- Hormones may be measured in blood/plasma or urine
- Markers of function
- Glucose in diabetes
- Calcium in hyperparathyroidism
Basal levels
Blood or plasma levels
- Useful measurements for hormones with long half-life, e.g. thyroxine (T4 and T3)
- Also applied to certain conditions in which normal values are known, e.g.
- Time of day - cortisol and adrenocorticotrophic hormone (ACTH)
- Period of menstrual cycle - follicle stimulating hormone (FSH), oestrogen, progesterone
- Posture - aldosterone
24-hour urine collections
- Provide an average of a whole day's secretion of a hormone
- Require normal renal function and accurately timed and complete urine collection
Dynamic tests
- Test ability of a gland to respond appropriately to stimulation or suppression
- Failure of normal negative fedback causing uncontrolled hormone secretion
- From within the gland
- From an ectopic source
- Failure of a normal positive response to stimulation of a gland
Examples
Stimulation test - Synacthen test
- Normal adrenal response to a dose of synthetic ACTH is an increase in plasma cortisol levels
- Primary adrenal failure - a diminished or absent response
- Adrenal failure secondary to lack of pituitary secretion of ACTH - normal or enhanced cortisol response
- Long synacthen = if short is equivocal and Addison's disease suspected
Suppression test - Dexamethasone suppression test
- Normal response to a dose of synthetic steroid is reduction in pituitary release of ACTH and subsequent fall in adrenal cortisol release and plasma levels
- Uncontrolled endogenous production of ACTH from a pituitary tumour or ectopic source leads to inadequate suppression of plasma cortisol level
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