
(Luteal phase)
0.4–4.8 ng/mL
(Men)
0.8–7.6 mIU/mL3
Dehydroepiandrosterone sulfate (DHEAS)
Men
80–560 µg/dL
Estradiol
Women
35–430 µg/dL
Follicular phase
0–0.587 nmol/L
Plasma renin
2.8–39.9 µIU/mL
Luteal phase
0.1–0.91 nmol/L
Progesterone
Aldosterone
Follicular phase
1.00–3.80 nmol/L
Supine
10–160 pg/mL
Mid-cycle
1.70–50 nmol/L
Upright
40–310 pg/mL
Luteal Phase
2.30–56.60 nmol/L
Urine metanephrine
<350 mg/day
Urine normetanephrine
<600 mg/day
Prolactin
Women
1.9–25.0 ng/mL
Pituitary
Men
2.5–17 ng/mL
Human growth hormone (basal)
0–5.0 ng/mL
(1 hour postglucose)
<0.4 ng/mL
Testosterone
(2 hour postglucose)
<0.4 ng/mL
Women
50–120 ng/dL
Insulin like growth factor-1 (IGF-1)
10 years
88–452 ng/mL
20 years
127–424 ng/mL
Men (20–49 yrs)
270–1030 ng/dL
26–30 years
117–329 ng/mL
(>50 yrs)
212–755 ng/dL
46–50 years
94–252 ng/mL
66–70 years
69–200 ng/mL
Adreno corticotrophic hormone (ACTH)
0–46 pg/mL
Sex hormone binding globulin (SHBG)
Cortisol
Basal (morning)
7–25 µg/dL
Women
26.1–110 nmol/L
Post-Synacthen (30 and 60 min)
>20 µg/dL
Men
14.5–48.4 nmol/L
Post-Dexa
<1.8 µg/dL
24-hr urinary free cortisol (UFC)
10–55 µg/24-hr
Inhibin A
<97 pg/mL
Anti-Müllerian hormone (AMH)
2.0–6.8 ng/mL