Clinical Laboratory Tests

Introduction

This page describes some of the more common medical diagnostics tests, their purpose and the expected normal result range values. This document is used for general information and should not be used as reference material. (See the disclaimer below.) Unless otherwise indicated a large majority of these tests require whole blood samples (Plasma or Serum).

Definition, throughout this document, are frequently reference to a provided glossary. If you are searching for a specific term or acronym* you might consider first using your browser's find option or look directly at the glossary page. Many of my sources of information can be accessed from the list below. When all else fails, I have had tremondous luck finding information about a many medical terms just by using a Web Search tool such as Yahoo.

*Index of Acronym is at the bottom of this page.

For browsing purposes, this page is broken into key body systems. This includes:

Also included are Other tests such as Cancer, Routine and Miscellaneous tests.

Cardiovascular System

Cardiac Enzyme Studies

CPK (Creatine phosphokinase); CK (Creatine kinase); CKNa, CK-B or CK-MB

Measure the cardiac component of the total enzyme providing an index of cardiac muscle damage, muscle diseases such as progressive Duchenne-type muscular dystrophy. An increase indicates myocardial damage. Normal values for CPK range from 5 to 75 mU/ml. CPK level rises within 6 hours after damage to myocardial cells, peaks in approximately 18 hours, and return to normal in 2 to 3 days. CPK may also be elevated with chronic alcoholism, Electrical cardioversion, Cardiac catheterization, Hypothryoidism, Stroke, Surgey or Clofibrate therapy.

AST (Serum Asparate Aminotransferase); SGOT (Serum Glutamic Oxaloacetic Transaminase); GOT

AST rises within 6 to 8 hours after myocardial injury, peaks at 12 to 48 hours, and returns to normal in approximately 3 to 4 days. Normal values for AST range from 12 to 36 U/ml or 5 to 40 IU/L. Other conditions that may cause AST elevation include liver disease, some anticougulants, Primary muscle disease, cardiac operations, Acute pancreatitis, extensive central nervous system, damage, Hemolytic crisis, Toxemia of pregnancy, Crash injuries or burns, Hypothyroidism , or Infraction of the kidneys, spleen or intestine.

LDH (Lactic dehydrogenase)

Measures a more specific index of cardiac muscle damage and liver diseases such as viral hepatitis, cirrhosiss and metatstatic carcinoma of the liver, tumors or the lung or kidneys. The heart muscle is rich in LDH. Normal values range from 90 to 200 ImU/ml. After myocardial infartion, the serum LDH level rises within 24 to 72 hours, peaks in 3 to 4 days and returns to normal in approximately 14 days. LDH may also be elevated with Pulmonary disease or Congestive Heart Failure.

Serum Lipid Studies

HDL (High Density Lipoprotein); HDLc

HDL (the so called "good" cholesterol) is inversely related to the risk of developing coronary artery disease. Low HDL/LDL cholesterol ration is directly related to the risk of developing coronary artery disease where as High HDL cholesterol is associated with the "longevity" syndrome. Normal value for HDL is around 45 mg/dl for men and 55 mg/dl for women.

LD-L (Lactate Dehydrogenase); LDL; LD-P

LDL (the so called "bad" cholesterol) measurements are use in the diagnostics and treatment of liver diseases such as acute viral hepatitis, cirrhosis, and metastatic carcinoma of the liver, cardiac diseases such as myocardial infaraction and tumors of the lung or kidneys. Normal values for LDL range from 60 to 180 mg/dl.

TRIG (Triglycerides); TGB

Triglyceride measurements are used in the diagnostics and treatment of diabetes mellitus, nephrosis, liver obstruction, and other diseases involving lipid metabolism, or various endocrine disorders. Normal values for TRIG range from 0.4 to 1.8 mmol/L

Other Cardiac Test

X-Ray Tests - Fermoral Arteriography (Peripheral Vascular Arteriography), Venography (Phlebography, Venogram)

Nuclear Scanning Tests - Cardiac Nuclear Scanning (Myocardial Scan, Cardiac Scan, Myocardial Scintiphotography, Nuclear Cardiac Scanning)

Special Studies - Fibrinogen Uptake Test, Cardiac Catheterization (Coronary Angiography, Angiocardiography, Ventriculography), Computerized Tomography of the Chest (Heart), Cat Scanning (Computerized Axial Tomobraphy, CT Scan of the Heart, Computerized Axial Transverse Tomography, EMI Scanning)

Ultrasound Tests - Doppler Ultrasound and plethysmographic arterial study (Noninvasive arterial studies), Doppler Ultrasound and plethysmographic venous study

Other Tests - Echocardiography (Cardiac Echo), Electrocardiography (ECG), Exercise Stress Testing (Stress, Exercise, or Electrocardiographic Stress Testing), Holter Monitoring, Event Records, Oculoplethysmography (OPG), Percardiocentesis (Pericardial Fluid Analysis).

Gastrointestinal System

CEA (Carcinoembryonic Antigen)

Used to monitor response to therapy for colorectal cancer or follow-up potentially curative resections for tumor recurrence. Normal value for CEA is (less than) <2 ng/ml.

Serum Gastrin Determination

Used to aid in the diagnostics of gastric ulcers and Zollinger-Ellison syndrome. Normal value range 40 to 150 pg/ml. Mildly elevated with pernicious anemia and antiulcer procedures.

D-XYLOSE Test

Used to assist in the diagnosis of malabsorption diseases. D-Xylose is injested and blood and urine are collected and analyzed for D-Xylose at a certain periods of time. Normal value range from 20 to 52 mg/dl for blood in 2 hours and 4g in a 5-hour urine specimen with a 25g initial dosage in 500 ml of water.

Other Gastrointestinal Test

Stool Tests - Stool Culture (Stool for culture and sensitivity, C & S; Stool for OVA and Parasites, O & P), Examination of Stool for Occult Blood

X-Ray Tests - Barium Enema Study (Lower GI Series), Barium Swallow, Upper Gastrointestinal Study (Upper GI, UGI), Gastrointestinal (GI Scintigraphy (Abdominal Scintigraphy, GI Bleeding Scan)

Special Studies - Colonoscopy, Esophagogastroduodenoscopy (UGI, Endoscopy, Gastroscopy), Sigmoidoscopy (Lower GI Endoscopy),

Esophageal Function Studies (EFS) - Manometry Studies (Les Pressure, Swalling Pattern, Acid Reflux, Acid Clearing, Berstein Test (Acid Perfusion))

Other Tests - Examinations for Gastric Cytrology, Gastric Analysis, Hydrogen Breath Test, Nutritional Assessment Studies, Small Bowel Biopsy

Hepatobiliary and Pancreatic System

AMM (Ammonia)

Used primarily to assistn in the diagnosis of Hepatic encephalopathy or coma. Normal Value range from 15 to 110 ug/dl in Adults, 40 to 80 ug/dl in Children and 90 to 150 ug/dl in Newborns. Elevated Levels may occur with liver dysfunction, hepatic failure, erythroblastosis fetalis, cor pulmonale, pulmonary emphysma, congestive heart failure and exercise. Decreased levels may occure with renal failure, essential or malignant hypertension or with the use of certain antibiotics (e.g. neomycin, tetracycline).

HAA (Hepatitis- Associated Antigen)

Aids in the diagnosis of hepatitis A, B, non-A and non-B, tracking recovery from hepatitis and to identify hepatitis 'carriers'. Normal Result Value is Negative. HAV (Hepatitis A), HAB (Hepatitis B, Dane Particle) and HAHB (Hepatitis C, Non-A or Non-B)

IgG (Immunoglobulin G)

Used in the diagnosis and treatment of immune deficiency states, protein-losing conditions, liver disease, chronic infections, as well as specific diseases such as multiple sclerosis, mumps, meningitis, IgG myeloma. Normal value ranges from 650 to 15500 mg/dl.

IgM (Immunoglobulin M)

Used in the diagnosis and treatment of immune deficiency states, protein-losing conditions, Waldenstrom's Macroglobinema, chronic infections and liver disease. Normal value ranges from 60 to 280 mg/dl

GOT (Glutamic Oxoacetic Transaminase); SGOT; AST

Measurement to diagnosis and treat certain types of liver and heart disease. High levels occure after myuocardial infraction and liver damage, AST Levels are also increased with pancreatitis, acute hemolytic anemia, severe burns, acute renal disease, musculoskeletal disease, trama, beriberi, diabetic katascidosis and in pregnant women. Normal value range from 5 to 50 IU/L.

ALT (Alanine Aminotransferase); GPT (Glutamic Pyruvate Transaminase); SGPT

This test helps confirm the liver origin of an AST increase. Normal value range from 5 to 35 IU/L. Deviations from normal usually indicate Liver dysfunction. AST and ALT levels are opten compared. The AST/ALT ration is usually (greater then) >1 in alcoholic cirrhosis, liver congestion, or metabolic tumor to the liver. A AST/ALT ration of (less than) <1 may appear with acute hepatitis, viral hepatitis, and infectious mononucleosis.

ALP (Alkaline Phosphatase); ALPd

Used to distinguish between liver and bone disease. Used in the diagnosis and treatment of parathyroid and intestinal diseases. Normal value ranges from 30 to 85 ImU/ml in adults, 85 to 235 ImU/ml in Children (less than) <2 years, 65 to 210 ImU/ml in children 2 to 8 years, 60 to 300 ImU/ml in children 9 to 15 (active bone growth) and 30 to 200 ImU/ml in adolescents 16 to 21 years. Increased levels may indicate obstructive extrahepatic and intrahepatic biliary disease, metastatic carcinoma to the liver, infarcted bowel, hyperphosphatasia, hepatoma, liver abscess, liver granulomas, hyperparathyroidism, Paget's disease, healing fractures and rheumatoid arthritis. Decreased levels mya appear with hypothyroidism, hypophosphatemia, excess vitamine B ingestion, scurvy, malnutrition, milk-alkali syndrome, celiac disease and pernicious anemia.

LAP (Leucine Amiopeptidase)

Used to diagnose liver disorders, and an aid in diferential diagnosisi of increased alkaline phosphatase levels. Normal value range from 80 to 200 U/ml in males and 75 to 185 U/ml in females for blood. Normal values range from 2 to 18 U/24 hours for Urine. Elevation may indicate liver metastasis and choledocholithiasis.

GGT (Gamma-Glutamyl Transpeptidase); GGTP

This test is used to detect liver cell dysfunction and alcohol ingestion. It is also used to help distinguish hepatic disease from skeletal disease when the serum alkaline phosphatase is elevated and to aid in the differential diagnosis of hepatocellular disease during pregnancy and childhood. Normal value ranges from 8 to 38 U/L for males and females (greater than) >45 years and 5 to 27 U/L for females (less than) <46 years. The level is high in 75% of chronic alcoholics and 4 to 10 days after an acute myocardial infraction. Certain medications can cause elevation (e.g. diphenylhydantoin [Dilantin] and phenobarbital).

AMY (Amylase); PAMY

To diagnose pancreatitis. Normal value ranges from 56 to 190 IU/L or 80 to 150 Somogyi units/dl. Normal values for urine range from 3 to 35 IU/h, 60 to 30 Wohlgemuth units/ml or up to 5000 Somogyi units/24 hours. An elevated test result can aid in diagnosis of ongoing inflammation (e.g. severe hemorrhagic pancreatitis), duct obstruction (e.g. cancer), pancreatic ductal leackage (e.g. pseudocysts). High levels may be caused by disorders affecting salivary glands, liver, intestines, kidney and the female genital tract (e.g. parotitis, cholecystitis, perforated bowel, renal infraction or ectopic pregnancy). Decreaded levels can ocure with advance chronic pancreatitis, chronic alcoholism and toxic herpatitis. PAMY has a greater sensitivity than total amylase for the diagnosis and treatment of acute pancreatitis with normal value ranging from 0 to 46 U/L or (less than) <320 U/L in Urine.

DBIL (Direct Bilirubin); TBIL (Total Bilirubin)

Used to diagnosis and treatment of liver, hermolytic, hermatological and metabolic disorders including hepatitis and gall bladder block. Normal values range from 0.1 to 0.3 mg/dl for Direct Bilirubin, 0.1 to 1.0 mg/dl for total bilirubin, 1 to 12 mg/dl for newborns and 0.2 to 0.8 mg/dl for indirect bilirubin. The effect of many different drugs (e.g. antibiotics, sulfonamides, allopurinol, diuretics, barbiturates, steroids and oral contraceptives) may cause elevated results. Decreased levels may indicate iron-deficiency anemia or effects of taking penicillin or large amounts of salicylates. Obstruction of the biliary ducts (e.g. gallstones) and hepatocellular disease (e.g. hepatitis) may cause conjugated hyperbilirubinemia. Accelerated erythrocyte hemolysis in newborns (erythroblastosis fetalis), absence of glucuronyl transferase and hepatocellular disease cause unconjugated hyperbilirubinemia.

Any Bilirubin in a Urine sample may indicate conugated hyperbilirubinemia.

Urine Urobilinogen normal value range from 0.1 to 1.0 Ehrlich units/dl (random specimen), 0.3 to 1.0 Ehrlich units/2 hours (usually between 1 and 3p.m or 2 and 4p.m. because urobilinogen levels are highest then, and .5 to 4.0 Ehrich units/24 hours all urine collected during time period. Higher than normal range may indicate hepatocellular disease or hemolytic anemia. A negative result can indicate biliary ductal obstruction or severe liver failure.

LIPA (Lipase)

Used to diagnose pancreatitis and pancreatic carcinoma. Normal values range from 0 to 100 units/L or 0 to 1.5 units/ml. Elevated levels usually follow damage to the pancreas or with pancreatitis.

TP (Total Proteins); ALB (Albumin); Globulin

Used to aid in diagnosing liver dysfunction. Normal value ranges 6 to 8 g/dl for Total Proteins, 3.2 to 4.5 g/dl for Albumin and 2.3 to 3.4 g/dl for Globulin. Lower results may indicate severe liver dysfuynction or excessive loss of albumin into the urine (e.g. nephrotic syndrome) or into third-space volumes (e.g. ascites).

5'-Nucleotidas

This test is used as an aid to in the differential diagnosis of liver disease from boan disease and of hepatobiliary disease during pregnancy. Normal value ranges from 0 to 1.6 units. Elevation may be an early indication of metastasis, especially if jaundice is absent.

(Also See LDH)

Other Hepatobiliary and Pancreatic Tests

Stool tests - Fecal Fat Test Normal Value is around 5g/24hours or a fat retention coefficient of (less than) >95%. This test may be used to indicate cystic fibrosis. Elevated levels may be affected by malabsorption or maldigestion (e.g. hypermobility, massive bowel resection and antiobesity surgical procedures).

X-Ray Tests - Oral Cholecystography (Gallbladder series, GB Series, Cholecystogram) can reveal pathologic gallbladder conditions (e.g. Calculi, Gallbladder polyps or tumors or Chronically inflamed gallbladder).

Cholangiography Procedures - ERCP (Endoscopic Retrograde of the Biliary Duct) can reveal Stones, benign strictures, cysts and malignant tumors which can indicate if an obstructive jaundice is intrahepatic or extrahepatic or to help visualize the biliary tree when the bilirubin level is greater than 3.5 mg/dl.

Endoscopic Retrograde Cholangiopancreatography of the Pancreatic Duct - This test can detect clinically significant degrees of pancreatic dysfunction indicating possible tumors or Chronic pancreatitis.

Intravenous Cholangiography (Intravenous Cholangiogram (IVC)) - This test is used to indicate existance stone, stricture or tumor of the hepatic duct, common gile duct and the gallbladder. It is also used to study the biliary tree for retained gallstones in the cholecystectomized patient, rule out the biliary system as the casue of acute abdominal inflammation, to desonstrate passage of the stones into the common bile with patients who have proven gallstones or as an alternative to Oral Cholecystography.

Percutaneous Transhepatic Cholangiography - (PTHC) is used to aid in diagnosing conditions of the intrahepatic and extrahepatic biliary ducts and occasionally the gallbladder of jaundice patients, This is used to help determine Gallstones, benign strictures and cysts and malignant tumors.

T-Tube Cholangiography (Postoperative Cholangiography) - Used to diagnose retained ductal stones postoperatively after a cholecystectomy or a common bile duct exploration.

Nuclear Scanning Tests - Cholescintigraphy (Hepatobiliary Scintigraphy, Hepatobiliary Imaging, Biliary Tract Radionuclide Scan, Biliary Scintigraphy and Disida Scanning), or Liver Scan.

Computer Tomography Tests - Computerized Tomography of the Abdomen (CT of the Abdomen).

Special Studies - Liver Biopsy, Secretin-Pancreozymin Test, Sweat Electrolyte Test (Iontophoretic Sweat Test).

Ultrasound Test - Ultrasound examination of the liver and biliary system, Ultrasound examination of the Pancreas (Pancreas Echogram).

Pulmonary System

pH, Pco2, HCO3, Po2 (Arterial Blood Gas Studies)

Indicates, assess and monitor respiratory and metabolic status. Normal pH ranges from 7.35 to 7.45, Pco2 from 35 to 45 torr and HCO3 from 22mEq/L to 26mEq/L.

Po2 normally ranges from 80 to 100 torr. A lower level may indicate pneumonia, shock lung, congential heart disease, Pickwickian syndrome or pulmonary embolus. (Also see Fetal Scalp Blood pH Test)

Alpha1 (Antitrypsin Determination)

This test is used to diagnose emphysema. A normal test result value is (greater than) >250mg/dl

Other Pulmonary System Tests

X-Ray Tests - Bronchography (Bronchogram, Larynography), Chest X-Ray (Chest Reoentgenogram), Pulmonary Angiography (Angiography), Tomography of the Lung (Laminography Planigraphy)

Nuclear Scanning Test - Lung Scanning (Pulmonary Scintiphotography), Computerized Tomography of the Chest (CT of the Chest or Lung),

Special Studies - Lung Biopsy, Pleural Biopsy, Bronchoscopy, Mediastinoscopy, Pulmonary Fuynction Studies, Sputum Studies (Acid-Fast Bacilli), Thoracentesis and Pleural Fluid Analyysis (Pleural Tap)

Nervous System

Anti-Acetylcholine Receptor Antibody Tests

To assist in evaluation of muscle weakness and the diagnosis of myasthenia gravis. A normal result would be an absent of Anti-Acetylcholine Receptor Antibodies.

Other Nervous System Tests

X-Ray Tests - Cerebral Angiography (Cerebral Arteriography), Lumbosacral Spinal X-Ray Study (LS Spine), Myelography, Pneumonencephalography (PEG), Skull X-Ray Study, Ventriculography (Ventriculogram)

Nuclear Scanning Test - Brain Scanning, CAT Scanning (Computerized Axial Tomography, Computer Tomography-CT Scan of the Brain; Computerized Axial Transverse Tomography-CATT)

Special Studies - Caloric Study, Cisternal Puncture, Echoencephalography (Brain Echogram; Ultrasound of the Brain), Electroencephalography (EEG), Electromyography, Evoked Potentials (EP), Lumbar Puncture and Cerebrospinal Fluid Examination (LP, Spinal Tap, Spinal Puncture), Nerve Conduction Studies (Electroneurography).

Urinary System

PAP (Prostatic Acid Phosphate)

This test is used to diagnose prostatic carcinoma, monitor efficacy of treatment for prostatic carcinmoma and to investigate alleged rape because phosphate occurs in high constrations in seminal fluid. Normal value ranges from 0.10 to 0.63U/ml (Bessey-Lowry), 0.5 to 2.0U/ml (Bodansky), 1.0 to 4.0 U/ml (King-Armstrong) or 0.0 to 0.8 U/L at 37oC (SI units) in Adults and 6.4 to 15.2 U/L in Children.

Aldosterone

Diagnosing pathological conditions when increased results accompany decreased renin level such as aldosteronism (Conn's syndrome). Normal values range from 1 to 21 ng/dl (morning, standing, peripheral vein), 3.2 to 11.6ng/dl (morning, supline for 2 hours, peripheral vein) or 2 to 16ug/25hours in Urine. Elevated results could indicate hyponatremia, hyperkalemia, stress, Cushing's syndrome, malignant hypertension, generalized edema (from congestive heart failure, nephrotic syndrome, cirrhosis), renal ischemia and Bartter's syndrome (a renin-producing renal tumor). Pregnancy and oral contraceptives can also increase levels. Diuretics and steroids promote sodium excretion and may raise aldosterone levels.

Decreased aldosterone levels are seen with high sodium diets or hypokalemia. Aldosterone can also indicate Addison's disease or toxemia of pregnancy. Antihypertensives may also reduce levels because they promote sodium and water retension.

ACE (Angiotensin-Converting Enzyume); SACE

Used to test severity of or response to therapy for diagnosed sarcoidosis.Normal test results values range from 23 to 57 U/ml (units - nanomoles/min). Elevated levels of ACE may indicate sarcoidosis. Other conditions that may cause a higher result than normal may be Gaucher's disease (a rare familial disorder of fat metabolism), leprosy, alcoholic cirrhosis, active histoplasmosis, tuberculosis, Hodgkin's disease, myeloma, scleroderma, pulmonary embolism, and idiopathic pulmonary fibrosis. Lower than normal levels may be expected with sarcoidosis treated with prednisone.

ASO Titer (Antistreptolysin O Titer)

ASO is used in the diagnosis of streptococcal infections such as rheumatic fever, scarlet fever, bacterial endocarditis and glomerulonephritis. Elevated ASO usually indicates a recent infection with group A betahemolytic streptococcus. Normal values range (less than) <160 Todd units/ml for adults, newborn similar to mother's value, (less than) <50 Todd units/ml for 6months to 2 year olds, (less than) <160 Todd units/ml for 2 to 4 year olds, (less than) <200 Todd units/mo for 5 to 12 year olds.

Plasma Renin Activity

This test is used to measure plasma aldosterone level for a differential diagnosis of hyperaldosteronism. It is also used to detect essential, renal or renovascular hypertension. Normal values range from 2.9 to 24 ng/ml/h in a 20 to 39 years old adult taken from an upright position, sodium depleted peripheral vein, or 2.9 to 10.8 ng/ml/h in a (greater than) >40 years old. Results vary for a sodium replete Normal adult value range from 0.1 to 4.3 ng/ml/h age 20 to 39 years old taken in an upright position from a peripheral vein or 0.1 to 3ng/ml/h in a (greater than) >40 years old. An Increased results in aldosterone accompany with a decreased renin level may indicate aldosteronism (Conn's syndrome) or primary hyperaldosteronism.

Pregnancy and several drugs (e.g. oral contraceptives, antihypertensives, vasodilators) and certain foods (e.g. licorice) affect renin levels. Elevated renin levels may indicate essential hypertension, malignant or renovascular hypertension, Addison's disease, cirrhosis, hypokalemia, hemorrhage, and reni-producing renal tumors (Bartter's syndrome). Decreased levels could be associated with salt-retaining steroid therapy and antidiuretic hormone therapy.

Blood UREA Nitrogen and Creatinine Tests

BUN (Blood Urea Nitrogen)

Part of a renal function test BUN levels indicate primary renal disease (e.g. glomerulonephritis, pyelonephritis, acute tubular necrosis and urinary obstrction from tumor or stones). Normal value ranges from 5 to 20mg/dl. An elevated level my indicate the kidneys are overwhelmed by excessive amounts of protein for hepatic catabolism and so are unable to excrete the sudden load of urea. BUN level may increase in gastrointestinal (GI) bleeding disorders. Decreased BUN levels can occure from toxins (e.g. gentamicin, tobromycin, myoglbin and free hemoglobin), overhydration or dehydration, shock, congestive heart failure, liver failure, negative nitrogen balance and pregnancy.

CREA (Creatinine)

Normal values range from 0.7 to 1.5 mg/dl. Elevated results may indicate renal disorders (e.g. glomerulonephritis, pyelonephritis, acute tubular necrosis and urinary obstructions).

Bun-Creatinine ratio may be used to assess kidney function. A normal value would expect a 20(BUN) to 1(Createnine) ratio. (some sorces use 15:1). When BUN level is elevated out of proportion to the creatinine level this may indicate dehydration, gastrointestinal bleeding or malnutrition. When BUN level decreased out of proprtion to the creatinine level, then low protein intake, overhydration or severe liver failure is indicated. If both levels are elevated this may be due to kidney failure or disease

Creatinine Clearance is used to assess renal function. Normal urine sample value ranges from 95 to 104 ml/min for men and 95 to 125 ml/min. for women. Lower than normal results may indicate renal artery atherosclerosis, dehydration or shock. Most primary renal diseases (e.g. glomerulonephritis and acute tubular necrosis) cause a decreas in creatinine clearance level. Long standing obstruction to urinary outflow can cause decreased levels.

Other Urineary Tests

24hr Urine Test for Vanillylmandelic Acid (VMA) and Catecholamines.

Diagnose hypertension secondary to pheochromocytoma. Normal Values range from 1 to 9 mg/24 hours. Catecholamines' Epinephrine range from 5 to 40ug/24 hours, Norepinephrine range from 10 to 80 ug/24 hours, Metanephrine range from 24 to 96 ug/24 hours, and Normetanephrime ranges from 75 to 375 ug/24 hours. One or all results in excessive quanities in a 24-hour collection of urine may indiecate pheochromocytoma. Elevated VMA and catecholamine levels also appear in neuroblastomas, ganglioneuromas, and ganglioblastomas. Servere stree, strenuous excercise and acute anxiety can cause elevated catecholamine results

Urinalysis tests -

pH - indicate acid-base balance. Normal values range from 4.6 to 8.0 (6.0 average). A higher result indicates a loss of acid (Alkademia or alkaline pH) which may be from bacteruria, urinary tract infection (caused by Pseudomonas or Proteus organisms) (see Microscopic examination below) or a diet high in fruits and vegetables. Lower then normal results indicate Acidemia (acid urine) which may be from metabolic or respiratory acidosis, starvation, diarrhea, or a diet high in meat protein or cranberries.

Appearance - Normally clear, presence of pus, red blood cells, bacteria or certain foods (e.g. large amoutns of fat), urates or phosphates may cause cloudy urine.

Color - Normal color is Amber yellow. Abnormally colored urine may indicate a pathological condition (e.g. bleeding from kidneys produces dark red urine; bleedin gfrom the urinary track produces bright red urine). Dark yellow urine may indicate the presence of bilirubin or urobilinogen. Pseudomanas organisums usually produce a green urine. where certain foods and medicines alter urine color (e.g. beets can cause a red urine, rhubarb can cause a brown colored urine.) Many commonly used drugs can affect the color of urine.

Odor - A severe smell of acetone can occure with diabetic ketosis. Infected urine has an unpleasant order.

Specific Gravity - May increase with dehydration, pituitary tumor that causes the release of excessive amounts of ADH, a decrease in renal blood flow, glucosuria and proteinuria. Normal values range from 1.005 to 1.030 (usually 1.010 to 1.025). A decrease in specific gravity may indicate overhydration, diabetes insipidus and chronic renal failure.

ALB (Albumin) Urine Protein - Normal values range up to 8 mg/dl. Any elevated results indicate the presence of protein in the urine which may be due to glumerulonephritis or preeclampsia in pregant women.

GLU (Glucose) Urine - There should be no Glucose in a urine sample. Any levels may occure in diabetics not well controlled with hypoglycemic agents, Intravenous (IV) administration of dextrose-containting fluids, central nervous system disorders (e.g. stroke), Cushning's syndrome, severe stress, infections and certain drugs (e.g. ascorbic acid, aspirin, keflin, epinephrine, and streptomycin).

Ketones - Any keytone levels may occur in poorly controlled diabetes (mmost often in juvenile diabetes). Nondiabetic clients may elevate levels with dehydration, starvation, or excessive aspirin ingestion.

Microscopic examinations - include Red Blood Cells (RBC), White Blood Cells (WBC) and Casts (White Blood Cell clumps indicating pyelonephritis or Red Blood Cell clumps indicating glomerulonephritis). Normal values would be up to 2 RBCs and up to 4 WBCs at low-power field, negative or occasional hyaline, no crystals or bacteria. Elevated RBC may indicate microscopic hematuria. Elevated WBC may indicate urinary track infection. Hyaline casts are conglomerations of protein and signal proteinuria. Crystals occure with high serum acid levels (gout). Phosphate and calcium oxalate crystals may indicate hyperparathyroidism or malabsorption states. The presence of bacteria may indicate urinary tract infection (see pH above).

Reagent strip method (dipstick) is the most commonly employed method to test for proteinuria. It tests mainly for albumin, is sensitive to 10-30 mg/dl and is read out by a color change. The intensity of the color change is proportional to the concentration of protein, with trace = 10-30 mg/dl, 1 + = 30 mg/ dl, 2 + = 100 mg/dl, 3 + = 500 mg/dl, and 4 + >1000 mg/dl. Highly concentrated or alkaline (pH>8) specimens may give a false positive reaction, while very dilute urine and globulins may give a false negative reaction.

X-Ray Tests -

Nephrotomography (detect presence of solid renal and adrenal tumors);

Pyelography (to localize ureteral obstructions caused by stricture, nonopaque stone, or tumor, postoperative ureteral diversion obstruction evaluation, and Ureteropelvic and ureterovesical obstruction in a child with hydronephrosis wich poor opaque excretion);

IVP (Intravenous Pyelography) or Excretory Urography to help detect Glomerulonephritis, Tumors (benign or malignant) or benign renal cyst, Intrinsic tumors or stones, Retroperitoneal and pelvic tumors, anerurysms and enlarged lymph nodes that produce extrinsic compression, renal hematomas, renal artery laceration, and Lacerations of the kidney, pelvis, ureters and bladder.

Retrograde Pyelography to detect tumors, benign strictures, stones and extrinsic compressions.

Renal Angiography (Renal Arteriography) used to detect abnormal renal vasculature or Transection of the renal artery.

Voiding Cystourethrography (Voiding Cystogram) used to detect Bladder tumors, Extrinsic compression of distortion of the bladder with pelvic tumors, Hematomas, Traumatic rupture of the bladder or Vesicoureteral reflux.

KUB (X-Ray Study of the Kidneys, Ureters and Bladder) used to detect tumor, malformation and calculi.

Nuclear Scanning - Renal Scanning (Kidney Scan, Radiorenography, Radionucleotide Renal Imaging, Nuclear imaging of the Kidney) is used to detect renal infraction, renal arterial atherosclerosis, trauma, kidney transplant rejection, glomerulonephritis or acute tubular necrosis, tumors, abscesses or cysts. Computer Tomography of the Kidney (CT of the Kidney) is used to detect Tumors, cysts, obstructions, calculi, and congential anomalies.

Special Studies -

Cystometry - is used to monitor and measure outflow of urine. The normal maximum cystometric capacity for men range from 350 to 750 ml and 250 to 550 ml for women. The normal intravesical pressure when bladder is empty is usually (less than) <40cm H2O. Detrusor pressure (less than) <10 cm H2O. The frequency and urgency especially before sugery and help elucidate the cause (neurologic, infectious, obstructive disease). Cystometry is also used to evaluate incontinence, persistent residual urine, vesico-ureteric reflex, neurologic disorders, sensory disorders and the effect of certain drugs on bladder function.

Cytoscopy allows direct inspection and removal of biopsy specimens of the prostate, bladder and urethra for dumor determination. It is also used to collect separate urine specimens directly from each kidney by the placement of ureteral catheters, measurement of bladder capacity and evidence of uretheral ruflex for identificaiton of bladder and ureteral calculi, or for placement of urethral catheters for retrograde pyelography and identification of the source of hematuria. Cytoscopy is used to permit resection of small tumors, removal of foreign bodies and stones, dilatation of the urethra and ureters, palcement of catheters to drain urine from the renal pelvis, coagulation of bleeding areas and implation of radium seeds into a tumor.

Endourology is used to evaluate hematuria, chronic infections, suspected stone, Stricture, neoplasia, prostatic hypertrophy and readiographic filling defects.

Pelvic Floor Sphincter EMG (Electromyography) is used to evaluate external sphincter (skeletal muscle) activity during voiding, evaluate the bulbocavernous reflex and voluntary control of external sphincter or pelvic floor muscles or to investigate functional or psychologic voiding disturbances. Normal EMG results would include increased signal during bladder filling and at the end of voiding and Silent EMG signal on voluntary micturition.

Renal Biopsy is used to diagnose the cause of glomerulonephritis (e.g. poststreptococcal, Goodpasture's syndrome, lupus nephritis), to diagnose or rule out primary and metastatic malignancy of the kidneys who are not surgical candidates or to evaluate the amount of rejection occuring after a kidney transplant.

Renal Ultrasounography (Kidney Sonogram) is used to locate renal cysts, to differentiate renal cysts from solid renal tumors, to demostrate renal or pelvic calculi or to guide a percutaneously inserted needle for cyst aspiration or removal of a biopsy specimen. Ultrasound-Guided Cyst Aspiration Study is also used to help diagnose a cystic tumor.

Renal Vein Assay for Renin is used to diagnose renovascular hypertension possibly from renal artery stenosis. Split Renal Function Studies is used to diagnose renal artery stenosis.

Urethral Pressure Measurement (Urethral Pressure Profile) is used to help diagnose prostatic obstruction and postprostatectomy problems, to assess stress incontinence in feamales, access the adequacy of external sphincterotomy and the adequacy of implated artificial urethral sphincter devices and to analyze the effects of drugs on the urethra and the effects of stimulation on urethral flow. The Maximum urethral pressures in normal patients would be 37 to 126 cm H2O in Males under 25 and 55 to 103 cm H2O in Females under 25, 35 to 113 cm H2O in Males and 31 to 115 cm H2O in Females ages 25 to 44 years, 40 to 123 cm H2O in Males and 40 to 100 cm H2O in Females ages 45 to 65, and 35 to 105 cm H2O in Males and 35 to 75 cm H2O in Females over 65.

Urine Flow Studies (Uroflometry) is used to investigate dysfunctional voiding, suspicious outflow tract obstruction and to assess the outflow tract of the kidney before and after any procedured designed to modify it's function. Normal volume expected would be Minimum of 100 ml for ages 4 to 13 and a minimum of 200 ml for ages above 13. Also the normal volume rate expected should be (greater than) >10 - 12 ml/sec for Males and >10 to 15 ml/sec for Females ages 4 to 13, >21 for Males and > 18 for Females ages 14 to 45, >12 for Male and > 15 for Females ages 46-65, and >9 for Males and >10 for Females ages 66 to 80 year old.

Endocrine System

Antithyroglobulin Antibody Test (Thyroid-Auto-Antibody)

This test is used to diagnose of thyroid diseases (e.g. Hashimoto's thyroiditis and cancer of the thyroid). The normal value should be (less than) <1:100 (1 part in 100) titer. Increased antihyroglobulin antibodies may indicate a rheumatoid-collagen disease, pernicious anemia, thyrotoxicosis (Graves' disease), and lupus erythematosus.

Antithyroid Microsomal Antibodies (Antimicrosomal Antibody Test; Microsomal Antibody)

This test is used to help diagnose Hashimoto's thyroiditis. Normal values should be (less than) <1:100 Titer (also present in 5-10% of healthy people). Elevated results may also appear with myxedema, thyroid carcinoma, granulomatous ththyroiditis, lupus erythematosus, rheumatoid arthritis, autoimmune hemolytic anemia and nontoxic nodular goiter.

Cortisone Administration Test (DENT Test)

Used to differentiate the hyperparathyroid patient from the hypercalcemia patient resulting from other causes. Lower serum levels indicate that hyperparathyyroidism is not causing hypercalcemia. Cause may be sarcoidosis, vitamin D intoxication or bone metastasis. Procedure uses Calcium (CA) baseline level followed by a second calcium level after a 10 day cortisone course.

FTI (Free Thyuroxine Index)

This test is used to diagnose hyperthyrodism and hypothyroidism especially with abnormalities in thyroxine binding protein levels. Normal results range from 0.9 to 2.3 ng/dl. High FTI suggests hyperthyroidism while Low FTI values indicate hypothyroidism.

ITT (Insulin Tolerance Test) and GH (Growth Hormone) Stimulation Tests

This test is used to obtain information about the reserve capacity of GH. Even though GH level may be normal, the pituitary may not be capable of producing more GH when needed, such as with the stress of sugery. Growth Hormone Stimulation tests are used with others to diagnose dwarfism and small stature. Normal values for ITT consitent rise in GH levels over 20 ng/ml in conjunction with a decrease in blood glucose to less than 40 mg/dl (or less than 50% basal fasting level). Children may have no ITT althought the GH level is adequate.The combination of ITT and arginine as a stimulation test is used for GH definciency testing in children. A normal response to use of arginine would be GH levels up to 7 ng/ml. An increase GH may indicate hyperthyroidism and starvation while a decreased GH is found with cirrhosis, diabetes mellitusm, hypothyroidism and obesity.

LATS (Long-Lasting Thyroid Stimulation)

Normally LATS does not appear in serum it usually indicates Hypethyroid or may appear with malignant exophthalmos. It may also appear in neonates whose mothers have Graves' disease.

CA (Calcium)

This test is used to evaluate parathyroid function and calcium metabolism. Normal result values range from 9 to 10.5 ng/dl (total). Elevated results (on three separate tests) indicate hypercalcemia caused by metastatic tumor to the bone, hyperparathyroidism, nonparathyroid PTH producing tumors (such as lung and renal carcinomas), vitamin D intoxication, sarcoidosis, and excessive ingestion of concentrated milk or calcium containing antacids. Thiazide duyretucs may cause hypercalcemia by impairing the urinary excretion of calcium. A serum parathormone blood level determination differentiates this condition from hyperparathyroidism. Low levels indicate hypocalcemia, which occurs with hypoparathyrodism (usually following parathyroid surgery) and with renal failure or rickets.

CA/PTH Differential Diagnosis using concomitant (occuring concurrently) serum parathormone (PTH) and serum calcium assays:

GH (Serum Growth Hormone); RIA

Increased secretion of GH is associated with adult acromegaly, bronchogenic cancer, gastric cancer, gigantism in children, infants with psychosocial deprivation syndrome, excercise, stress, sleep, ingestion of high levels of protein, l-dopa medication use and increased levels of human placental lacogen in pregnant women. Normal levels range from 0 to 8ng/ml for Adults and 0 to 10ng/ml for children. Lower than normal secretion of GH is associated with pituitary dwarfism in children, older children with psychosocial deprivation syndrome, ingestion of a glucose lead hyperglycemia and doses of glucocorticoid. GH levels fluctuate throught the day but usually secreates consistently during sleep. GH levels are used to assist in the diagnosis of secreting pituitary tumors and idiopathic pituitary deficiencies.

PTH (Serum Parathyroid Hormone); Parathormone Test

Normal value should be (less than) <2,000 pg/ml. Increased levels may indicate hyperparathyroidism or nonparathyroid, ectopic, PTH-producing tumors (as in lung and kidney carcinoma) or as a normal compensatory response to hypocalcemia due to renal failure or vitamin D deficiency. (See CA/PTH Differential Diagnosis above). Decreased levels may indicate hypoparathyroidism (mostly resulting from surgery) or an appropriate response to hypercalcemia in patients with metastatic bone tumors, sarcoidosis, vitamin D intoxication, or milk-alkali syndrome.

T4 (Serum Thyroxine)

To test thyroid functions and detect hypothyroidism in infants. Murphy-Pattee results normally range 10.1 to 20.0 ug/dl for neonate, 5.6 to 12.6 ug/dl for 1 to 6 year olds, 4.9 to 11.7 ug/dl for 6 to 10 year olds and 4 to 11 ug/dl for 10 year olds. Radioimmunoassay results range normally from 5 to 10ug/dl. Greater than normal levels indicate hyperthyroid states (e.g. Graves' disease, Plummer's disease, or toxic thyroid adenoma). Pregency and oral contraceptives can elevate results. Lower than normal results can appear in hypothyroid states (e.g. cretinism or myxedema).

T3 (Serum Triiodothyronine)

Another test to aid in the diagnosing of Hypothyroidism, and hyperthyroidism particularly when T4 level is normal but when other symptoms of hyperthyrodism exists. Normal result values range from 110 to 230 ng/dl. Below normal indicates possible hypothyroid state.

RT3U (T3 Resin Uptake)

TBG and TBPA levels are used to accurately assess the thyroid status.

TSH (Thyroid-Stimulating Hormone); Thyroid Stimulation Test

This test is used to detect primary hypothyroidism in newborns who have low screening T4 leves. It is also used to differentiate pituitary from thyroid dysfunction or primary from secondary hypothyroidism. Normal Values range from 1 to 4uU/ml. (Less than) <25 uIU/ml in Neonates by 3 days of age. TRH and TSH levels are elevated in primary hypothyroid states (e.g. surical or radioactive thyroid ablation, burned-out thyroiditis, thyroid agenesis, congenital cretinism) or in taking antithyroid medications. Plasma levels of TRH and TSH are near zero in secondary hypothyroidism because the function ot the hypothalamus or pituitary is faulty possibly due to a tumor, trauma or infarction, and TRH and TSH cannot be secreated. A decreased T4 and a normal or elevated TSH level can indicate a thyroid disorder where a decreased T4 with a decreased TSH can indicate a pituitary disorder.

TSH Stimulation Test (Thyroid Stimulation Test)

This test is used to differentiate "primary" or thyroidal hyperthyroidism from "secondary" or hypothalmic-pituitary hypothyroidism. Normal results would be increased thyroid function with administration of exogenous TSH. An increase of (less than) <10% in RAIU or (less than) <1.5 ug/dl rise in T4 (or PBI) indicatea a "primary" or thyroidal hypothyroid state. An RAIU increase of at least 1% or a T4 level increaseof 1.5ug/dl or more indicates inadequate pituitary stimulation or an intrinsically normal thyroid (i.e., if condition is secondary hypothyroidism).

TSH Suppression Test (Thyroid Suppression Test)

Normally a 50% reduction in RAIU in response to T3 administration is expected. Little or no decrease in TSH levels indicates autonomous and overactive thyroid function (e.g. Graves' disease, Plummer's disease, or toxic adenomas). This test is used to assess whether normal homeostatic mechanisms control thyroid function.

TRH (Thyrotropin-Releaseing Hormone) Test

This test is used to aid in the detection of primary, secondary and tertiary hypothyroidism or to differentiate primary from manic-depressive psychiatric illness and from secondary types of depression. Normally a prompt rise in Serum TSH to approximate twice the baseline level by 30 minutes after a dose of an IV bolus of TRH (Response is normally greater in women than in men.) A slight or no increase in TSH levels occurs in hyperthyroidism. With secondary hypothyroidism (anterior pituitary failure) no TSH response occurs. A delayed rise in TSH indicates hypothyroidism (hypothalamic failure). Multiple injections of TRH may be needed to induce the appropriate TSH response in this case. Certain conditions (e.g. psychiatric primary depression, acute starvation) and medication therapy (aspirin, levodopa or adrenocorticosteroids) depress TSH response to TRH. A blunt TSH response occurs in the majority of primary depression patients.

TBG (Thyroxine-Binding Globulin) Test

To elevate abnormal thyroid states not correlating with T3 or T4 values because an underlying TBG abnormality makes T3 and T4 test results inaccurate. This test helps identify TBG abnormalities. Normal values range from 12 to 28 ug/ml. Increased levels may indicate hypothyroidism, pregnancy or with presences of certain medication (e.g. estrogens, oral contraceptives and long-term perphenazine medications). TBG levels may be decreased with hyperthyroidism, nephrotic syndrome, malnutrition with hypoproteinemia, acromegaly, liver disease, uncompensated acidosis, acute stress or surgical stress.

ADH (Antidiuretic Hormone); Water Deprivation Test

By withholding all fluids intake over a set period of time, Check urine and serum for changes in osmolarity. Serum osmolarity is an indirect measurement of ADH. ADH is measured using the 24-hour Mosenthal test, 12-hour Fishbert test, the 14- and 8- hour deprivation tests, and the renal concentration test. Normal values should be (greater than) >800mOsm/kg of water in Urine, Urine osmolarity greater than serum osmolarity or unchanged Serum osmolarity. Deviations from normal may indicate nephrogenic diabetes insipidus, Neurohypophyseal diabetes insipidus or primary polydipsia. This test is used to differentiate among possible causes of polyuria and to assess ability to produce ADH.

CA (Urine); Calcium

Normal range values differs according to diet but usually range from 100 to 300 mg/24 hours. Increased calcium excretion occurs in most clients with primary hyperparathyroidism. Hypercalciuria may also occure with idiopathic hypercalciuria, Cushing's syndrome, milk-alkali syndrome, osteoporosis, osteolytic bone disease, renal tubular acidosis, sarcoidosis, or vitamin D intoxication. Decreased values indicate hypoparathyrodisim, malabsorption disorder, vitamin D deficiency or dilute urine.

Radiologic Tests

PRL (Lactogenic Hormone); Luteotrophin; Mammotropin; RIA (Prolactin) - are used to assist in the diagnosis of pituitary necrosis or infraction where decreased levels are detected and with amenorrhea, galactorrhea, hypothalmic tumors and primary pituitary tumors with increased levesl of PRL. Normally Prolactin increases with sleep and decreases during activity. Normal value ranges from 6 to 30 ng/ml in adult females, 5 to 18 ng/ml in adult males, and elevated levels in neonate children through 6 weeks of age.

RAIU (Radioactive Iodine Uptake) Test - is used to assess thyroid function. Normal values range from 4% to 12% absorbed by thyroid within 2 hours, 6% to 15% absorbed within 6 hours and 8% to 30% absorbed within 24 hours. An increase thyroid uptake of radioactive iodine occurs in hypethyroid states. Decreased uptake occures in hypothyroid conditions. Artifically decreased RAIU levels occur with suppressive doses of thyroid extract or antithyroid drugs. Diarrhea will decrease absorption of tracer doses in the gastrointestinal (GI) tract thereby decreasing RAIU test results. Iodine deficent patients will uptake markedly and falsely increase results.

Thyroid Scanning (Thyroid Scintiscan) - The size, shape, position and function of the thyroid gland is examined. Functioning nodule may represent benign adenoma or localized toxic goiter. A nonfunctioning nodule may represent a cyst, carcinoma, nonfunctioning adenoma or goiter, lymphoma or a localized area of thyroiditis. This is used to determine whether a neck or substernal mass arises from within or outside the thyroid and to assist in differentiating the two formes of hyperthyroidism: Graves' disease (diffusely enlarged hyperfunctiong thyroid gland) or Plummer's disease (nodular hyperfunctioning gland). It is also used to evaluate the success of medical treatment for hyperthyroidism, demostrate a primary thyroid tumor with metastatic tumor without a know primary site or to determine areas of metastasis with a well differentiated form of thyroid cancer.

Special Studies - Ultrasound Examination of the Throid (Thyroid Echogram)

Used to distiguish a cyst from a solid or mixed nodule, which may be cancerous. Also used to determine response of a thyroid mass to medical treatments.

Adrenal Glands

ACTH (Serum Adrenocorticotropic Hormone) Test

This test is used to help determine the cause of Cushing's syndrome or Addison disease. Normal result values range form 15 to 100 pg/ml. Elevated ACTH levels with Addison's disease indicates primary adrenal gland failure (e.g. adrenal gland destruciton caused by infarction, hemorrhage, or autoimmunity, surgical removal of the adrenals; congenital enzyme deficiency or adrenal suppression oafter prolonged ingestion of exogenous steroids). Below normal levels of ACTH with Addison's disease may indicate that hypopituitarism is the most probable casue of the hypofunction.

High levels (greater than) >200pg/ml may indicate ectopic ACTH production with Cushing's syndrom, a pituitary ACTH producting tumor (rare), or a nonpituitary (ectopic) ACTH producing tumor usually in the lung, pancreas, thymus or ovary which can cause bilateral hyperplasia. Low levels in cushingoid patients may indicate that an adrenal adenoma or carcinoma is the most progable casue of the hyperfunction.

ACTH (Adrenocorticotropic Hormone) Stimulation Test

To aid in diagnosing and determining the cause of Addison's disease or Cushing's syndrome. Normal levels would be 40 ug/dl after 24hr infusion. Elevated results occurs in cusingoid clients with biateral adrenal hyperplasia. Lower than normal results may indicate hyperfunctioning adrenal tumors. When Addison's disease is suspected, 10 ug/dl to 40 ug/dl indicate the adrenal gland is capabl.e of function if stimulated indicating that the cause of adrenal insufficiency lies within the pituitary (hypopituitarism) aand the secondary adrenal insufficiency. When Addison's disease is suspected and little or no rise in the cortisol level indiacates that the adrenal gland is capable of secreting cortisol (primary adrenal insufficiency) because of adrenal descrution from hemorrhage, infarction, autoimmunity, metastatic tumor, surgical removal of the adrenals or congenital adrenal enzyme deficiency.

Plasma Cortisol Test

Cushing's syndrome often have top-normal plasma cortisol levels in the morning and od not exhibit a decline as the day proceeds. Normal Morning specimen ranges from 6 to 28 ug/dl. Afternoon specimen normally decrease from 2 to 23 ug/dl. Low levels of plasma cortisol suggest Addison's disease.

17-OCHS (Urine tests for 17-Hydroxycorticosteroids and 17-Ketosteroids)

This test is used to assess adrenal cortical function. Normal 17-OCHS results in men range from 5.5 to 15 mg/24hr., 5 to 13.5 mg/24hr in women and lower thatn adult values in children. 17-KS normal results range from 8 to 15 mg/24hr in men, 6 to 12 mg/24hr in women, 5 to 12 mg/24hr. in children 12 to 15 yrs. and (less than) <t mg/24hr in children under 12.

Elevated levels of 17-OCHS may indicate hyperfunctioning of the adrenal gland (Cushing's syndrome) whether pituitary or adrenal tumor, bilateral adrenal hyperplasia or ectopic ACTH-producing tumor causes the condition. Decreased levels of 17-OCHS may indicate hypofunctioning adrenal gland (Addison's disease) resulting from destruction of adrenals by hemorrhage, infarction, metastatic tumor, or autoimmunity, surgical removal of adrenals without appropriate steroid replacement, congenital enzyme deficiency, hypopituitarism, or adrenal suppression aftger prolonged exogenous steroid ingestion.

Elevated 17-KS levels may indicate congenital adrenal hyperplasia and testosterone or estrogen secreting tumors of the adrenal, overies or testes. Low levels of 17-KS can occur in addisonian patients and in patients who have undergone removal of the ovaries or testes.

Dexamethasone Supression Test (Prolonged/Rapid)

Normally the rapid method would result in nearly zero cortisol levels. In the Prolonged method results would normally be (greater than) >50% reduction of plasma cortisol and 17-OCHS levels (low or high dose). With Cushing's syndrome: bilateral adrenal hyperplasia, a low dose would expect no change while a high dose would expect (greater than) >50% reduciton of plasma cortisol and 17-OCHS levels. With Adrenal adenoma or carcinoma no change is expected for either a low or high dose. With Ectropic ACTH producing tumor - no change is expected for either a low or high dose. No reduction in plasma or urinary steroid levels on low dose dexamethasone suppression may indicate Cushing's disease caused by bilateral adrenal hyperplasia. With cushingoid patients with autonomous adrenal tumors, pituitary ACTH will already be suppressed, and the tumor will screte high levels of cortisol despite the dexamethasone. Therefore no reduciton in plasma and urine steroid levels will occur with low dose dexamethasone suppression. If dexamethasone is adminstred in hign enough doses, with adrenal hyperplasia, pituitary ACTH production can be suppressend and plasma and urineary steriod levels can be expected to fall. With adrenal tumors or ectopic ACTH producing tunmors still no plasma or urine steroid level reduction will occur even with high dose suppression.

Metyrapone Test

To differentiate adrenal hyperplasia from adrenal tumor by determining whether the pituitary-adrenal feedback mechanism is intact. A normal result would be a baseline excretion of urinary 17-OCHS should be more than doubled. Increased levels of 17-OCHS may indicate adrenal hyperplasia while no response (no increase levels) occurs to metyrapone with Cushing's syndrome resulting form adrenal adenoma or carcinoma.

Adrenal Angiography, Adrenal Venography, X-Ray Study of the Sella Turcica and Computerized tomography of the Adrenal Glands (CT scan of the adrenals)

These Rediologic Laboratory tests may be used to diagnose benign and malignant adrenal tumors and belated adrenal hyperplasia, to detect pathologic anatomy of the adrenal vein, to diagnose ACTH-producing tumors of the pituitary, to detect small tumors (adenomas, carcinomas, and pheochromocytomas) of the adrenal glands, bilateral adrenal hyperplasia or adrenal hemorrhage causing Addison's disease.

Endocrine Glands

GTT (Glucose Tolerance Test); OGTT (Oral Glucose Tolerance Test)

Used to diagnose diabetes mellitus. Markedly elevated serum glucose levels from 1 to 5 hours after glucose administration indicates diabetes mellitus. Glucose can als usually be detected in the urine. Persistent hyperglycemia after glucose laoding can also be seen in nondiabetic clients with hyperthyrodism, acromegaly, infections or ongoing chronic illness (e.g. cancer). Pregnant or obese clients may also show elevations. Drugs such as nicotine, aspirin, steroids, thiazides and oral contraceptives may also cause glucose intolerance ain nondiabetic clients. Normal result range values range after fasting before test and 3 hours after glucose administration would be 70 to 115 mg/dl for Serum and 60 to 100 mg/dl for Whole blood. 30 mins and 1 hr after glucose administration Serum normal range should be (less than) <200 mg/dl and (less than) <180 mg/dl for Whole Blood. 2 hours after glucose administration Serum normal range is (less than) 140mg/dl and (less than) 120 mg/dl for Whole Blood.

HbA1c (Glycosylated Hemoglobin); Glycohemoglobin

Used to evaluate the success of diabetic treatment, which included hypoclycemic agents, dietary therapy, or insulin pumps, to compare and contrast the success of old and new forms of diabetic therapy, to aid in determining the duration of hyperglycemia in newly diagnosed diabetics, to provide a sensitive estimate of glucose impalance in a mild case of diabetes, and to individualize diabetic control regimens. Normal ranges from 2.2% to 4.8% in adults, 1.8% to 4.0 % in children. Good diabetic control can range from 2.65% to 6%, Fair diabetic control can range from 6.1% to 8% where poor diabetic control is usually over 8%

Plasma Insulin Assey

To diagnose insulinoma, and to evaluate abnormal lipid and carbohydrate metabolism. Normal result values range from 5 to 20 uU/ml. An Insulin to glucose ratio of (less than) <0.3 occurs with insulinoma.

GLU (Serum Glucose Test)

Glucose measurements are used in the diagnosis and treatment of carbohydrate metabolism disorders including diabetes mellitus, neonatal hypoglycemia and idiopathic hypoglycemia and of pancreatic islet cell carcinoma. Normal Adult result value ranges from 70 to 115 mg/dl in serum and 60 to 100 mg/dl with whole blood. Normal children result value ranges from 60 to 100 mg/dl in serum and 30 to 80 mg/dl with whole blood. True glucose elevations generally indicate diabetes mellitus. Hyperglycemia caused by acute stress response (e.g. surgery), Cushing's disease, hyperthyroidism, adenoma of the pancreas, pancreatitis, diuretics and corticosteroid therapy. Low serum levels can be caused by insulin overdose, insulinoma, hypothyroidism, hypopituitaris, Addison's disease and extensive liver diseae.

Serum Osmolality Test

Normally calculated from the results of several tests, expected result ranges from 275 to 300 mOsm/kg. Elevated results can indicate hypernatremia, ketosis, dehydration and diabetis insipidus. Low serum osmolality usually results from fluid overload and inappropriate secretion of antidiuretic hormone (ADH).

PPG (2-Hour Postprandial Glucose Test); PPBS (2-hour Postprandial Blood Sugar)

Used to screen for diabetes mellitus, normal serum result levels expect (less than) <140 mg/dl or (less than) <120 mg/dl for whole blood. Elevated levels 2 hours after a meal indicates positive.

Urine test for Glucose and Acetone (Urine S & A; Fractional Urine)

Negative results for glucose and acetone can be used to rule out hyperglycemia when used to monitor insulin therapy in diabetics.

PHOS (Serum Phosphate) Phosphorus Concentration Test

Used in the diagnosis and treatment of parathyroid gland and kidney diseases and vitamin D imbalance. Normal results value ranges from 2.5 to 4.5 mg/dl in adults and 3.5 to 5.8 mg/dl in children. Hypoparathyroidism, renal failure, or increased dietary or IV intake can cuase hyperposphatemia (Higher than normal results). Inadequate dietary ingestion of phosphorus, chronic antacid ingestion, hyperparathyroidism and hypercalcemia resulting from other causes may result in hypophosphatemia (lower than normal resutls).

Reproductive System

Infertility

Hormone Assay for Urinary Pregnanediol

This test is used to determind if and the exact time ovulation has occured, monitor the status of the placenta during pregnancy by performing repeated tests and to monitor progesterone supplementation with inadequate luteal phase. Increased excretion after ovulation to (greater than) >1 mg/24 hr. for approximately 10 days is normally expected. Normal preovulation levels range from 0.3 to .05 mg/24hr. A decrease in prenanediol levels may preceed a spontaneous abortion. Pregnanediol levels rise immediately after ovulation and normally during pregnancy because of placental progesterone production.

X-Ray Hysterosalpingography (Uterotubograhy; Uterosalpingography) is used to aid in diagnosing fallopian tube obstruction and document adequacy of surgical tubal ligation.

Special Studies includes

Pregnancy and the Reproductive System

Fetal Scalp Blood pH

This test is used to assess fetal acid-base status which can help diagnose fetal distress. A decrease in pH occurs as a result of acidosis (increased hydrogen ion concentration). Fetal hypoxia is then indicated. Normal Fetal pH value range from 7.25 to 7.35, O2 saturation range from 30% to 50%, PO2 normally range from 18 to 22 torr, PCO2 range from 40 to 50 torr and Bass excess range from 0 to -10 mEq/L.

HPL (Human Placental Lactogen)

Normally HPL levels gradually rise until the 36th week of pregnancy and then tend to stabilize. Result values of (less than) <4ug/dl are raely found in the last 10 weeks of pregnancy, Low HPL levels may indicate fetal distress, theatened abortion, toxemia, intrauterine growth retardation and postmaturity. High HPL levels may indicate maternal sickle cell disease, maternal liver disease, maternal diabetes mellitus, Rh sensitization and multiple pregnancies.

Pregnancy Tests, HCG (Human chorionic gonadotropin)

Usually negative unless patient is pregnant. A positive test may indicate pregnancy unless some premonopausal or preimenopausal with gonadal homone difficiencies usually caused by over production of pituitary gonadotropin, which can cause "HCG-Like" positive reactions. Certain tranquilizers, especially promazine and its derivativesmay also cause false positive results. A false negative could occur as a result of the test performed too early in the pregnancy before a sufficient HCG level develops, or urine diluted by diuretic-induced excesses off excreted free water used. A pregnancy test is also used in diagnosing tumor activity because tumors alos produce HCG.

HAI (Hemagglutination Inhibition) Test, Rubella (German Measles) Antibody Test

To diagnose rubella and to assess pregnant patient's immunity to rubella at the first prenatal vistion she is exposed to rubella. A rise in antibody titer indicates that both the mother and fetus have been infected by rubella. If eht exposure occured during the first trimester of pregnancy, the fetus is at risk for congenital heart defects, deafness, mental retardation and cataracts. A normal HIT titer is (greater than) >1:10 and (less than) <1:20 or if complement-fixation test is positive indicates a lack of susceptibility to rubella. A titer of (less than) <1:9 indicate lottle or no rubella immunity.

VDRL, RPF, FTA (Serological test for syphilis)

This positive/negative resulting test should confirm positive results by the FTA-ABS test. With the VDRL and RPR, conditions such as myucoplasia, pneumonia, malaria, acute bacterial and viral infections, autoimmune diseases and pregnancy can cause false-positive results.

AFP (Serum Alfa-Fetoprotein) Test

Expected normal result would be (less than) <25ng/ml. Elevated results may indicate NTD (neural tube defacts), abortion, multiple pregancy and intrauterine fetal death. Levels of (greater than) >500 ng/ml indicate primary liver cancer in 97% of all cases. AFP levels may also be elevated with Hodgkin's disease, lymphoma and renal tumor.

TORCH (Toxoplasmosis, Other, Rubella, Cyutomegalovirus, Herpes) Test

The term TORCH applies to infections with recognized direct or indirect detrimental effects on the fetus. A positive/negative result where negative is the expected normal value and a positive result may indicate one of the diseases listed above.

Toxoplasmosis Antibody Titer

Used to diagnose toxoplasmosis, a titer of (less than) <1:4 indicates no previous infections, a titer of (greater than) >1:4 and (less than) 1:256 is generally prevalent in the general population, a titer of (greater than) 1:256 suggests a recent infection. P{ersistently elevated or rising titer on the Sabin-Feldman dye test or the indirect fluorescent antibody titer test in the infant 2 to 3 months of age indicates toxoplasmosis. A positive result on a complement-fixation test indicates active disease.

Estriol Excretion Studies

This test helps assess fetal-maternal well-being. Normal result values range from 0.7 to 1.5 mg/dl over a 24 hour period for urine or 1 mg/24h which is approximately equivelent to 0.6 to 0.8 ng/ml for unconjugated plasma estriol. Decreasing values suggest fetoplacental deterioration (failing pregnancy, dysmaturity, preeclampsia/eclampsia, complicated diabetes mellitus, anencephaly, fetal death).

X-Ray Tests (Radiological Laboratory Tests)

X-Ray Pelvimetry (Radiographic Pelvimetry) is used to assess the patients suspected of carrying the fetus in a abnormal position (e.g. breech) when a vaginal delivery is anticipated. A normal value would be a transverse of midpelvis diameter of (greater than) > 10.5cm. Less than 10.5cm indicates that delivery through the birth canal may be difficlut. It is also used to

  • assess patients who have had injury or disease of the bony pelvis or hips that may have caused pelvic distortion.
  • assess a patient with clinically abnormal pelvic measurements.
  • assess patients with debilitating illness complicating the pregnancy and a clinically small or unfavorable pelvis.
  • assess a patient with a history of difficult delivery
  • evaluate the primiparas patient in early labor with the fetus's head unengaged (to rule out cephalopelvic disproportion).
  • assess a patient admitted for trial labor to rule out a contracted pelvis.
  • evaluate a patient experiencing dysfunctional labor.

Special Studies include:

Newborn Evaluation

GAL-1-PUT (Galactose-1-Phosphate Uridyl Transferase)

This blood test usually results ranges from 18.5 to 28.5 U/g hemoglobin, with increased results possibily indicating galactosemia.

PKU (Phenylketonuria Test)

This blood test usually results from (less than) <4 mg/dl. A result level of (greater than) >8 to 12 mg/dl usually indicates phenylketonuria. The urine is also inspected and should normally have no green coloration.

Special Studies

Barr Body Analysis (Sex Chromatin Body; Chromation-Positive Body) is used to detect sex chromosome abnormalities. It is also used to aid in assigning a sex to an infant when ambiguity of the newborn's genitalia make assigning sex to the infant difficult. A lack of Bar body in a female indicates Turner's syndrom (XO), Normal males (XY) have no Barr bodies. A male with Kelinefelter's syndrom (XXY) would have one Barr body. An XXX female has two Barr bodies.

Hematologic System

IVY Bleeding Time (Bleeding Time Test)

To evaluate vascular and platelet factors associated with hemostatis, prolonged bleeding times (greater than) >9mins, can occur in decreased platelet counts, infiltration of marrow by primary or metastic tumor, consumption of platelets during disseminated intravascular coagulation (DIC), increased platete descrution (e.g. in primary and secondary thrombocytopenia and hypersplenism), inadequate platelet function, increased capillary fragility and ingestion of antiinflamatory drugs (e.g. aspirin or indomethacin).

Blood Typing

Blood typing is used to detect antibodies to the recipient's blood in the donor's blood, to screen pregnant women for incompatibility with the fetus' blood and to advise the mother whether she is a candidate for Rhogam (Rh immunoglobulin) after delivery. (Also see: "The Natural History of Genes" Blood Type Web Page at the University of Utah School of Medicine's Web Site.)

Coagulating Factors Concentration

Normally 50 to 200% this test is used to identify the factors involved in the coagulating defect so that appropriate blood component replacement can be administrated.

Factor

Minimum Hemostatic Level

I

60-100 mg/dl

II

10-15 mg/dl

V

5-10 mg/dl

VII

5-20 mg/dl

VIII

30 mg/dl

IX

30 mg/dl

X

8-10 mg/dl

XI

25 mg/dl

If factors I, II, V, VI, IX, X, XI are diminished, Liver disease is indicated, diminished I, V, VIII factors may indicate Disseminated introvascular coagulation (DIC) where diminished I, V, VII factors may indiecate Fibrinolysis. If factors I, II, V, VII, VIII, IX, X, XI are all diminished then Congenital deficiency is indicated where if just II factor is diminished then Heparin adminstration may be indicated. Warfarin ingestion is indicated with II, VII, IX, X, XI factors diminished and if just VIII factor is diminished then Autoimmune disease may be indicated.

CBC (Complete Blood Count) and DIFF (Differential Count); Hemogram

RBC (Red Blood Cell Count)

The red blood cell count varies according to sex and age but normal results for men would be 4.7 to 6.1 million/mm3, for women 4.2 to 5.4 million/mm3, 3.8 to 5.5 million/mm3 for infants and children and 4.8 to 7.1 million/mm3 for newborns.

Lower than 10% of normal results is anemic. Low RBC may indicate Hemorrhage (e.g. gastrointestinal bleeding or trauma, hemolysis (e.g. glucose 6-phosphate dehydrogenase deficiency, spherocytosis, secondary splenomegaly), dietary deficiency (e.g. iron or vitamin B12), genetic aberrations (e.g. sickle cell anemia or thalassemia), drug ingestion (e.g. chloramphenicol, hydantoins, quinine), marrow failure (e.g. fibrosis, leukemia, antieoplastic chemotherapy), chronic illness (e.g. tumor or sepsis) and other organ failure (e.g. renal disease).

Higher than normal results may occure in high altitudes or may indicate diseases that produce chronic anoxia (e.g. congenital heart disease). Polycythemia vera, a neoplastic condition, involves uncontroled production of RBCs.

Hgb (Hemoglolbin) Concentration

Deviations from normal closely parallel those for the RBC count. Hemoglobin concentration more accurately reflects changes in plasma volume. Dilutional overhydration decreases the concentration. Dehydration tends to cause an artifically hige value. Values are decreased during pregnancy. Normal Hgb for men range from 14 to 18 g/dl, women range from 12 to 16 g/dl. Pregnant women would be less than <11 g/dl, children range from 11 to 16 g/dl and newborns range normally from 14 to 24 g/dl.

Hct (Hematocrit)

 

Other Tests

Spinal Tap

The Lumbar puncture and Cerebrospinal fluid examination (LP, Spinal Tap, Spinal Puncture) are used to diagnose brain or spinal cord neoplasm, cerebral hemorrhage, meningitis, encephalitis and degenerative brain disease.

Pressure is measured. Normal Value is (less than) <200mm H20. Elevated results may indicate tumor, hemorrhage, hematoma, tissue edema, scarring, foreign body or intervertebral disc.

Color is observed. Deviation from normal could indicate blood either from subarachnoid bleeding or from the lumbar needle puncture penetrating a blood vessel. Blood in the cerebrospinal fluid indicates cerebral hemorrhage into the subarachnoid space or a traumatic tap. No red blood cells with (less than) <5 lyumphocytes/mm3. Elevated levels may indicate the presence of polymorphonuclear leukocytes (neutrophils) in the cerebrospinal fluid indicating bacterial meningitis or cerebral abscess. The presence of monoculear leukocyutes indicates viral or tubercular meningitis or encephalitis.

Cuture and Sensitivity should indicate no organisms present. Cultured organisms may indicate atypical bacterial, fungi or Bacterium tuberculosis.

TP (Protein) is measured for the normal range values of 15mg/dl to 45 mg/dl. Infectious or inflammatory processes such as meningitis, encephalitis, or myelitis (inflammation of the spinal cord) may yeild deviations from normal. Increase results may indicate Tumors. Elevated globulin fraction of Total Protein may occur with multiple sclerosis, neurosyphilis or degenerative cord or brain disease.

GLU (Glucose) normally ranges from 50 mg/dl to 75mg/dl or (greater than) >40% of blood Glucose. Lower than normal results may indicate meningitis or neoplasm.

Cl (Chloride) normally ranges from 700 mg/100dl to 750mg/100dl. Lower than normal results may indicate meningeal infuctions, tubercular meningitis and conditions of low blood chloride levels.

LDH (Lactic Dehydrogenase) normally ranges from 2U/ml to 7.2U/ml. Elevated LDH indicates infection or inflammation (e.g. bacterial meningitis).

Cytology searches for the presence of malignant cells which may be tumor cells indicating neoplasm.

Serology for syphilis should normally be negative. A positive result on Wassermann, Venereal Disease Research Laboratory (VDRL) or fluorescent treponemal antibody (FTA) tests indicate neurosyphilis.

Index of Acronyms

17-KS | 17-OCHS

ACE | ACTH | ADH | AFP | ALB | ALB (Urine) | ALP | ALPd | ALT | AMM | AMY | ASO | AST

BUN

CA | CA (Urine) | CAT | CATT | CBC | CEA | CL (CSF) | CK | CKNa | CK-B | CK-MB | CPK | CREA | CST

DBIL | DIC & DIC | DIFF

EEG | EFS | EMG | EMI | EP | ERCP

FTA | FTI

GAL-1-PUT | GGT | GGTP | GH | GLU (CSF) | GLU (Serum) | GLU (Urine) | GOT | GPT | GTT

HAA | HAI | HbA1c | HCG | HCO3 | Hct | HDL | HDLc | Hgb | HPL

IgG | IgM | ITT | IVC | IVP | IVY

KUB

LAP | LATS | LDH | LDH (CSF) | LD-L | LDL | LD-P | LIPA | LP

NTD & NTD

OGTT

PAMY | PAP | Pco3 | pH | pH (Urine) | PHOS | PKU | Po2 | PPBS | PPG | PRL | PTH | PTHC

RAIU | RBC & RBC | RIA | RPF | RT3U

SACE | SGO | SGOT | SGPT

T3 | T4 | TBG | TBIL | TGB | TORCH | TP (CSF) | TP | TRH | TRIG | TSH

VDRL | VMA

WBC

Information Sources: (1) The Pocket Nurse Guide to Laboratory and Diagnostics Tests from the C.V Mosby Company, (2) Microsoft Office 97's American Heritage Dictionary of the English Language by Houghton Mifflin Company, (3) Various Internet sources including but not limited to http://allserv.rug.ac.be/~rvdstich/eugloss/EN/lijst.html, http://www.medicinenet.com, and http://www.ipoline.com/~guoli/med/dict0.htm

Disclaimer: The content displayed is designed for entertainment only. Under no circumstance is it meant to replace the expert care and advice of a qualified physician. No medical advice or care should be rendered with this information. Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate. Accuracy cannot be guaranteed. There is no assume responsibility for how information presented is used by the public.

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