Primary

Aldosteronism

Renal tubular
acidosis

Cushing syndrome

Pleural fluid
TmP/GFR
FHH
HOMA
Thyroid

Gonads

Calcitonin

Hypoglycemia

Oral salt loading test: 6g/day for 3 days

- urine aldosterone <27.7, >33.3 or 38.8 nmol/day
Saline infusion test: 2L over 4 hours
- plasma aldosterone: <140, >277 pmol/L
Fludrocortisone suppression test (0.1 mg q6H for 4 days, NaCl 30
mmol tds)
- Aldosterone > 166 pmol/L, with suppressed PRA & cortisol
10AM<7AM
Captopril challenge (25-50 mg after standing for 1 h)
- 30% suppression of aldosterone
Adrenal venous sampling (R more difficult than L, ACTH 50ug/h infus or
250ug)
- cortisol corrected ratio unstimulated >2, stimulated <3, >4
- cortisol cath > peripheral 10x = correct catheterization
- or one side > 2.5x peripheral, other side no higher than peripheral
Urine pH during acidosis, <5.3 prox, >5.3 distal
Urine anion gap = Na + K Cl, <0 prox >0 distal
Urine osmolal gap = UOsm [2xNa + 2xK + 2xUr + 2xGlc]
Urine pKa = 6.33 0.5 x sqrt(Na+K), Na and K in mol/L
FEHCO3 >15% proximal
pCO2 gradient normal >20 mmHg (1 kPa = 7.5 mmHg)
ONDST 1mg 50 nmol/L
LDDST 0.5mg q6h x 2/7 50 nmol/L
LNSC <= 4 nmol/L
IPSS, stimuli CRH 1 ug/kg (confirm Cushing and lateralize)
- central to peripheral ACTH ratio >2.0 (pre-CRH) <2.0, >3.0 (postCRH)
- gradient >1.4x or 1.5x predict lateralization
- prolactin peripheral ratio >1.8 confirm catheterization
CRH stimulation test (1 ug/kg or 100 ug)
- ACTH increase by 50%, Cortisol by 20%
Chylothorax TG >1.24 mmol/L (chylomicron+)
Pseudochylothorax TC >5.18 mmol/L (cholesterol crystal+)
TRP <= 0.86, TmP/GFR = TRP * PPO4 (i.e. abnormal)
TRP > 0.86, TmP/GFR = (0.3 x TRP) / [ 1-(0.8 x TRP) ]
FECa = CCCR: FHH < 0.01, PHPT > 0.02 after vitamin D replenishment
HOMA-IR = insulin x glucose / 22.5 cutoff = 2
HOMA-%b = 20 x insulin / (glucose 3.5)
Tg 0.1 1 need stimulation, >1 positive
Tg half-life = 2-4 days post-surgery, retest 6w after surgery, 3m after
I131
TRH stimulation (200 ug IV) : Baseline <7 rise >2 but <25
TSH stimulation (0.9 mg daily x 2): for Tg stimulation
GnRH stimuilation test (2.5 ug/kg, up to 100 ug) IV
- prepubertal, 2-4x, LH/FSH ratio 0.7
- postpubertal, LH 6-10x, FSH 4-6x (some say 2-3x), LH/FSH ratio 3.5
- single LH > 15 U/L >90% sensitive
GnRH stimulation test (100 ug sc)
- prepubertal < 5 U/L, FSH > LH
- postpubertal LH > 10 U/L, FSH>LH
- LH 5-10 suggestive of CPP
Pentagastric/Calcium = Ca Gluconate 2 mg/kg over 1 min,
pentagastrin 5 ug/kg over 5s
- positive if >200 ng/L
- normal <100 in male, <50 in female, both in ng/L
Insulin >= 3 miu/l

Steroid Ratios

C-peptide >= 0.2 nmol/l

Proinsulin >= 5 pmol/l
3OHB <= 2.7 mmol/l
Rise > 1.4 mmol/l
T:A ratio < 0.8 17beta HSD deficiency
T:DHT ratio >10 5alpha reductase deficienty