Endocrine Board Review

270 Pages·2021·34.567 MB·English

by  Serge A. Jabbour, MD, Program Chair

ENDOCRINE
BOARD
13TH EDITION
REVIEW
*
SERGE A. JABBOUR, MD, PROGRAM CHAIR
59
ENDOCRINE
SOCIETYH
*
T
ENDOCRINE
BOARD
REVIEW
:
SergeA.Jabbour,MD,ProgramChair
ProfessorofMedicine
Director,DivisionofEndocrinology,
Diabetes&MetabolicDiseases
Sidney(CimmeiMedicalCollege
ThomasJeffersonUniversity
.
NatalieE Cusano,MD,MS JacquelineJonkiaas,MD,PhD,MPH KathrynA.Martin,MD
AssociateProfessorofMedicine Professor AssistantProfessorofMedicine
ZuckerSchoolofMedicine DivisionofEndocrinology HarvardMedicalSchool
atHofstra/Northwell GeorgetownUniversityMedicalCenter FacultyClinician,Reproductive
DirectoroftheBone EndocrineUnit
MetabolismProgram SangeetaR.Kashyap,MD MassachusettsGeneralHospital
DivisionofEndocrinology ProfessorofMedicine SeniorPhysicianEditor,
atLenoxHillHospital ClevelandClinicLerner EndocrinologyandDiabetes
CollegeofMedicine UpToDate
TobiasElse,MD PhysicianScientist
AssociateProfessor EndocrinologyInstitute MarieE.McDonnell,MD
DivisionofMetabolism, atClevelandClinic SectionChief,DiabetesSection
Endocrinology,andDiabetes DivisionofEndocrinology
UniversityofMichigan LaurenceKatznelson,MD DiabetesandHypertension
ProfessorofNeurosurgery BrighamandWomen'sHospital
FrancesJ.Hayes,MBBCh,BAO andMedicine HarvardMedicalSchool
AssociateClinicalChief DivisionofEndocrinology
.
ofEndocrinology StanfordUniversitySchoolofMedicine AbbieL Young,MS,CGC,ELS(D)
MassachusettsGeneralHospital MedicalEditor
AssociateProfessorofMedicine
HarvardMedicalSchool
EndocrineSociety ENDOCRINE
2055LStreetNW,Suite600,Washington,DC 20036 SOCIETY
1-888-ENDOCRINE(cid:127)www.endocrine.org
ENDOCRINE®
SOCIETY
HormoneSciencetoHealth::
TheEndocrineSocietyistheworld'slargest,oldest,andmost
activeorganizationworkingtoadvancetheclinicalpracticeof
.
endocrinologyandhormoneresearch,Foundedin1916 the
Societynowhasmorethan18,000globalmembersacrossa
rangeofdisciplines.TheSocietyhasearnedaninternational
reputationforexcellenceinthequalityofitspeer-reviewed
journals,educationalresources,meetings,andprogramsthat
improvepublichealththroughthepracticeandscienceof
endocrinology.
Forbetween-editionupdates,visitusat:
https://www.endocrine.org/education-and-trnining/book-updates
Otherpublications:
endocrine.orgfcublications
Thestatementsandopinionsexpressedinthispublicationare
thoseoftheindividualauthorsanddonotnecessarilyreflect
theviewsofthetndocrineSociety.TheEndocrineSocietyisnot
responsibleorliableinanywayforthecurrencyoftheinformation,
foranyerrors,omissions,orinaccuracies,orforanyconsequences
arisingtherefrom.Withrespecttoanydrugsmentioned,
thereaderisadvisedtorefertotheappropriatemedical
literatureandtheproductinformationcurrentlyprovidedbythe
manufacturertoverifyappropriatedosage,methodandduration
ofadministration,andotherrelevantinformation.Inallinstances,
itistheresponsibilityofthetreatingphysicianorotherhealthcare
professional relyingonindependentexperienceandexpertise,as
,
wellasknowledgeofthepatient,todeterminethebesttreatment
forthepatient.
PERMISSIONS:Forpermissiontoreusematerial,pleasevisitthe
CopyrightClearanceCenter(CCC|atwww.copyright.comorcall
978-750-8400.CCCisanot-for-profitorganizationthatprovides
licensesandregistrationforavarietyofuses.
.
Copyright©2021bytheEndocrineSociety.2055LStreetNW
Suite600.Washington.DC20036.Allrightsreserved.Nopartof
thispublicationmaybereproduced,storedinaretrievalsystem,
postedontheInternet,ortransmittedinanyform,byanymeans,
electronic,mechanicol.photocopying,recording,orotherwise,
withoutwrittenpermissionofthepublisher.
TRANSLATIONSANDLICENSING:Rightstotranslateand
reproduceEndocrineSocietypublicationsinternationallyare
extendedthroughalicensingagreementonfullorpartialeditions.
Torequestrightsforalocaledition,pleasevisit:endocrine.org/
products-and-services/licensing.
ISBN:978-1-936704-04-0
LibraryofCongressControlNumber:2021939123
ii
OVERVIEW EndocrineBoardReview2021 Bundle,and Endocrine
TheEndocrineBoardReview(EBR)isaboardexamination BoardReview,13thEditionfora maximumof 21 AMA
preparationcoursedesignedbothforendocrinefellows PRACategory1Credits and21pointsintheABIM
whohavecompletedorarenearingcompletionoftheir MaintenanceofCertification(MOC) program.Physicians
fellowshipandarepreparingtosittheboardcertification shouldclaimonlythecreditcommensuratewiththeextent
exam,andforpracticingendocrinologistsinsearchofa oftheirparticipationintheactivity.Participantswillearn
comprehensiveself-assessmentofendocrinology,eitherto MOCpointsequivalenttotheamountofContinuing
prepareforrecertificationortoupdatetheirpractice.EBR MedicalEducation(CME)creditsclaimedfortheactivity.
consistsof220case-based,AmericanBoardofInternal
SuccessfulcompletionofthisCMEactivityincludes
Medicine(ABIM)style,multiple-choicequestions,presented
participationintheactivityevaluation.Tocompletethe
inamockexamformat.EachsectionfollowstheABIM
activityevaluationandclaimCMEcreditsand/orMOC
Endocrinology,Diabetes,andMetabolismCertification
points,participantsmustvisittheEndocrineSociety’s
Examinationblueprint,coveringthebreadthanddepth
CenterforLearning.Aftercompletingtheactivity
ofthecertificationandrecertificationexaminations.Each
evaluation,participantswillbeabletosaveorprintaCME
caseisdiscussedcomprehensivelywithdetailedanswer
certificate.ItistheCMEactivityprovider'sresponsibilityto
explanationsandreferences.Acustomizedscorereportis
submitparticipantcompletioninformationtotheACCME
providedtothoseparticipatingintheonlinecourses.
forthepurposeofgrantingABIMMOCpoints.
ACCREDITATION STATEMENT y. i*. CMEcreditsand/orMOCpointsfortheactivitiesrelated
TheEndocrineSocietyisaccredited
tothismaterialmustbeclaimedbythefollowingdeadlines:
bytheAccreditationCouncilfor %ACCME? (cid:127) EndocrineBoardReview2021VirtualMeeting:
ContinuingMedicalEducation ACCREDITEDWITH
COMMENDATION December31,2021
(ACCME)toprovidecontinuing
(cid:127) EndocrineBoardReview2021Bundle:December31,2022
medicaleducationforphysicians.TheEndocrineSociety
(cid:127) EndocrineBoardReview,13thEdition:December31,2022
hasachievedAccreditationwithCommendation.
Forquestionsaboutcontentor obtainingCMEcredit
METHODSOFPARTICIPATION orMOCpoints,pleasecontacttheEndocrineSocietyat
. .
Thismaterialispresentedin3activities,asfollows: info@endocrineorg
(cid:127) EndocrineBoardReview2021VirtualMeeting
(ifpurchasedbySeptember24,2021): LEARNING OBJECTIVES
0 Earlyaccessto9interactive,on-demandmockexam Uponcompletionofthiseducationalactivity,learnerswillbe
presentationsinAugust2021 abletodemonstrateenhancedmedicalknowledgeandclinical
0 LivetopicalQ&Asessionswiththeexpertfacultyheld skillsacrossallmajorareasofendocrinology;applyknowledge
September22-24,2021 andskillsindiagnosing,managing,andtreatingawide
° RecordingsfromthelivetopicalQ&Asessions spectrumofendocrinedisorders;andsuccessfullycomplete
,
° HardcopyofEndocrineBoardReview 13thEdition theboardexaminationforcertificationorrecertificationin
containingall220case-basedquestionswithcomplete thesubspecialtyofendocrinology,diabetes,andmetabolism.
answerrationales
(cid:127) EndocrineBoardReview2021Bundle TARGET AUDIENCE
(ifpurchasedafterSeptember24,2021): ThisCMEactivityisintendedforendocrinefellowsplanning
0 Accessto9interactive,on-demandmockexam forinitialcertification,practicingendocrinologistspreparing
presentations foranMOCassessment,orphysiciansseekinganin-depth
° RecordingsfromthelivetopicalQ&Asessions reviewofendocrinology.Thesecondarytargetaudience
0 HardcopyofEndocrineBoardReview,13thEdition includesadvancedpracticenursesandphysicianassistants.
containingall220case-basedquestionswithcomplete
answerrationales STATEMENTOFINDEPENDENCE
(cid:127) EndocrineBoardReview,13thEdition AsaproviderofCMEaccreditedbytheACCME,the
° HardcopyofEndocrineBoardReview,13thEdition EndocrineSocietyhasapolicyofensuringthatthecontentand
containingall220case-basedquestionswithcomplete qualityofthiseducationalactivityarebalanced,independent,
answerrationales objective,andscientificallyrigorous.Thescientificcontent
AMAPRA CATEGORY1CREDITS AND ofthisactivitywasdevelopedunderthesupervisionofthe
MAINTENANCEOFCERTIFICATION EndocrineSociety'sEBRfaculty.Therearenocommercial
TheEndocrineSocietydesignatesEndocrineiiafpr supportersofthisactivity,andnocommercialentitieshavehad
BoardReview2021VirtualMeeting, influenceovertheplanningofthisCMEactivity.
-
EnchrfHns Board Review Hi
DISCLOSUREPOLICY DISCLAIMERS
Thefaculty,committeemembers,andstaffwhoareinposition Theinformationpresentedinthisactivityrepresentsthe
tocontrolthecontentofthisactivityarerequiredtodisclose opinionofthefacultyandisnotnecessarilytheofficial
totheEndocrineSocietyandtolearnersanyrelevantfinancial positionoftheEndocrineSociety.
relationship(s)oftheindividualorspouse/partnerthathave
occurredwithinthelast12monthswithanycommercial Useofprofessionaljudgment:
interest(s)whoseproductsorservicesarerelatedtotheCME Theeducationalcontentinthisactivityrelatestobasic
contentFinancialrelationshipsaredefinedbyremuneration principlesofdiagnosisandtherapyanddoesnotsubstitute
inanyamountfromthecommercialinterests)intheformof forindividualpatientassessmentbasedonthehealthcare
grants;researchsupport;consultingfees;salary;ownership provider'sexaminationofthepatientandconsideration
interest{eg,stocks,stockoptions,orownershipinterest oflaboratorydataandotherfactorsuniquetothepatient.
excludingdiversifiedmutualfunds);honorariaorother Standardsinmedicinechangeasnewdatabecomeavailable.
paymentsforparticipationinspeakers’bureaus,advisory
boards,orboardsofdirectors;orotherfinancialbenefits.The Drugsanddosages:
Whenprescribingmedications,thephysicianisadvisedto
intentofthisdisclosureisnottopreventCMEplannerswith
checktheproductinformationsheetaccompanyingeach
relevantfinancialrelationshipsfromplanningordeliveryof
content,butrathertoprovidelearnerswithinformationthat drugtoverifyconditionsofuseandtoidentifyanychanges
indrugdosagescheduleorcontraindications.
allowsthemtomaketheirownjudgmentsofwhetherthese
financialrelationshipsmayhaveinfluencedtheeducational
activitywithregardtoexpositionorconclusion. POLICYONUNLABELED/OFF-LABELUSE
TheEndocrineSocietyhasdeterminedthatdisclosureof
TheEndocrineSocietyhasreviewedalldisclosuresand unlabeled/off-labelorinvestigationaluseofcommercial
resolvedormanagedallidentifiedconflictsofinterest,as product(s)isinformativeforaudiencesandtherefore
applicable. requiresthisinformationtobedisclosedtothelearners
atthebeginningofthepresentation.Usesofspecific
Thefacultyreportedthefollowingrelevantfinancial therapeuticagents,devices,andotherproductsdiscussed
relationship(s)duringthecontentdevelopmentprocessfor inthiseducationalactivitymaynotbethesameasthose
thisactivity:
indicatedinproductlabelingapprovedbytheFoodandDrug
NatalieE.Cusano,MD,MS,hasservedasaresearch Administration(FDA).TheEndocrineSocietyrequiresthat
anydiscussionsofsuch“off-label”usebebasedonscientific
investigatorforShire/Takeda,aspeakerforAlexion
Pharmaceuticals,andDSMBmemberforAscendisPharma. researchthatconformstogenerallyacceptedstandards
ofexperimentaldesign,datacollection,anddataanalysis.
TobiasElse,MD,hasservedasanadvisoryboardmember
toCorceptTherapeutics,HRAPharma,andMerck,and Beforerecommendingorprescribinganytherapeuticagent
hisinstitutionhasreceivedresearchsupportfromCorcept ordevice,learnersshouldreviewthecompleteprescribing
Therapeutics,Merck,andStrongbridgeBiopharma. information,includingindications,contraindications,
SangeetaR.Kashyap,MD,hasservedasaconsultantand warnings,precautions,andadverseevents.
coinvestigatortoGIDynamicsandasaconsultantto
Fractyl,Inc;herinstitutionhasreceivedresearchsupport PRIVACYANDCONFIDENTIALITYSTATEMENT
fromFractyl,Inc,andJanssenPharmaceuticals. TheEndocrineSocietywillrecordlearners’personal
LaurenceKatznelson,MD,hasservedasaconsultantand informationasprovidedonCMEevaluationstoallowfor -
principalinvestigatortoChiasmaandCamarus,andhehas issuanceandtrackingofCMEcertificates.TheEndocrine
servedasanadvisoryboardmembertoNovoNordisk. Societymayalsotrackaggregateresponsestoquestionsin
MarieE.McDonnell,MD,hasservedasatrialevent activitiesandevaluationsandusethesedatatoinformthe
adjudicatorforatrialconductedbyEisai. ongoingevaluationandimprovementofitsCMEprogram.No
individualperformancedataoranyotherpersonalinformation
Thefollowingfacultyreportednorelevantfinancial
relationships:FrancesJ.Hayes,MBBCh,BAO;SergeA. collectedfromevaluationswillbesharedwiththirdparties.
Jabbour,MD;JacquelineJonklaas,MD,PhD,MPH;and
ACKNOWLEDGEMENT OF COMMERCIAL
KathrynA.Martin,MD
SUPPORT
Themedicaleditorforthisactivityreportednorelevant Theactivityisnotsupportedbyeducationalgrant(s)or
financialrelationships:AbbieL.Young,MS,CGC,ELS(D) otherfundsfromanycommercialsupporters.
EndocrineSocietystaffassociatedwiththedevelopment LastReview:August2021
ofcontentforthisactivityreportednorelevantfinancial ActivityRelease:August2021
relationships. ActivityExpirationDate:December31,2022 i
.
iv - Endocrine Board Review
Contents
QUESTIONS ANSWERS
LABORATORYREFERENCERANGES 1
COMMONABBREVIATIONSUSEDIN
ENDOCRINEBOARDREVIEW 5
ADRENALBOARD REVIEW .7 93
TobiasElse,MD
CALCIUMAND BONEBOARDREVIEW 18 111
NatalieE.Cusano,MD,MS
DIABETESMELLITUS,SECTION1BOARDREVIEW ...29 130
SergeA.Jabbour,MD
DIABETESMELLITUS,SECTION2BOARDREVIEW....40 158
MarieE.McDonnell,MD
FEMALEREPRODUCTIONBOARDREVIEW 53 179
KathrynA.Martin,MD
MALEREPRODUCTIONBOARDREVIEW 59 191
FrancesJ.Hayes,MBBCh,BAO
OBESITYANDLIPIDSBOARDREVIEW 66 205
SangeetaR.Kashyap,MD
PITUITARYBOARDREVIEW 74 226
LaurenceKatznelson,MD
THYROIDBOARDREVIEW 82 239
JacquelineJonklaas,MD,PhD,MPH
Forbetween-editionupdates,visitusat:https'//www.endocrine.org/education-and-training/book-updates.
Endocrine BoardReview v
LABORATORY REFERENCE RANGES
Reference ranges varyamonglaboratories.Conventionalunitsarelistedfirst withSIunitsinparentheses.
LipidValues ThyroidValues
High-densitylipoprotein(HDL)cholesterol Thyroglobulin 3-42ng/mL(SI:3-42pg/L) (aftersurgeryand
Optimal —>60mg/dL(SI:>1.55mmol/L) radioactiveiodinetreatment:<1.0ng/mL[SI:<1.0pg/L])
Normol- 40-60mg/dL(SI:1.04-1.55mmol/L) Thyroglobulinantibodies <4.0lU/mL(SI:<4.0klU/L)
Low <40mg/dL(SI:<1.04mmol/L) Thyrotropin(TSH) — 0.5-5.0miU/L
Low-densitylipoprotein(LDL)cholesterol Thyrotropin-receptorantibodies(TRAb) <1.75tU/L
Optimal - <100mg/dL(SI:<2.59mmol/L) Thyroid-stimulatingimmunoglobulin <120%ofbasalactivity
Low 100-129mg/dL(SI:2.59-3.34mmol/L) Thyroperoxidase(TPO)antibodies <2.0lU/mL(Si:<2.0klU/L)
—
Borderline-high-- 130-159mg/dL(SI:3.37-4.12mmol/L) Thyroxine(T)(free) 0.8-1.8ng/dL(SI:10.30-23.17pmol/L)
4
High 160-189mg/dL(SI:4.14-4.90mmol/L) Thyroxine(T)(total)-—5.5-12.5pg/dL(SI:94.02-213.68nmol/L)
4
Veryhigh — >190mg/dL(SI:>4.92mmol/L) Freethyroxine(T)index 4-12
4
Non-HDLcholesterol Triiodothyronine(T) (free)—2.3-4.2pg/mL(SI:3.53-6.45pmol/L)
3
Optimal <130mg/dL(SI:<3.37mmol/L) Triiodothyronine(T3)(total)—70-200ng/dL(SI:1.08-3.08nmol/L)
Borderline-high— 130-159mg/dL(SI:3.37-4.12mmol/L) Triiodothyronine(T3),reverse—10-24ng/dL(SI:0.15-0.37nmol/L)
High —>240mg/dL(SI:>6.22mmol/L) Triiodothyronineuptake,resin 25%-38%
Totalcholesterol Radioactiveiodineuptake— 3%-16%(6hours);
Optimal <200mg/dL(SI:<5.18mmol/L) 15%-30%(24hours)
Borderline-high 200-239mg/dL(SI:5.18-6.19mmol/L)
High >240mg/dL(SI:>6.22mmol/L) Endocrine Values
Triglycerides Serum
Optimal — <150mg/dL(SI:<1.70mmol/L) Aldosterone — 4-21ng/dL(SI:111.0-582.5pmol/L)
Borderline-high 150-199mg/dL(SI:1.70-2.25mmol/L) Alkalinephosphatase— —50-120U/L(SI:0.84-2.00pkat/L)
High — 200-499mg/dL(SI:2.26-5.64mmol/L) Alkalinephosphatase(bone-specific)-
Veryhigh >500mg/dL(SI:s5.65mmol/L) <20pg/L(adultmale);<14pg/L(premenopausalfemale);
Lipoprotein(a) <30mg/dL(SI:sl.07pmol/L) <22pg/L(postmenopausalfemale)
-
ApolipoproteinB — 50-110mg/dL(SI:0.5-1.1g/L) Androstenedione
65-210ng/dL(SI:2.27-7.33nmol/L)(adultmale);
Hematologic Values 30-200ng/dL(51:1.05-6.98nmol/L) (adultfemale)
Erythrocytesedimentationrate 0-20mm/h Antimullerianhormone -
Haptoglobin 30-200mg/dL(SI:300-2000mg/L) 0.7-19.0ng/mL(SI:5.0-135.7pmol/L)(male,>12years):
Hematocrit— — 41%-51%(SI:0.41-0.51)(male); 0.9-9.5ng/mL(SI:6.4-67.9pmol/L)(female,13-45years);
35%-45%(SI:0.35-0.45) (female) <1.0ng/mL(SI:<7.1pmol/L)(female,>45years)
HemoglobinAlc- 4.0%-5.6%(20-38mmol/mol) Calcitonin <16pg/mL(SI:<4.67pmol/L) (basal,male);
Hemoglobin — 13.8-17.2g/dL(SI:138-172g/L)(male); <8pg/mL(SI:<2.34pmol/L) (basal,female);
12.1-15.1g/dL(SI:121-151g/L)(female) <130pg/mL(Si:S37.96pmol/L) (peakcalciuminfusion,male);
Internationalnormalizedratio— 0.8-1.2 <90pg/mL(SI:<26.28pmol/L) (peakcalciuminfusion,female)
Meancorpuscularvolume(MCV) 80-100pm3(SI:80-100fL) Carcinoembryonicantigen <2.5ng/mL(SI:<2.5pg/L)
Plateletcount 150-450x103/pL(SI:150-450x109/L) ChromograninA (cid:127)<93ng/mL(SI:<93pg/L)
Protein(total) — 6.3-7.9g/dL(SI:63-79g/L) Corticosterone—53-1560ng/dL(SI:1.53-45.08nmol/L)(>18years)
Reticulocytecount—0.5%-1.5%ofredbloodcells(SI:0.005-0.015) Corticotropin(ACTH) -10-60pg/mL(SI:2.2-13.2pmol/L)
Whitebloodcellcount- 4500-11,000/pL(SI:4.5-11.0x109/L) Cortisol(8AM) 5-25pg/dL(SI:137.9-689.7nmol/L)
EndocrineBoardReview 1
Cortisol(4PM) -2-14pg/dL(SI:55.2-386.2nmol/L) 17a-Hydroxyprogesterone ---
C-peptide 0.5-2.0ng/mL(SI:0.17-0.66nmol/L) <220ng/dL(SI:<6.67nmol/L)(adultmale); 1
C-reactiveprotein 0.8-3.1mg/L(SI:7.62-29.52nmol/L) <80ng/dL(SI:<2.42nmol/L) (follicular,female); ; 1
Cross-linkedN-telopeptideoftype1collagen <285ng/dL(SI:<8.64nmol/L)(luteal,female);
5.4-24.2nmolBCE/mmolcreat(male); <51ng/dL(SI:<1.55nmol/L) (postmenopausal,female)
6.2-19.0nmolBCE/mmolcreat(female) 25-HydroxyvitaminD
Dehydroepiandrosteronesulfate(DHEA-S) <20ng/mL(SI:<49.9nmol/L)(deficiency);
21-29ng/mL(SI:52.4-72.4nmol/L) (insufficiency);
PatientAge Female Male
30-80ng/mL(SI:74.9-199.7nmol/L) (optimallevels);
18-29years 44-332pg/dL 89-457pg/dL >80ng/mL(SI:>199.7nmol/L)(toxicitypossible) :
(SI:1.19-9.00pmol/L) (SI:2.41-12.38pmol/L) I I
InhibinB 15-300pg/mL(SI:15-300ng/L) ! i
30-39years 31-228pg/dL 65-334pg/dL Insulinlikegrowthfactor1(IGF-1) l
(SI:0.84-6.78pmol/L) (SI:1.76-9.05pmol/L)
40-49years 18-244pg/dL 48-244pg/dL PatientAge Female Male
(SI:0.49-6.61pmol/L) (SI:1.30-6.61pmol/L)
18years 162-541ng/mL 170-640ng/mL
50-59years i5-200pg/dL 35-179pg/dL (SI;21.2-70.9nmol/L) (SI:22.3-83.8nmol/L)
(SI:0.41-5.42pmol/L) (SI:0.95-4.85pmol/L)
19years 138-442ng/mL 147-527ng/mL
>60years 15-157pg/dL 25-131pg/dL (SI:18.1-57.9nmol/L) (SI:19.3-69.0nmol/L)
(SI:0.41-4.25pmol/L) (SI:0.68-3.55pmol/L)
20years 122-384ng/mL 132-457ng/mL
(SI:16.0-50.3nmol/L) (SI:17.3-59.9nmol/L)
Deoxycorticosterone —<10ng/dL(SI:<0.30nmol/L)(>18years)
1,25-DihydroxyvitaminD—-16-65pg/mL(SI:41.6-169.0pmol/L) 21-25years 116-341ng/mL 116-341ng/mL
3 (SI:15.2-44.7nmol/L) (SI:15.2-44.7nmol/L)
Estradiol 10-40pg/mL(SI:36.7-146.8pmol/L)(male);
26-30years 117-321ng/mL 117-321ng/mL
10-180pg/mL(SI:36.7-660.8pmol/L) (follicular,female); (SI:15.3-42.1nmol/L) (SI:15.3-42.1nmol/L)
100-300pg/mL(SI:367.1-1101.3pmol/L) (midcycle,female);
31-35years 113-297ng/mL 113-297ng/mL
40-200pg/mL(SI:146.8-734.2pmol/L) (luteal,female); (SI:14.8-38.9nmol/L) (SI:14.8-38.9nmol/L) i
<20pg/mL(SI:<73.4pmol/L) (postmenopausal,female)
36-40years 106-277ng/mL 106-277ng/mL
Estrone 10-60pg/mL(SI:37.0-221.9pmol/L) (male); (SI:13.9-36.3nmol/L) (SI:13.9-36.3nmol/L)
17-200pg/mL(SI:62.9-739.6pmol/L)(premenopausalfemale); 41-45years 98-261ng/mL 98-261ng/mL
7-40pg/mL(SI:25.9-147.9pmol/L) (postmenopausaffemale) (SI:12.8-34.2nmol/L) (SI:12.8-34.2nmol/L)
a-Fetoprotein— <6ng/mL(SI:<6pg/L) 46-50years 91-246ng/mL 91-246ng/mL
Follicle-stimulatinghormone(FSH) (SI:11.9-32.2nmol/L) (SI:11.9-32.2nmol/L)
! ' 1
1.0-13.0mlU/mL(SI:1.0-13.0IU/L) (male); 51-55years 84-233ng/mL 84-233ng/mL
<3.0mlU/mL(SI:<3.0IU/L)(prepuberty,female); (SI:11.0-30,5nmol/L) (SI:11.0-30.5nmol/L)
2.0-12.0mlU/mL(SI:2.0-12.0IU/L)(follicular,female); 56-60years 78-220ng/mL 78-220ng/mL
4.0-36.0mlU/mL(SI:4.0-36.0IU/L)(midcycle,female); (SI:10.2-28.8nmol/L) (SI:10.2-28.8nmol/L)
1.0-9.0mlU/mL(SI:1.0-9.0IU/L) (luteal,female); 61-65years 72-207ng/mL 72-207ng/mL
>30.0mlU/mL(SI:>30.0IU/L) (postmenopausal,female) (SI:9.4-27.1nmol/L) (SI:9.4-27.1nmol/L) :
Freefattyacids 10.6-18.0mg/dL(SI:0.4-0.7nmol/L) 66-70years 67-195ng/mL 67-195ng/mL
(SI:8.8-25.5nmol/L) (SI:8.8-25.5nmol/L)
Gastrin <100pg/mL(SI:<100ng/L)
Growthhormone(GH)—0.01-0.97ng/mL(SI:0.01-0.97pg/L)(male); 71-75years 62-184ng/mL 62-184ng/mL
(SI:8.1-24.1nmol/L) (SI:8.1-24.1nmol/L) I-
0.01-3.61ng/mL(SI:0.01-3.61pg/L)(female)
Homocysteine <1.76mg/L(SI:<13pmol/L) 76-80years 57-172ng/mL 57-172ng/mL
p-Humanchorionicgonadotropin(fJ-hCG)— (SI:7.5-22.5nmol/L) (SI:7.5-22.5nmol/L) IL
<3.0mlU/mL(SI:<3.0IU/L)(nonpregnantfemale); >80years 53-162ng/mL 53-162ng/mL
(SI:6.9-21.2nmol/L) (SI:6.9-21.2nmol/L) 1
>25mlU/mLSI:>25IU/L)indicatesapositivepregnancytest
p-Hydroxybutyrate <3.0mg/dL(SI:<288.2pmol/L) Insulinlikegrowthfactorbindingprotein3 —2.5-4.8mg/L 3!
—
17-Hydroxypregnenolone 29-189ng/dL(SI:0.87-5.69nmol/L) Insulin— 1.4-14.0plU/mL(SI:9.7-97.2pmol/L) ;!
2 EndocrineBoardReview
Islet-cellantibodyassay Renin,directconcentration 4-44pg/mL(SI:0.1-1.0pmol/L)
0JuvenileDiabetesFoundationunits Sexhormone-bindingglobulin(SHBG)
Luteinizinghormone(LH) 1.1-6.7pg/mL(SI:10-60nmol/L)(mole);
1.0-9.0mlU/mL(SI:1.0-9.0IU/L) (male); 2.2-14.6pg/mL(SI:20-130nmol/L) (female)
<1.0mlU/mL(SI:<1.0IU/L) (prepuberty,female); a-Subunitofpituitaryglycoproteinhormones --
1.0-18.0mlU/mL(SI:1.0-18.0IU/L) (follicular,female); <1.2ng/mL(SI:<1.2pg/L)
20.0-80.0mlU/mL(SI:20.0-80.0IU/L)(midcycle,female); Testosterone(bioavaiiable)
0.5-18.0mlU/mL(SI:0.5-18.0IU/L) (luteal,female); 0.8-4.0ng/dL(SI:0.03-0.14nmol/L)
>30.0mlU/mL(SI:>30.0IU/L) (postmenopausal,female) (20-50years,femaleonoralestrogen);
Metanephrines(plasmafractionated) 0.8-10.0ng/dL(SI:0.03-0.35nmol/L)
Metanephrine— (cid:127)-<99pg/mL(SI:<0.50nmol/L) (20-50years,femalenotonoralestrogen);
Normetanephrine <165pg/mL(SI:<0.90nmol/L) 83.0-257.0ng/dL(SI:2.88-8.92nmol/L)(male20-29years);
75-goralglucosetolerancetestbloodglucosevalues 72.0-235.0ng/dL(SI:2.50-8.15nmol/L)(male30-39years);
60-100mg/dL(SI:3.3-5.6mmol/L) (fasting); 61.0-213.0ng/dL(SI:2.12-7.39nmol/L) (male40-49years);
<200mg/dL(SI:<11.1mmol/L) (1hour); 50.0-190.0ng/dL(SI:1.74-6.59nmol/L) (male50-59years);
<140mg/dL(SI:<7.8mmol/L)(2hour); 40.0-168.0ng/dL(SI:1.39-5.83nmol/L) (male60-69years)
between140-200mg/dL(SI:7.8-11.1mmol/L)isconsidered Testosterone(free)— 9.0-30.0ng/dL(SI:0.31-1.04nmol/L)(male);
impairedglucosetoleranceorprediabetes.Greaterthan 0.3-1.9ng/dL(SI:0.01-0.07nmol/L) (female)
200mg/dL(SI:>11.1mmol/L)isasignofdiabetesmellitus Testosterone(total)-300-900ng/dL(SI:10.4-31.2nmol/L)(male);
50-goralglucosetolerancetestforgestationaldiabetes 8-60ng/dL(SI:0.3-2.1nmol/L) (female)
<140mg/dL(SI:<7.8mmol/L)(1hour) VitaminBn 180-914pg/mL(SI:133-674pmol/L)
100-goralglucosetolerancetestforgestationaldiabetes
<95mg/dL(SI:<5.3mmol/L) (fasting); ChemistryValues
<180mg/dL(SI:<10.0mmol/L) (1hour); Alanineaminotransferase - 10-40U/L(SI:0.17-0.67pkat/L)
<155mg/dL(SI:<8.6mmol/L) (2hour); Albumin-— --3.5-5.0g/dL(SI:35-50g/L)
<140mg/dL(SI:<7.8mmol/L) (3hour) Amylase— 26-102U/L(SI:0.43-1.70pkat/L)
Osteocalcin 9.0-42.0ng/mL(SI:9.0-42.0pg/L) Aspartateaminotransferase— 20-48U/L(SI:0.33-0.80pkat/L)
Parathyroidhormone,intact(PTH)- 10-65pg/mL(SI:10-65ng/L) Bicarbonate —21-28mEq/L(SI:21-28mmol/L)
Parathyroidhormone-relatedprotein(PTHrP) <2.0pmol/L Bilirubin(total) 0.3-1.2mg/dL(SI:5.1-20.5pmol/L)
Progesterone <1.2ng/mL(SI:<3.8nmol/L) (male); Bloodgases
<1.0ng/mL(SI:<3.2nmol/L) (follicular,female); Po,arterialblood - (cid:127)80-100mmHg(SI:10.6-13.3kPa)
2
2.0-20.0ng/mL(SI:6.4-63.6nmol/L) (luteal,female); Pco,arterialblood 35-45mmHg(SI:4.7-6.0kPa)
2
<1.1ng/mL(SI:<3.5nmol/L) (postmenopausal,female); BloodpH 7.35-7.45
>10.0ng/mL(SI:>31.8nmol/L) (evidenceofovulatoryadequacy) Calcium 8.2-10.2mg/dL(SI:2.1-2.6mmol/L)
Proinsulin —26.5-176.4pg/mL(SI:3.0-20.0pmol/L) Calcium(ionized) 4.60-5.08mg/dL(SI:1.2-1.3mmol/L)
Prolactin 4-23ng/mL(SI:0.17-1.00nmol/L) (male); Carbondioxide -- 22-28mEq/L(SI:22-28mmol/L)
4-30ng/mL(SI:0.17-1.30nmol/L) (nonlactatingfemale); CD ceilcount— —- 500-1400/pL(SI;0.5-1.4x109/L)
4
10-200ng/mL(SI:0.43-8.70nmol/L) (lactatingfemale) Chloride 96-106mEq/L(SI:96-106mmol/L)
Prostate-specificantigen(PSA) - Creatinekinase-- 50-200U/L(SI:0.84-3.34pkat/L)
<2.0ng/mL(SI:<2.0pg/L) (<40years); Creatinine 0.7-1.3mg/dL(SI:61.9-114.9pmol/L) (male);
<2.8ng/mL(SI:<2.8pg/L) (<50years); 0.6-1.1mg/dL(SI:53.0-97.2pmol/L) (female)
<3.8ng/mL(SI:<3.8pg/L) (<60years); Ferritin 15-200ng/mL(SI:33.7-449.4pmol/L)
<5.3ng/mL(Si:<5.3pg/L) (<70years); Folate >4.0ng/mL(SI:>4.0pg/L)
<7.0ng/mL(SI:<7.0pg/L)(<79years); Glucose 70-99mg/dL(SI:3.9-S.5mmol/L)
<7.2ng/mL(SI:<7.2pg/L) (>80years) y-GIutamyItransferase 2-30U/L(SI:0.03-0.50pkat/L)
Reninactivity,plasma,sodiumreplete,ambulatory
0.6-4.3ng/mLperh
EndocrineBoardReview 3
Iron Citrate 320-1240mg/24h(SI:16.7-64.5mmol/d)
50-150pg/dL(SI:9.0-26.8pmol/L)(male); Cortisol 4-50pg/24h(SI:11-138nmol/d)
35-145pg/dL(St:6.3-26.0pmol/L)(female) Cortisolfollowingdexamethasone-suppressiontest
Lactatedehydrogenase 100-200U/L(SI:1.7-3.3pkat/L) (low-dose:2day,2mgdaily) <10pg/24h(SI:<27.6nmol/d)
Lacticacid 5.4-20.7mg/dL(SI:0.6-2.3mmol/L) Creatinine' 1.0-2.0g/24h(SI:8.8-17.7mmol/d)
Lipase — 10-73U/L(SI:0.17-1.22pkat/L) Glomerularfiltrationrate(estimated) —>60mL/minper1.73m2
Magnesium- 1.5-2.3mg/dL(SI:0.6-0.9mmol/L) 5-Hydroxyindoleaceticacid—2-9mg/24h(SI:10.5-47.1pmol/d)
Osmolality 275-295mOsm/kg(SI:275-295mmol/kg) Iodine(random) >100pg/L
Phosphate-—- —2.3-4.7mg/dL(SI:0.7-1.5mmol/L) 17-Ketosteroids—6.0-21.0mg/24h(SI:20.8-72.9pmol/d)(male);
Potassium — 3.5-5.0mEq/L(SI:3.5-5.0mmol/L) 4.0-17.0mg/24h(SI:13.9-59.0pmol/d) (female)
Prothrombintime -8.3-10.8s Metanephrinefractionation
Serumureanitrogen- 8-23mg/dL(SI:2.9-8.2mmol/L) Normotensivenormalranges;
TSroadniusfmerr-insaturation —- 136-142mEq/L(SI:136-14214m.04m,-5o0l/%L) <M1e8ta0npegp/h2r4inhe(SI:<913<n2m61opl/dg)/2(f4emha(SleI:)<1323nmol/d) (male); )
TroponinI — <0.6ng/mL(SI:<0.6pg/L) Normetanephrine-- ageandsexdependent
Tryptase — <11.5ng/mL(SI:<11.5pg/L) Totalmetanephrine ageandsexdependent
Uricacid —3.5-7.0mg/dL(SI:208.2-416.4pmol/L) Osmolality 150-1150mOsm/kg(SI:150-1150mmol/kg)
—
Oxalate - <40mg/24h(SI:<456mmol/d)
Urine
Phosphate —0.9-1.3g/24h(SI:29.1-42.0mmol/d)
Albumin 30-300pg/mgcreat(SI:3.4-33.9pg/molcreat) Potassium 17-77mEq/24h(SI:17-77mmol/d)
Albumin-to-creatinineratio <30mg/gcreat Sodium — 40-217mEq/24h(SI:40-217mmol/d)
Aldosterone- 3-20pg/24h(SI:8,3-55.4nmol/d) Uricacid— <800mg/24h(SI:<4.7mmol/d) I
(shouldbe<12pg/24h[SI:<33.2nmol/d]withoralsodium
loading—confirmedwith24-hoururinarysodium>200mEq) SaJiva
Calcium 100-300mg/24h(SI:2,5-7.5mmol/d) Cortisol(salivary),midnight <0.13pg/dL(SI:<3.6nmol/L) i
Catecholaminefractionation
Normotensivenormalranges: Semen
Dopamine — <400pg/24h(SI:<2610nmol/d) Semenanalysis >20millionsperm/mL;>50%motility
Epinephrine —<21pg/24h(SI:<115nmol/d)
Norepinephrine —-<80pg/24h(SI:<473nmol/d)
I
|;t
1
»
4 EndocrineBoardReview
-.
A