Description
Book SynopsisEndocrinology is perhaps, the only branch of medicine where stimulation and suppression testing are required as the initial step for biochemical confirmation of the clinical condition as hormone secretion is pulsatile. One of the primary needs for an endocrinologist is a pocketbook that can serve as a guide for performing and interpreting these tests. Unfortunately, there is no single source of these protocols, procedures, and interpretation of these tests in the country or even in the Southeast Asia region. This protocol manual is designed to be a ‘ready reckoner’ for endocrinologists for performing these tests.
Disorders of various endocrine glands, including pituitary, thyroid, pancreas, adrenal, gonads, and bone and mineral disorders, have been addressed. The book includes prerequisites and indications of a given test, principles of the testing, detailed procedure, and interpretation. Participant information and instruction sheets have been included, when applicable, to be given as a handout to patients prior to these tests. The manual contains algorithms (e.g., for approaching cases with hypoglycemia) and interpretation provided in a tabular format. It also lists troubleshooting measures for specific tests, when applicable. Further, clinical case scenarios substantiated by clinical and radiological images have been incorporated in the manual to highlight the procedure and interpretation of these tests in the management of challenging clinical cases. The manual is designed to be a comprehensive yet concise document covering all these aspects. Besides blood-based investigations, procedures which are undertaken in challenging endocrine scenarios, including inferior petrosal sinus sampling, and adrenal venous sampling have been elucidated in a crisp and practical manner.
Table of ContentsI. Protocol for testing in diabetes, thyroid and related disorders
i) Standard oral glucose tolerance test
ii) Evaluation of gestational diabetes mellitus
iii) Glucagon-stimulated c-peptide test
iv) Mixed meal test
v) Prolonged supervised fast
vi) Selective arterial calcium stimulation test
vii) TRH releasing test
viii) T3 suppression test
II. Protocol for testing in pituitary disorders
i) Insulin induced hypoglycaemia/Insulin tolerance test
ii) Clonidine stimulation test
iii) Glucagon stimulation test
iv) Levodopa stimulation test
v) Oral glucose tolerance test for acromegaly
vi) Bilateral inferior petrosal sinus sampling
vii) IV CRH stimulation test
viii) IV AVP stimulation test
ix) Low dose dexamethasone suppression test
x) High dose dexamethasone suppression test
xi) Patient instruction sheet for dexamethasone suppression test
xii) Patient instruction sheet for 24 hour urinary free cortisol estimation
xiii) Patient instruction sheet for 2300 h awake cortisol
xiv) Water deprivation test
xv) Prolonged water deprivation test
III. Protocol for testing of adrenal disorders
i) Test for adrenal insufficiency – synacthen stimulation test
ii) 1µg ACTH stimulation test
iii) Acton prolongatum test
iv) Confirmatory test for hyperaldosteronism
v) Adrenal venous sampling
vi) Dexamethasone androgen suppression test
vii) Test to differentiate between Cushing’s and pseudo Cushing’s syndrome
viii) Test for AIMAH – Lacroix protocol
IV. Protocol for testing of gonadal disorders
i) Gonadotropin release hormone agonist test
a) Triptorelin stimulation test
b) Leuprolide stimulation test
ii) hCG stimulation test
iii) Cosyntropin stimulation test for congenital adrenal hyperplasia (CAH)
V. Protocol for testing in metabolic bone disease
i) Ammonium chloride loading test
ii) Bicarbonate loading test
iii) Measurement of TmP/GFR
VI. Protocol for testing in special situations
i) Evaluation in pregnancy
ii) Evaluation in chronic kidney disease
VII. Appendices
i) Reference ranges
ii) Consent forms
