ESAP™ 2016 Endocrine Self-Assessment Program Questions&Answers Discussions Endocrine Society

193 Pages·2016·19.944 MB·English

ENDOCRINE SELF-ASSESSMENT PROGRAM
QUESTIONS, ANSWERS, DISCUSSIONS
f
V
ENDOCRINE
SOCIETY
1916-2016
100 YEARS
-
OfHORMONE5C:6NCE HEALT*
ESAP 2016
TM
Endocrine Society’s
Endocrine Self-Assessment Program
Questions, Answers, and Discussions
Alan C. Dalkin, MD, Program Chair
Professor of Medicine
Division of Endocrinology and Metabolism
University of Virginia
Shehzad S. Basaria, MD Pamela U. Freda, MD Lisa R. Tannock, MD
Associate Professor of Medicine Professor of Medicine at CUMC Professor of Medicine
Medical Director, Section on Men’s Columbia University, College of Chief, Division of Endocrinology and
Health, Aging, and Metabolism Molecular Medicine
Physicians and Surgeons
Brigham and Women’s Hospital University of Kentucky and
Han ard Medical School Department of Veterans Affairs
/ Marie Freel, MB, ChB, PhD
Consultant Endocrinologist
Kristien Boelaert, MD Nicholas A. Tritos, MD, DSc
Queen Elizabeth University Hospital
Reader in Endocrinology Associate Professor of Medicine
Glasgow, United Kingdom
Center for Endocrinology, Diabetes, Harvard Medical School
and Metabolism Neuroendochne and Pituitary Clinical Center
Jennifer Green, MD
University of Birmingham Massachusetts General Hospital
Associate Professor of Medicine
Division of Endocrinology, Metabolism,
Maria L. Collazo-Clavell, MD Adrian V. Vella, MD
and Nutrition
Associate Professor of Medicine Professor of Medicine
Duke University Medical Center
Mayo Clinic College of Medicine Mayo Clinic College of Medicine
Shubhada Jagasia, MD, MMHC
Kathryn McCrystal Dahir, MD Corrine WeJt, MD
Professor of Medicine
Assistant Professor of Medicine Professor of Medicine
Vice Chair for Clinical Affairs
Division of Endocrinology University of Utah School of Medicine
Department of Medicine
Vanderbilt University Medical Center
Vanderbilt University Medical Center
Abbie L. Young, MS, CGC, ELS(D)
Thomas W. Donner, MD Medical Editor
Jacqueline Jonklaas, MD, PhD
Associate Professor of Medicine
Associate Professor
Division of Endocrinology,
Division of Endocrinology and Metabolism
Diabetes, and Metabolism
Georgetown University
Johns Hopkins University
James W. Findling, MD
Professor of Medicine
Medical College of Wisconsin
ENDOCRINE
SOCIETY
Endocrine Society
2055 L Street NW, Suite 600, Washington, DC 20036 1916-2016
1 0 0 Y E A R S
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1-888 ENDOCRINE (cid:127) www.endocrine org
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CF HORMONE SCIENCE TO HEALTH
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1916 2016
ENDOCRINE
1 0 0 Y E A R S
L
'
SOCIETY
OF HORMONE SCIENCE TO HEALTH
The Endocrine Society is the worlcTs largest, oldest and most active organization working
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to advance the climcal practice of endocnnology and hormone research. Founded
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disciplines The Society has earned an international reputation for excellence the
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quality of its peer reviewed journals, educational resources, meetings, and programs that
improve public health through the practice and science of endocnnology.
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ISBN• 978-1-943550-01-2
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Library of Congress Control Number• 2016932454
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On the Cover:
Left • Abdommal computed tomography (axial view) demonstrating low-attentuation bilateral
,
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adrenal nodules (arrows), representing corticotropin-dependent nodular adrenal hyperplasia
-
a patient with Cushing syndrome and a normal pituitary study
in imaging
•
Top right: Malignant osteosarcoma in a patient with Paget disease of bone
.
Bottom right• Nonproliferative diabetic retinopathy with retinal hemmorhages and hard
•
exudates a patient with diabetes mellitus
in
•
OVERVIEW (cid:127) Identify risk factors for endocrine and metabolic
The Endocrine Self-Assessment Program (ESAPTM) is a self- disorders and develop strategies for prevention.
study curriculum aimed at physicians seeking initial certification (cid:127) Evaluate endocrine and metabolic manifestations of
or recertification in endocrinology, program directors systemic disorders.
interested in a testing and training instrument, and clinicians (cid:127) Use existing resources pertaining to clinical guidelines
-
simply wanting a self assessment and a broad review of and treatment recommendations for endocrine and
endocrinology. ESAP 2016 is available in both print and online related metabolic disorders to guide diagnosis and
.
formats. It consists of 120 brand-new multiple-choice questions treatment
in all areas of endocrinology, diabetes, and metabolism.
There is extensive discussion of each correct answer, a TARGET AUDIENCE
comprehensive syllabus, and references. ESAP is updated ESAP is a self-study curriculum aimed at physicians seeking
.
annually with new questions and new syllabus materials initial certification or recertification in endocrinology, program
ESAP is composed of two key components: the initial directors interested in a testing and training instrument, and
online interactive module and the printed book. Upon purchase, clinicians simply wanting a self-assessment and a broad
.
learners will initially receive access to the online module. To review of endocrinology
use ESAP as a true self-assessment tool, learners are strongly
- STATEMENT OF INDEPENDENCE
encouraged to complete the online interactive self assessment
module first before continuing self-study with the printed book; As a provider of CME accredited by the Accreditation
the online module may be accessed at education.endocrine.org. Council for Continuing Medical Education, the Endocrine
Society has a policy of ensuring that the content and quality
ACCREDITATION STATEMENT of this educational activity are balanced, independent,
The Endocrine Society is accredited by objective, and scientifically rigorous. The scientific content
the Accreditation Council for Continuing of this activity was developed under the supervision of the
Medical Education to provide continuing Endocrine Society’s ESAP Faculty Working Group.
.
medical education for physicians
DISCLOSURE POLICY
The Endocrine Society has received
Accreditation with Commendation. The faculty, committee members, and staff who are in
The Endocrine Society designates this enduring material position to control the content of this activity are required
for a maximum of 40.0 AMA PRA Category 1 CreditsTM . to disclose to the Endocrine Society and to learners any
Physicians should claim only the credit commensurate with relevant financial relationship(s) of the individual or spouse/
the extent of their participation in the activity. partner that have occurred within the last 12 months with
any commercial interest(s) whose products or Services
MAINTENANCE OF CERTIFICATION are related to the CME content. Financial relationships are
Successful completion of this ABIM defined by remuneration in any amount from the commercial
CME activity, which includes CME MOC interest(s) in the form of grants; research support; Consulting
participation in the evaluation fees; salary; ownership interest (eg, stocks, stock options,
ACCREDITED
component, enables the or ownership interest excluding diversified mutual funds);
participant to earn up to 40 MOC points in the American honoraria or other payments for participation in speakers’
Board of Internal Medicine’s (ABIM) Maintenance of bureaus, advisory boards, or boards of directors; or other
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judgments of whether these financial relationships may have
LEARNING OBJECTIVES influenced the educational activity with regard to exposition
ESAP 2016 will allow learners to assess their knowledge of or conclusion. The Endocrine Society has reviewed all
all aspects of endocrinology, diabetes, and metabolism. disclosures and resolved or managed all identified conflicts
of interest, as applicable.
Upon completion of this educational activity, learners will be The following faculty reported relevant financial
able to: relationship(s): Shehzad S. Basaria, MD, is a consultant for Eli
(cid:127) Recognize clinical manifestations of endocrine and Lilly. Kathryn McCrystal Dahir, MD, is on the advisory board
metabolic disorders and select among current options for Alexion. Thomas W. Donner, MD, is a study site principal
.
for diagnosis, management, and therapy investigator for Novo Nordisk. James W. Findling, MD, is an
3
investigator/consultant for Corcept Therapeutics and Novartis. at the beginning of the presentation. Uses of specific
.
Pamela U Freda, MD, is an investigator for Novo Nordisk, therapeutic agents, devices, and other products discussed
Pfizer, and Novartis; serves as an advisory board member for in this educational activity may not be the same as those
Pfizer, IPSEN, and Novo Nordisk; and is a content reviewer indicated in product labeling approved by the Food and Drug
for UpToDate. Duke University receives funds from Merck, Administration (FDA). The Endocrine Society requires that
AstraZeneca, Janssen, and GlaxoSmithKline for research any discussions of such “off-label” use be based on scientific
performed by Jennifer Green, MD. These funds support a research that conforms to generally accepted standards
portion of her salary. Dr. Green has also received honoraria of experimental design, data collection, and data analysis.
from Merck and Boehringer Ingelheim for serving as a Before recommending or prescribing any therapeutic agent
consultant and honoraria from BioScientifica for editorial or device, learners should review the complete prescribing
activities. Nicholas Tritos, MD, receives research support information, including indications, contraindications,
from Ispsen, US, Novo Nordisk, Novartis, and Pfizer, Inc. Dr. warnings, precautions, and adverse events.
Tritos also receives consultant fees from Pfizer, Inc, and his
spouse is an employee of Pfizer, Inc. Adrian V. Vella, MD, is PRIVACY AND CONFIDENTIALITY STATEMENT
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a consultant for sanofi aventis and Genentech and receives The Endocrine Society will record learner’s personal
grant support from Novartis and BioKier. Corrine Welt, MD, information as provided on CME evaluations to allow for
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is a writer for UpToDate and a consultant for Takeda issuance and tracking of CME certificates. The Endocrine
The following committee members reported no relevant Society may also track aggregate responses to questions in
financial relationships: Kristien Boelaert, MD; Maria L. activities and evaluations and use these data to inform the
Collazo-Clavell, MD; Alan C. Dalkin, MD; Marie Freel, MB, ongoing evaluation and improvement of its CME program. No
ChB, PhD; Shubhada Jagasia, MD, MMHC; Jacqueline individual performance data or any other personal information
I '
Jonklaas, MD, PhD; and Lisa R. Tannock, MD. collected from evaluations will be shared with third parties.
The medical editor for this program, Abbie L. Young, MS,
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CGC, ELS(D), reported no relevant financial relationships ACKNOWLEDGMENT OF COMMERCIAL SUPPORT
The Endocrine Society staff associated with the This activity is not supported by educational grant(s) or other
development of content for this activity reported no relevant funds from any commercial supporter.
financial relationships.
ÅMA PRA CATEGORY 1 CREDfT (CME) INFORMATION
DISCLAIMERS To receive a maximum of 40.0 AMA PRA Category 1 Credits,
The information presented in this activity represents the participants must complete the online interactive module
opinion of the faculty and is not necessarily the official and activity evaluation located at education.endocrine.
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position of the Endocrine Society org. Participants must achieve a minimum score of 70% to
claim CME credit. After initially completing the module, if
USE OF PROFESSIONAL JUDGMENT: participants do not achieve a minimum score of 70%, they
The educational content in this self-assessment test relates have the option to change their answers and make additional
to basic principles of diagnosis and therapy and does attempts to achieve a passing score Learners also have the
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not substitute for individual patient assessment based on option to clear all answers and start over.
the health care provider’s examination of the patient and
consideration of laboratory data and other factors unique METHOD OF PARTICIPATION
to the patient. Standards in medicine change as new data This enduring material is presented online and in print format.
become available. The estimated time to complete this activity, including
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DRUGS AND DOSAGES: minimum score of 70% to claim CME credit and MOC points.
When prescribing medications, the physician is advised to After initially completing the module(s), if participants do
check the product information sheet accompanying each not achieve a minimum score of 70%, they have the option
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POLICY ON UNLABELED/OFF-LABEL USE
SYSTEM REQUIREMENTS
The Endocrine Society has determined that disclosure of
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4 ESAP 2016
32+, Safari, or Google Chrome 37+. In addition, cookies and
JavaScript must be enabled in the browser’s options.
LAST REVIEW DATE: January 2016
ACTIVITY RELEASE DATE: April 1, 2016
ACTIVITY EXPIRATION DATE: April 30, 2019 (date
after which this enduring material is no longer certified for
AMA PRA Category 1 Credits and ABIM Medical Knowledge
MOC points)
For questions about content or obtaining CME credit or
MOC points, please contact the Endocrine Society at http://
education.endocrine.org/contact.
ESAP 2016 5
Laboratory Reference Ranges
.
Reference ranges vary among laboratories The listed reference ranges should be used when interpreting laboratory values presented in
.
.
ESAPTM Conventional units are listed first with Sl units in parentheses
Lipid Values - -
Thyrotropin (TSH) 0.5 5.0 mlU/L
-
High-density lipoprotein (HDL) cholesterol Thyroid stimulating <120% of basal immunoglobulin activity
Optimal ------------------·--·--·-------·--------- >60 mg/dL (>1.55 mmol/L) immunoglobulins
__ ____________
Normal-----------------·----·------------40-60 mg/dL (1.04-1.55 mmol/L) Thyroperoxidase (TPO) antibodies , <2.0 IU/mL (<2.0 klU/L)
—
-
Low <40 mg/dL (<1.04 mmol/L) T (free) 0.8 1.8 ng/dL (10.30-23.17 pmol/L)
4
_________
__ ___________________
Low-density lipoprotein (LDL) cholesterol T (total) , , 5.5-12.5 pg/dL (94.02-213.68 nmol/L)
4
Optimal -------~---------·--- -·---------------<100 mg/dL (<2.59 mmol/L) Free T index —----------------·-----------------------------------·-------- 4-12
4
-
Low 100 129 mg/dL (2.59-3.34 mmol/L) j (free)-------------------~------------ 2.3-4.2 pg/mL (3.53-6.45 pmol/L)
3
-
Borderline-high 130-159 mg/dL (3.37-4.12 mmol/L) T (total) -------------------------------·- 70 200 ng/dL (1.08-3.08 nmol/L)
3
-
High------------------------------ 160-189 mg/dL (4.14 4.90 mmol/L) T uptake, resin 25%-38%
3
Very high ^190 mg/dL (>4.92 mmol/L) Radioactive iodine uptake— 3%-16% (6 hours); 15%-30% (24 hours)
-
Non HDL cholesterol
----------------·--------------------- Endocrine Values
Optimal <130 mg/dL (<3.37 mmol/L)
_____________ _
.,
Borderline-high -— 130-159 mg/dL (3.37-4.12 mmol/L) Serum
- ----------- -
High--------------------------------------- s240 mg/dL (>6.22 mmol/L) Aldosterone-----,--.-----·------ 1 21 ng/dL (27.7-582.5 pmol/L)
...........
Total cholesterol Alkaline phosphatase ----------·--------·-, - 50-120 U/L (0.84-2.00 pkat/L)
------------
Optimal - <200 mg/dL (<5.18 mmol/L) Alkaline phosphatase (bone-specific) <20 pg/L (adult male);
Borderline-high — 200-239 mg/dL (5.18-6.19 mmol/L) <14 pg/L(premopausal female);
--------------
------________ __ _____ __ _
High >240 mg/dL (>6.22 mmol/L) <22 pg/L (postmenopausal female)
,..,., ,_ , ,
Triglycerides Androstenedione 65-210 ng/dL (2.27-7.33 nmol/L) (adult male); 80-240
Optimal __ I ________ ,_ , __________ , ____• ____, ______ , __ <150 mg/dL (<3.88 mmol/L) ng/dL (2.79-8.38 nmol/L) (adult female)
Borderline-high — !!!11!!!11--19--·- 150-199 mg/dL (3.88-5.15 mmol/L) Calcitonin —<16 pg/mL (<4.67 pmol/L) (basal, male); <8 pg/mL (<2.34
---!!!1!;!!!1!1!!!!1
___________ _______ ___________ _
-
High , , 200 499 mg/dL (5.18-12.92 mmol/L) pmol/L) (basal, female); <130 pg/mL (37.96 pmol/L) (peak
Very high >500 mg/dL (>12.95 mmol/L) calcium infusion, male); <90 pg/mL (26.28 pmol/L) (peak
Lipoprotein (a) ---------~---------------------- s30 mg/dL (<1.07 pmol/L) calcium infusion, female)
--------.------------------
Apolipoprotein B 50-110 mg/dL (0.5-1.1 g/L) Carcinoembryonic antigen <2.5 ng/mL (<2.5 pg/L)
—
Corticotropin (ACTH)------------!!!!!!!!!!!!'-!90'!!!!!!'! 10-60 pg/mL (2.2-13.2 pmol/L)
Hematologic Values
Cortisol (8 AM) - 5-25 pg/dL (137.9-689.7 nmol/L)
- -
Erythrocyte sedimentation rate 0-20 mm/h Cortisol (4 PM) 2 14 pg/dL (55.2-386.2 nmol/L)
------------------------·
_____________ _______________ _
- - - ,
Haptoglobin 30 200 mg/dL (300 2000 mg/L) C peptide 0.9-4.3 ng/mL (0.30-1.42 nmol/L)
______ ____________ _
-------- -
Hematocrit 41%-50% (0.41-0.51) (male); 35%-45% (0.35-0.45) C reactive protein , ,_, 0.8-3.1 mg/L (7.62-29.52 nmol/L)
-
(female) Cross-linked N telopeptide ------------------- 5.4-24.2 nM BCE (male);
Hemoglobin A 4.0%-5.6% (20-38 mmol/mol) of type 1 collagen 6.2-19.0 nM BCE (female)
|c
-
Hemoglobin 13.8 17.2 g/dL (138-172 g/L) (male); 12.1-15.1 g/dL Dehydroepiandrosterone sulfate (DHEA-S)
(121-151 g/L) (female) Female Male
---·----------------~------------ 3
Mean corpuscular- 80-100 pm (80-100 fL) Age 18-29 years 44-332 pg/dL 89-457 pg/dL
volume (MCV) (1.19-9.00 pmol/L) (2.41-12.38 pmol/L)
103 109
Platelet count ---------------------- 150-450 x /pL (150-450 x /L) Age 30-39 years 31-228 pg/dL 65-334 pg/dL
--------------- -
Protein (total) ----·--------·---·-------- 6.3-7.9 g/dL (63-79 g/L) (0.84-6.78 pmol/L) (1.76 9.05 pmol/L)
Reticulocyte count — 0.5%-1.5% of red blood cells (0.005-0.015) Age 40-49 years 18-244 pg/dL 48-244 pg/dL
109
White blood cell count 4500-11,000/pL (4.5-11.0 x /L) (0.49-6.61 pmol/L) (1.30-6.61 pmol/L)
-
Age 50-59 years 15 200 pg/dL 35-179 pg/dL
Thyroid Values (0.41-5.42 pmol/L) (0.95-4.85 pmol/L)
Thyroglobulin 3-42 ng/mL (3-42 pg/L) (after surgery and radioactive Age >60 years 15-157 pg/dL 25-131 pg/dL
-
iodine treatment: <1.0 ng/mL [<1.0 pg/L]) (0.41-4.25 pmol/L) (0.68 3.55 pmol/L)
Thyroglobulin antibodies s4.0 IU/mL (<4.0 klU/L) 1,25-Dihydroxyvitamin D 16-65 pg/mL (41.6-169.0 pmol/L)
3
6
- -
Estradiol 10-40 pg/mL (36.7 146.8 pmol/L) (male); Age 46-50 y 91-246 ng/mL 91 246 ng/mL
- -
10 180 pg/mL (36.7-660.8 pmol/L) (follicular, female); 100 300 (11.9-32.2 nmol/L) (11.9-32.2 nmol/L)
-
pg/mL (367.1 1101.3 pmol/L) (midcycle, female); 40-200 pg/mL Age 51-55 y 84-233 ng/mL 84-233 ng/mL
-
(146.8 734.2 pmol/L) (luteal, female); <20 pg/mL (<73.4 pmol/L) (11.0-30.5 nmol/L) (11.0-30.5 nmol/L)
(postmenopausal, female) Age 56-60 y 78-220 ng/mL 78-220 ng/mL
-
Estrone 10-60 pg/mL (37.0-146.8 pmol/L) (male); 17-200 pg/mL (10.2-28.8 nmol/L) (10.2-28.8 nmol/L)
!1!!11!_"'!!11!! __ _
-
62.9-739.6 pmol/L) (premenopausal female); 7-40 Age 61-65 y 72 207 ng/mL 72-207 ng/mL
-
pg/mL (25.9-147.9 pmol/L) (postmenopausal female) (9.4-27.1 nmol/L) (9.4 27.1 nmol/L)
- -
a-Fetoprotein ---------- <6 ng/mL (<6 pg/L) Age 66 70 y 67 195 ng/mL 67-195 ng/mL
—
Follicle-stimulating hormone (FSH) 1.0-13.0 mlU/mL (8.8-25.5 nmol/L) (8.8-25.5 nmol/L)
- -
(1.0-13.0 IU/L) (male); <3.0 mlU/mL (<3.0 IU/L) Age 71-75 y 62 184 ng/mL 62 184 ng/mL
(prepuberty, female); 2.0-12.0 mlU/mL (2.0-12.0 IU/L) (8.1-24.1 nmol/L) (8.1-24.1 nmol/L)
- -
(follicular, female); 4.0 36.0 mlU/mL (4.0 36.0 IU/L) Age 76-80 y 57-172 ng/mL 57-172 ng/mL
(midcycle, female); 1.0-9.0 mlU/mL (1.0-9.0 IU/L) (7.5-22.5 nmol/L) (7.5-22.5 nmol/L)
(luteal, female); >30 mlU/mL (>30 IU/L) >Age 80 y 53-162 ng/mL 53-162 ng/mL
(postmenopausal, female) (6.9-21.2 nmol/L) (6.9-21.2 nmol/L)
-
Free fatty acids 10.6-18.0 mg/dL (0.4 0.7 nmol/L) Insulinlike growth factor binding protein 3 -2.5-4.8 mg/L
-
Gastrin ----·--------------------------------------<100 pg/mL (<100 ng/L) Insulin ----~--------~---------------- 1.4-14.0 plU/mL (9.7-97.2 pmol/L)
- -
Growth hormone (GH) 0.01 0.97 ng/mL (0.01-0.97 pg/L) (male); Islet-cell antibody assay - 0 Juvenile Diabetes Foundation units
-----------l!l!!!'IJ!III _____ ,
0.01-3.61 ng/mL (0.01-3.61 pg/L) (female) Luteinizing hormone (LH) 1.0-9.0 mlU/mL (1.0-9.0 IU/L)
iiil _____
Homocysteine ,_ ______, __________ ,lllillirriiiill&ii&<lii _____ iill <1.76 mg/L (<13 pmol/L) (male); <1.0 mlU/mL (1.0 IU/L) (prepuberty, female); 1.0-18.0 mlU/mL
- -
P-Human chorionic gonadotropin (P-hCG) <3.0 mlU/mL (<3.0 IU/L) (1.0-18.0 IU/L) (follicular, female); 20.0-80.0 mlU/mL (20.0-80.0
nonpregnant female; >25 mlU/mL (>25 IU/L) IU/L) (midcycle, female); 0.5-18.0 mlU/mL (0.5-18.0 IU/L) (luteal,
indicates a positive pregnancy test female); >30 mlU/mL (>30 IU/L) (postmenopausal, female)
________ _______________ ____ _
P-Hydroxybutyrate , , , <3.0 mg/dL (<300 pmol/L) Metanephrines (plasma fractionated)
17-Hydroxypregnenolone 29-189 ng/dL (0.87-5.69 nmol/L) Metanephrine —__._ ________, __ ___, ______________' "'!- <57 pg/mL (<289 pmol/L)
17a-Hydroxyprogesterone — <220 ng/dL (<6.67 nmol/L) (adult male); Normetanephrine- <148 pg/mL (<808 pmol/L)
-
<80 ng/dL (<2.42 nmol/L) (follicular, female); <285 ng/dL 75-g oral glucose tolerance test (fasting) 60-100 mg/dL (3.3-5.6 mmol/L)
(<8.64 nmol/L) (luteal, female); <51 ng/dL (<1.55 nmol/L) Blood glucose values <200 mg/dL (<11.1 mmol/L)
.
(postmenopausal, female) (1 hour); <140 mg/dL (7.8 mmol/L) (2 hour) Between 140-200
25-Hydroxyvitamin D _,------------~--<10 ng/mL (<25.0 nmol/L) (severe mg/dL (7.8-11.1 mmol/L) is considered impaired glucose tolerance
deficiency); 10-24 ng/mL (25.0-59.9 nmol/L) mild to moderate or prediabetes; greater than 200 mg/dL (11.1 mmol/L) is a sign of
deficiency); 25-80 ng/mL (62.4-199.7 nmol/L) (optimum levels); diabetes mellitus
-
>80 ng/mL (>199.7 nmol/L) (toxicity possible) 50 g oral glucose tolerance test— <140 mg/dL (<7.8 mmol/L) (1 hour)
-
Inhibin B ,-,----------------------------·---·-,--- 15 300 pg/mL (15-300 ng/L) for gestational diabetes
-
Insulinlike growth factor 1 (IGF-1) 100 g oral glucose tolerance- - <95 mg/dL (<5.3 mmol/L) (fasting),
Female Male test for gestational diabetes <180 mg/dL (<10.0 mmol/L) (1 hour)
Age 18 y 162-541 ng/mL 170-640 ng/mL <155 mg/dL (<8.6 mmol/L) (2 hour)•
-
(21.2 70.9 nmol/L) (22.3-83.8 nmol/L) <140 mg/dL (<7.8 mmol/L) (3 hour)
—
- - -
Age 19 y 138-442 ng/mL 147 527 ng/mL Osteocalcin •--------'!!!I 9.0 42.0 ng/mL (7.0-42.0 pg/L)
dliiiil-jjii! !!!!I! !!!!!ll-9!!!!!!!!!!!;!!!,! ----------iii
- -
(18.1 57.9 nmol/L) 19.3-69.0 nmol/L) Parathyroid hormone (PTH) (intact) 10-65 pg/mL (10 65 ng/L)
- - -
Age 20 y 122 384 ng/mL 132-457 ng/mL Parathyroid hormone-related protein (PTHrp) 14 27 pg/mL (14-27 ng/L)
- - -
(16.0-50.3 nmol/L) (17.3 59.9 nmol/L) Progesterone ------------------------·-<1.2 ng/mL (<3.8 nmol/L) (male);
-
Age 21-25 y 116 341 ng/mL 116-341 ng/mL <-1.0 ng/mL (<3.2 nmol/L) (follicular, female); 2-20
- -
(15.2-44.7 nmol/L) (15.2 44.7 nmol/L) ng/mL (6.5 63.6 nmol/L) (luteal, female); <1.1 ng/mL
, _
-
Age 26-30 y 117 321 ng/mL 117-321 ng/mL (<3.5 nmol/L) (postmenopausal, female); >10
(15.3-42.1 nmol/L) (15.3-42.1 nmol/L) ng/mL (>31.8 nmol/L) (evidence of ovulatory
-
Age 31-35 y 113-297 ng/mL 113 297 ng/mL adequacy)
iiil-----·---------·------------,-
(14.8-38.9 nmol/L) (14.8-38.9 nmol/L) Proinsulin 26.5-176.4 pg/mL (3.0-20.0 pmol/L)
Age 36-40 y 106-277 ng/mL 106-277 ng/mL Prolactin -·------------------------4-23 ng/mL (0.17-1.00 nmol/L) (male);
-
(13.9-36.3 nmol/L) (13.9-36.3 nmol/L) 4 30 ng/mL (0.17 -1.30 nmol/L
-
Age 41-45 y 98 261 ng/mL 98-261 ng/mL (nonlactating female); 10-200 ng/mL
- -
(12.8 34.2 nmol/L) (12.8 34.2 nmol/L) (0.43-8.70 nmol/L) (lactating female)
2016 7
_
Prostate-specific antigen ------------------------ <2.0 ng/ml (<2.0 (jg/L) Prothrombin time -— 8.3-10.8 s
(<40 years); <2.8 ng/mL (<2.8 gg/L) (s50 years); <3.8 ng/mL (<3.8 Serum urea nitrogen ---------------------- 8-23 mg/dL (2.9-8.2 mmol/L)
---·-----·--·-
gg/L) (<60 years); <5.3 ng/mL (<5.3 gg/L) (s70 years); <7.0 ng/mL Sodium·-·-----·------------- 136-142 mEq/L (136-142 mmol/L)
-
(<7.0 gg/L) (<79 years); <7.2 ng/mL (<7.2 gg/L) (>80 years) Transferrin saturation 14% 50%
·------ -----------•--liill---------·------,--,--.------·---·
Renin activity, plasma, Na+ replete, ambulatory 0.6-4.3 ng/mL7h Troponin I <0.6 mg/mL (<0.6 gg/L)
-
Renin, direct concentration -30-40 pg/mL (0.7 1.0 pmol/L) Tryptase---------------------------------------- <11.5 ng/mL (<11.5 gg/L)
—
-
Sex hormone-binding globulin 1.1-6.7 gg/mL (10-60 nmol/L) (male); Uric acid --------------------------- 3.5-7.0 mg/dL (208.2 416.4 gmol/L)
-
2.2-14.6 gg/mL (20 130 nmol/L)
Urine
(female)
- - -
a-Subunit of pituitary glycoprotein hormones <1.2 ng/mL (<1.2 gg/L) Albumin 30 300 gg/mg creat (3.4 33.9 gg/mol creat)
— -------
-
Testosterone (bioavailable) 0.8-4.0 ng/dL (0.03-0.14 nmol/L) (20 50 Albumin-to-creatinine ratio <17 mg/g (male); <25 mg/g (female)
__________ _________ _
years, female on oral estrogen); 0.8-10.0 ng/dL (0.03-0.35 nmol/L) Aldosterone , -3-20 gg/24 h (8.3-55.4 nmol/d) (should be
-
(20 50 years, female not on oral estrogen); 83.0-257.0 ng/dL (2.88- <12 gg/24 h [<33.2 nmol/d] with oral
—
8.92 nmol/L) (male 20-29 years); 72.0-235.0 ng/dL (2.50-8.15 sodium loading confirmed with 24-hour
-
nmol/L) (male 30-39 years); 61.0-213.0 ng/dL (2.12 7.39 nmol/L) urinary sodium >200 mEq)
-
(male 40-49 years); 50.0-190.0 ng/dL (1.74-6.59 nmol/L) (male 50- Calcium 100-300 mg/24 h (0.5 7.5 mmol/d)
59 years); 40.0-168.0 ng/dL (1.39-5.83 nmol/L) (male 60-69 years) Catecholamine fractionation
-------·-------------------·------
Testosterone (free) 9-30 ng/dL (0.31-1.04 nmol/L) (male); Dopamine <700 gg/24 h (<4567 nmol/d)
—
0.3-1.9 ng/dL(0.01-0.07 nmol/L) (female) Epinephrine <35 gg/24 h (<191 nmol/d)
-
Testosterone (total) 300 900 ng/dL (10.4-31.2 nmol/L) (male); Norepinephrine <170 gg/24 h (<1005 nmol/d)
-------------------------~--,--~--'!'I!!•---
8-60 ng/dL (0.3-2.1 nmol/L) (female) Cortisol 4-50 gg/24 h (11-138 nmol/L)
~--------------
Dexamethasone suppression <10 gg/24 h (<27.6 nmol/L)
Chemistry Values test (low-dose: 2 day, 2 mg
___ _______ _
—
Alanine aminotransferase— , 10-40 U/L (0.17-0.67 gkat/L) daily), urinary free cortisol
Albumin ----·---·---------------------·--·-,-------,------ 3.5-5.0 g/dL (35-50 g/L) Creatinine ------------------------1-2 g/24 h (15-20 mg/kg/24 h, female;
-----------------------------------
Amylase- 26-102 U/L (0.43-1.70 gkat/L) 20-25 mg/kg/24 h, male)
—
-
Aspartate aminotransferase 20-48 U/L (0.33-0.80 gkat/L) Glomerular filtration rate---------- ------------->60 mL7min per 1.73 m2
—
---- -
Bicarbonate---------------~-------- 21 28 mEq/L (21-28 mmol/L) 5-Hydroxyindole acetic acid 2-9 mg/24 h (10.5-47.1 gmol/d)
- -
Bilirubin (total) 0.3-1.2 mg/dL (5.1 20.5 gmol/L) 17-Ketosteroids 6.0 21.0 mg/24 h (20.8-72.9 gmol/d) (male);
Blood gases
4.0-17.0 mg/24 h (13.9-59.0 gmol/d) (female)
Por arterial blood -------------~------ 80-100 mm Hg (10.6-13.3 kPa)
- Metanephrine fractionation
Pco , arterial blood 35-45 mm Hg (4.7-6.0 kPa)
Metanephrine --------------------------- <400 gg/24 h (<2028 nmol/d)
2
___________________ __________ ________ _______ __________ _
Blood pH _, , _,_,.... , 7.35-7.45 Normetanephrine -- - <900 gg/24 h (<4914 nmol/d)
___ _
- ...., —
Calcium 8.2-10.2 mg/dL (2.1 2.6 mmol/L) Total metanephrine <1000 gg/24 h (<5260 nmol/d)
Calcium (ionized) ---------------------4.60-5.08 mg/dL (1.2-1.3 mmol/L) Albumin 30-300 gg/mg creat (3.4-33.9 gg/mol creat)
Carbon dioxide ---------------- ----------- 22-28 mEq/L (22-28 mmol/L) Osmolality ---------------------- 150-1150 mOsm/kg (150-1150 mmol/kg)
- - 109
CD,cell count 500 1400/gL (0.5 1.4 x /L) Oxalate <40 mg/24 h (<456 mmol/d)
_________________________
_,
Chloride 96-106 mEq/L (96-106 mmol/L) Phosphorus <0.9-1.3 g/24 h (29.1-42.0 mmol/d)
--------
Creatine kinase --------------------------- 50-200 U/L (0.84-3.34 gkat/L) Potassium ___ ----------,-__ ..,.-____ 17-77 mEq/24 h (17-77 mmol/d)
,_
-
Creatinine -------------------- 0.7-1.3 mg/dL (61.9-114.9 gmol/L) (male) Sodium-------------------------------40-217 mEq/24 h (40 217 mmol/d)
0.6-1.1 mg/dL (53.0-97.2 gmol/L) (female) Uric acid -----------,---·----------------·-------<800 mg/24 h (<4.7 mmol/d)
-
Ferritin______ _______ ,_ ________ i-___ !!!!'"' ____ _ 15 200 ng/mL (33.7-449.4 pmol/L)
Glucose — 70-99 mg/dL (3.9-5.5 mmol/L) Saliva
•
W-iiiii,•-ilil-iliiil!.liiiil-iiii!
-
y-Glutamyltransferase 2 30 U/L (0.03-0.50 gkat/L) Cortisol (salivary), midnight- <0.13 gg/dL (<3.6 nmol/L)
__ _________________________ _
—
Iron , 50-150 gg/dL (9.0-26.8 gmol/L) (male);
Semen
35-145 gg/dL (6.3 26.0 gmol/L) (female)
-
Lactate dehydrogenase 100 200 U/L (1.7-3.3 gkat/L) Semen analysis- >20 million sperm/mL; >50% motility
Lactic acid 5.4-20.7 mg/dL (0.6-0.9 mmol/L)
-----------------------------
-
Lipase ------------------------·------------10-73 U/L (0.17 1.22 gkat/L)
Magnesium - 1.5-2.3 mg/dL (0.6-0.9 mmol/L)
----------------------------
.. __ &1,liiiil.-----------------
Osmolality - 275-295 mOsm/kg (275-295 mmol/kg)
--------------·--------------- - -
Phosphorus 2.3 4.7 mg/dL (0.7 1.5 mmol/L)
Potassium 3.5-5.0 mEq/L (3.5-5.0 mmol/L)
8 ESAP 2016
Abbreviations
I
—
ACTH ------~---·-·------- _,_ ___ '"""'!"'!!!!'!!l!!'!!!!!"I!!'!;'--!!'!""-"""!"'---------""""'--!!'!!!""'!!""-·--~----- corticotropin
ACE inhibitor angiotensin-converting enzyme inhibitor
BMI body mass index
-------------------------------------------------------
CNS -----------------------------------------------central nervous system
CT computed tomography
------------------------------------------------
—
DHEA dehydroepiandrosterone
·------.-------·----------·----------
DHEA-S dehydroepiandrosterone sulfate
DNA deoxyribonucleic acid
------------------------------------------------
DXA ----·... .· ----·-·---- -----------•llilliiiil,tiil!ila--iliiiliia- dual-energy x-ray absorptiometry
FDA-·----·---,---------------------·-·-----·-•--US Food and Drug Administration
FNAB--------------------------------------- fine-needle aspiration biopsy
FSH------------------------------------~----~-follicle-stimulating hormone
GH growth hormone
-------------------~-----------------------------------
—
-
GHRH growth hormone releasing hormone
__ ,_ __ -----------"!!"!'!!'!1!11!1' ___ illll p·--
------------------
-_______________
GnRH , gonadotropin-releasing hormone
_____ ___________________ ___________ _
,.._
hCG ,_ , , human chorionic gonadotropin
___________ ______________________ _________ _
_____
HDL , , , high-density lipoprotein
------------·-----------------~-----------
HIV human immunodeficiency virus
----------·--·- -
HMG-CoA reductase inhibitor 3 hydroxy-3-methylglutaryl
coenzyme A reductase inhibitor
;!iJl!!--------·----,----""!!!!!'!!!!!~!!!f@W,liii,iii,liii!' ____
IGF-1 insulinlike growth factor 1
lll!!!'_'!l!!!_!!!!!!'l __ "!!!!!!!!!!!!!!!!!!I!!---
LDL Iow-density lipoprotein
LH ---------------------------------------------------- luteinizing hormone
________ ____________ __________ ____________ _
_,,_
MCV , , , mean corpuscular volume
MRI - magnetic resonance imaging
----------
NPH insulin neutral protamine Hagedorn insulin
PTH"""'!!!P!I ___ , ________, __________, _ __ ,. ______________________ _ parathyroid hormone
—
-
PTHrP _________ l!"""', __________, _ , _____ _ parathyroid hormone related protein
T ----;jijjf-iili&iil,_, triiodothyronine
--·----- - _ , ___ ,oiiiiiiiit ____ - __, _____ -Ol'!!'C!!!!!! l!B.'liillltiiil8,tiiii;Miiiiiifiiiiioiiiii liiii,iiiil,-,;i'!!,""!!!!~<e!
3
T thyroxine
4
TPO antibodies-------------------------·-----"""!- thyroperoxidase antibodies
-
TRH thyrotropin releasing hormone
TSH thyrotropin
-------
VLDL -------------------------------- very Iow-density lipoprotein
ESAP 2016
9