Diagnostic Test For Endocrine Disorders

Diagnostic Test for Endocrine Disorders 1. Diagnostic Test of Thyroid Disorder Thy Function Test a. Thyroid – Stimulation hormone assay : Hypofunction of thyroid gland; primary hypothyroidism. : Pituitary disorder; hyperthyroidism. b. Radioactive Iodine Uptake( RAIU) :Hyperthyroidism; urine: hypothyroidism :Hyperthyroidisms; urine: hyperthyroidism. - Patient Teaching: = Radioactive dose is small and harmless. = Contraindicated in pregnancy. = Seafood’s may elevate result. = Drugs that may elevate result: barbiturates, estrogen, lithium Phenothiazines. = Drug that may decrease result: Lugol’s solution, saturated Solution of potassium iodine (SSKI), antithyroid, cortisone, aspirin antihistamines. = Collect 24-hour urine specimen after oral trace dose give. = Thyroid is scanned after 24 hours. c. Thyroid antibodies : thyroiditis d. T3T4 Radioimmunoassay : Hyperthyroidism : Hypothyroidism e. Free Thyroxine Concentration T3 Resin Uptake Thyroid Binding Globulins : Hyperthyroidism : Hypothyroidism Diagnostic Imaging Stuadies a. Thyroid scan - Radioactive iodine taken orally; dose is harmless. - Scanning done after 24 hour. - Avoid iodine containing foods, dyes, medication. - Cold nodules: cancer - Hot nodules” bening b. Ultrasound - No special preparation. c. Magnetic Resonance Imaging - Test cannot be done in client with metal implants( e.g., Pacemakers, arthroplasties, skull plates).

- Assess for allergy to contrast media. d. Computed Tomography - If contrast medium is used, note allergy history. 2. Diagnostic Test of Parathyroid Disorders a. Total serum calcium - Venous blood is collected. - :Hyperparathyroidism - :Hypoparathyroidism b. Qualitative Urinary Calcium( Sulkowitch test ) - Collect urine specimen. - Fine white precipitate should form when Sulkowitch reagent is added to urine specimen. - Absent or decreased precipitate indicate low serum calcium and hypoparathyroidism. c. Quantitative Urinary Calcium ( Calcium Deprivation Test) - Collect 24 hours urine specimen. - :Hyperparathyroidism - :Hypoparathyroidism d. Serum Phosphorous - Collection Venous blood Specimen. - :Hypoparathyroidism - :Hyperparathyroidism e. Serum Alkaline Phosphatase - Collection Venous blood Specimen. - :Hyperparathyroidism - :Hypoparathyroidism f. Parathormore (PTH) Radioimmunoassay - Collection venous blood - : Hyperparathyroidism - When elevated in conjunction with serum calcium levels, this Is the most specific test for Hyperparathyroidism. 3. Diagnostic Test of Adrenocortical Disorder a. Cortisol level with dexamethasone soppression test - Give dexamethasone before phlebotomy to suppress diurnal formation of ACTH. :Pituitary tumor, Cushing’s syndrome or disease. - Addision’s disease. b. Cortisol plasma level - Fasting is required; the patient should be on bed rest for 2 hours before the test because activity increases cortisol level. - :Cushing’s Disease. - :Addison’s Disease.

c. 17- Hydroxysteroids - 24 Hour Urine collection to be kept on ice. - :Cushing’s syndrome or disease. - :Addison’s Disease. d. 17-kefosteroids -24 hour urine test; keep collection cold; may need preservative. - :Cushing’s syndrome. - :Hypofunction of adrenal gland. 4. Diagnostic Tests of Adrenal Medullary Disorders a. Vanillymandelic acid Test (VMA test) - VMA is a metabolite of apinephrine. - 24 hour urine specimen is collected - intruct the client to avoid the following medication and foods Which may alter the result: *Coffee *Chocolate *Tea *Bananas *Vanilla *Aspirin - Normal Value: 0.7 – 6.8mg/24hr. b. Total plasma Catecholamine Concentration - The client should lie supine and rest for 30 minutes. - Butterfly needle is inserted 30 minutes before blood specimen is collected(to prevent elevation of catecholamine levels by the stress of venipuncture). c. Clonidine Suppression Test. - Clonidine (Catapress), a centrally acting adrenergic blocker Suppresses the release of catecholamines. - In pheochromocytoma, clonidine does not suppress the Release of catecholamines. - Normal Response: 2 to 3 hours after a single oral dose of Clonidine the total plasma catecholamine value decreases at at least 40% from the client’s baseline. d. CT Scan, MRI and Ultrasound - To localize the pheochromocytoma. 5. Dianostic Test of Pancreatic Disorder (Diabetes Mellitus) a. FBS (Fasting Blood Sugar); FBG(Fasting Blood Glucose): - Normal: 70 – 110 mg/dl. - DM: ↑140 mg/dl for 2 readings. b. 2 PBBS (2hr. Postprandial Blood Sugar) -initial blood specimen in with drawn. -100 g. of carbohydrate in diet is taken by the client. -2 after meal, blood specimen is withdrawn – blood sugar Return to normal level. c. OGTT/GTT (Oral Glucose Tolerance Test)

Hgb (component rbc bloood ) Excess Glucose in ofthe Attaches to hemoglobin Lifespan is 90-120 days

-Take high carbohydrate diet (200 to 300g) for 3 days. -Avoid alcohol, coffee and smoking for 36 hours before the test. -NPO for 10 to 16 hours. -initial blood and urine specimen are collected. -150 to 300 g. of glucose per orem or IV is given. - Series of blood specimen is collected after administration of glucose (30 min., 1 hour,2hour, if required 3 hour,4hour, and 5hours after.) - If glucose levels peak at the higher than normal at 1 and 2 hours after ingestion or injection of glucose, and slower then normal to return to fasting levels, then DM(diabetes mellitus) is confirmed. -Done when result of FBS an 2 PPBS are borderline( higher normal). d.Glycosylated Hgb(HbAIC) -Most accurate indicate of DM (diabetes mellitus). -Reflects serum glucose level for the past 3 to 4 month -NV is 4% to 6%(up to 7%) for nondiabetics. -the goal for the client with DM is 7 .5% or less

↓ ↓