ESAP™ 2018 Endocrine Self-Assessment Program Questions&Answers Discussions Endocrine Society

192 Pages·2018·6.945 MB·English

ESAPTM 2018
Endocrine Society’s
Endocrine Self-Assessment Program
Questions, Answers, and Discussions
LisaR.Tannock,MD,ProgramChair
ProfessorofMedicine
Chief,DivisionofEndocrinology
andMolecularMedicine
UniversityofKentuckyand
DepartmentofVeteransAffairs
KristienBoelaert,MD MarieFreel,MB,ChB,PhD DeepikaReddy,MD
ReaderinEndocrinologyCenterfor ConsultantEndocrinologist AssistantProfessor
Endocrinology,Diabetes,andMetabolism QueenElizabethUniversityHospital DivisionofDiabetes,Endocrinology,
UniversityofBirmingham Glasgow,UnitedKingdom andMetabolism
UniversityofUtahHealthcare
BarbaraGiseilaCarranzaLeon,MD MimiHu,MD
AssistantProfessorofMedicine AssociateProfessor RobertoSalvatori,MD
DivisionofDiabetes,Endocrinology, DepartmentofEndocrineNeoplasia ProfessorofMedicine
andMetabolism andHormonalDisorders MedicalDirector,
VanderbiltUniversityMedicalCenter UniversityofTexasMDAnderson JohnsHopkinsPituitaryCenter
CancerCenter JohnsHopkinsUniversity
StephenClement,MD
MedicalDirector,EndocrineServices MichaelS.Irwig,MD SavithaSubramanian,MD
InovaFairfaxHospital AssociateProfessor AssociateProfessorofMedicine
GeorgeWashingtonUniversity UniversityofWashington
KathrynMcCrystalDahir,MD
AssistantProfessorofMedicine JacquelineJonklaas,MD,PhD AnandVaidya,MD,MMSC
DivisionofEndocrinology Professor AssistantProfessorofMedicine
VanderbiltUniversityMedicalCenter DivisionofEndocrinologyandMetabolism BrighamandWomen’sHospital
GeorgetownUniversity HarvardMedicalSchool
ThomasW.Donner,MD
AssociateProfessorofMedicine StevenMagill,MD,PhD CorrineWelt,MD
DivisionofEndocrinology, AssociateClinicalProfessorofMedicine ProfessorofMedicine
Diabetes,andMetabolism Endocrinology,Diabetes,andMetabolism UniversityofUtahSchoolofMedicine
JohnsHopkinsUniversity MedicalCollegeofWisconsin
AbbieL.Young,MS,CGC,ELS(D)
MedicalEditor
EndocrineSociety
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HormoneSciencetoHealth
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ENDOCRINE
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ISBN:978-1-879225-41-1
LibraryofCongressControlNumber:2017951680
OntheCover:
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Middle:PET-CTshowingfluorodeoxyglucose-avidskeletalmetastaticdiseaseintheright
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OVERVIEW (cid:127)Identifyriskfactorsforendocrineandmetabolic
TheEndocrineSelf-AssessmentProgram(ESAP )isaself- disordersanddevelopstrategiesforprevention.
studycurriculumaimedatphysiciansseekinginitialcertification (cid:127)Evaluateendocrineandmetabolicmanifestationsof
orrecertificationinendocrinology,programdirectorsinterested systemicdisorders.
inatestingandtraininginstrument,andclinicianssimply (cid:127)Useexistingresourcespertainingtoclinicalguidelines
wantingaself-assessmentandabroadreviewofendocrinology. andtreatmentrecommendationsforendocrineand
ESAP2018isavailableinbothprintandonlineformats.It relatedmetabolicdisorderstoguidediagnosisand
consistsof120brand-newmultiple-choicequestionsinallareas treatment.
ofendocrinology,diabetes,andmetabolism.Thereisextensive
discussionofeachcorrectanswer,acomprehensivesyllabus, TARGETAUDIENCE
andreferences.ESAPisupdatedannuallywithnewquestions ESAPisaself-studycurriculumaimedatphysiciansseeking
andnewsyllabusmaterials. initialcertificationorrecertificationinendocrinology,program
ESAPiscomposedoftwokeycomponents:theinitial directorsinterestedinatestingandtraininginstrument,and
onlineinteractivemoduleandtheprintedbook.Upon clinicianssimplywantingaself-assessmentandabroad
purchase,learnerswillinitiallyreceiveaccesstotheonline reviewofendocrinology.
module.TouseESAPasatrueself-assessmenttool,learners
arestronglyencouragedtocompletetheonlineinteractive STATEMENTOFINDEPENDENCE
self-assessmentmodulefirstbeforecontinuingself-study AsaproviderofCMEaccreditedbytheAccreditation
withtheprintedbook;theonlinemodulemaybeaccessedat CouncilforContinuingMedicalEducation,theEndocrine
education.endocrine.org. Societyhasapolicyofensuringthatthecontentandquality
ofthiseducationalactivityarebalanced,independent,
ACCREDITATIONSTATEMENT objective,andscientificallyrigorous.Thescientificcontent
TheEndocrineSocietyisaccreditedbythe 1^1 ofthisactivitywasdevelopedunderthesupervisionofthe
AccreditationCouncilforContinuingMedical EndocrineSociety’sESAPFacultyWorkingGroup.
Educationtoprovidecontinuingmedical ACCME
educationforphysicians.TheEndocrine A%CCREDITEDWI#TH DISCLOSUREPOLICY
COMMENDATION
SocietyhasreceivedAccreditationwith Thefaculty,committeemembers,andstaffwhoarein
Commendation. positiontocontrolthecontentofthisactivityarerequired
TheEndocrineSocietydesignatesthisenduringmaterial todisclosetotheEndocrineSocietyandtolearnersany
foramaximumof40.0AMAPRACategory 1Credits . relevantfinancialrelationship(s)oftheindividualorspouse/
Physiciansshouldclaimonlythecreditcommensuratewith partnerthathaveoccurredwithinthelast12monthswith
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LEARNING OBJECTIVES orconclusion.TheEndocrineSocietyhasreviewedall
ESAP2018willallowlearnerstoassesstheirknowledgeofall disclosuresandresolvedormanagedallidentifiedconflicts
aspectsofendocrinology,diabetes,andmetabolism. ofinterest,asapplicable.
Uponcompletionofthiseducationalactivity,learnerswill Thefollowingfacultyreportedrelevantfinancial
beableto: relationship(s):ThomasW.Donner,MD,isastudysite
(cid:127)Recognizeclinicalmanifestationsofendocrineand principalinvestigatorforNovoNordisk.MimiHu,MD,isa
metabolicdisordersandselectamongcurrentoptions primaryinvestigatorforAstraZeneca.MichaelIrwig,MD,
fordiagnosis,management,andtherapy. servedasmalehypogonadismfacultyforMedscape.
ESAP2018 3
Roberto Sarvatori, MD, recerves grant support from research that conforms to generally accepted standards
National Institutes of Health and the Department of Defense; of experimental design, data collection, and data analysis.
is a reviewer for the National Institutes of Health; and is Before recommending or prescribing any therapeutic agent
an investigator for Pfizer Novartis, Chiasma, Millendo or device, learners should review the complete prescribing
Therapeutics, and Strongbridge Biopharma. Savitha information, including indications, contraindications,
Subramanian, MD, receives grant support from lonis warnings, precautions, and adverse events.
Pharmaceuticals. Anand Vaidya, MD, received grant support
from the National lnstiMes of Health and the Doris Duke PRIVACY AND CONFIDENTIALITY STATEMENT
Charitable Foundation. Corrine Welt, MD, is a writer for The Endocrine Society will record learner's personal
UpToDate and a consultant for Takeda. information as provided on CME evaluations to allow for
The following faculty members reported no relevant issuance and tracking of CME certificates. The Endocrine
financial relationships Kristien Boelaert, MD; Barbara Society may also track aggregate responses to questions in
Gisella Carranza Leon, MD; Stephen Clement, MD; activities and evaluations and use these data to inform the
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MD, PhD; Steven Magill, MD; Deepika Reddy, MD; and individual performance data or any other personal information
Usa R. Tannock, MD. collected from evaluations will be shared with third parties.
The madlcal editor for this program, Abbie L. Young,
MS, CGC, EL.SfDt, reported no relevant financial relatioMhips. ACKNOWLEDGMENT OF COMMERCIAL
The Endocrine Society staff associated with the SUPPORT
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4 ESAP 2018
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ESAP 2018 5
Laboratory Reference Ranges
Reference ranges vary among laboratories. Conventional units are listed first with SI units in parentheses.
Lipid Values Thyrold•stimulatlng lmmunoglobulln ---.:120% of basal activity
High-density lipoprotein (HDL) cholesterol Thyroperoxidase {TPO) anlibodies••··---<2.0 IU/mL (<2.0 klU/L)
Optimal•····-----·---·········->60 mg/dL (>1.55 mmol/L) Thyroxine (T.) (lree)·--····----·---· 0.8·1.8 ng/dl (10.30·23.17 pmol/L)
Normal••·-·-··· -··· 40-60 mg/dL (1.04·1.55 mmol/L) Thyroxlne(T.J (total)---5.5·12.5 µg/dL (94.02·213.68 nmolfW
rr,)
Low •·········-<40 mg/dL (<1.04 mmol/L) Free thyroxine Index-----·-------···••-.-4•1 2
Low•density fipoprotein (LDL) cholesterol Triiodolhyronjne (T:J (free) •-·---2.3-4.2 pg,'mL (3.53-6.45 pmol/L)
Optimal •····• • -···- ···• ·····• --·• ······• <100 mg/dL (<2. 59 mmol/L) Triiodothyronine {TJ ~otall•····-··-·· 70·200 ng/dl (1.08-3.0B nmollll
Low··············---···· 100·129 mg/dL (2.59·3.34 mmol/L) lrliooothyronine (T: ,), reverse-·-· 10·24 ng/dl (0.15·0.37 nmol/L)
Borderline-high-----130·159 mg/dL (3.37-4.12 mmol/L) Triiodothyronlne uptake, resln-------········25%•38%
High,-.....---·······-·····-··· 160·189 mg/dL (4.14•4.90 mmol/L) Radioactive iodine uptake·•· 3%·16% (6 hours): 15%·30% (24 hours)
Ve,y high ---······-······-··-··~190 mg/dL (a.4.92 mmol/L)
Non•HDL cholesterol Endocrine values
Optimal------- ----<130 mg/dL (<3.37 mmol/L)
Botdertine-h ig h • -··--··• • -· •• 130·1 59 mg/dL (3.37-4. 12 mmoI ll) Se,um
High·····--···---··-·····--·-·-·--··---·--· "'240 mg/dL (,.6.22 mmol!L) Aldosteron&--······-··-··········-·--4-21 ng/dL (111.0-582.5 pmol/L)
Total cholesterol Alkaline phosphatase------50-120 U/L (0.84·2.00 µkat/L)
Optimal-······--- ---<200 mg/dL (<5.18 mmol/L) Alkaline phosphatase (bona-specific) ---·"20 IJQ/L (adult male);
Bordenlne--h igh •··-····• -·- ··· 200-239 mgldL (5.18-6. 19 mm ol/L) ,., 4 l,IQfL ipn.menopausaf female): s22 µ~L (postmenopausal female)
High--········----····-·-·---····--·-.>,240 mg/dl ~6.22 mmol/L) Androstened!one ••·--··65·210 ng/dl (2.27-7.33 nmol/L) (adult male);
Triglycerides B0·240 ng/dL (2. 79·8.38 nmol/L) (adult female)
Optimal-· ---<150 mg/dl (<3.88 mmol/L) Antimullerlan hormone----0.7·19.0 ng/mL (5.0·135.7 pmol/L)
Borderline·high •···-····-····· 150·199 mg/dL (3.88-5.16 mmol/L) (male, >12 years):
High•···--·····-···-·-···--···· 200-499 mw'dL (5.18·12.92 mmol/L) 0.9-9.5 ng/mL (6.4-67.9 pmol/L) (female. 13-45 ysa,s);
V«y high----- ____. ,,500 mg/dL (,.12.95 mmol/L) <1.0 ng/ml (< 7 .1 pmol/l) (female, ;,45 yea,s)
Upoproteln (a) ----$3!l mg/dL ("1 .07 µmol/L) Calcitonln ------<16 pg/ml (<4.67 pmol/1.l (basal, male);
Apolipoprotein B -··-·····-·----5(H1 0 mg/dL (0.5·1 .1 g/L) <8 pg.lmL (<2.34 pmol/L) (basal, female);
,.130 pg.lml (.:37 .96 pmol/L) (peak calcium infusion, male):
Hematologic varues "90 pg/ml (s26.26 pmoVL) (peak calcium infusion, female)
Erythrocyte sedimerrtalion rate ---------0·20 mm/h Carcinoembryonic antigen ----····-·· <2.5 ng/mL (<2.5 µg/L)
Haptoglobin ··---··--··---··-30-200 mgtdL (300·2000 mg/L) Chromogranin A··-----·---··< 93 ng/ml (<93 µg/L)
Hematocrit ••···--·······-·······--····41 %-50% (0.41-0.51) (male): Corticosterone-•-53-1560 nwdL (1.53-45.0B nmol/L) (>18 years)
35%-45% (0.35·0.45) (female) Corticotropln (ACTH)-----10-60 pg/mL. (2.2·1 3,2 pmol/l)
Hemoglobin A,.--- ---4.0%·5.6% (20·3S mmol/mol) Cot1isol (8 AM)··········-······-··- 5·25 µg/d L (137 .9·689.7 nmol/l)
Hemoglobin--- ····•···••• 13.8·17.2 g/dL(138·172 g/l) (male); Cortisol (4 PM,-...------2·14 IJg/dl (55.2-386.2 nmol/l)
12.1-15.1 g/dL (121•151 g/L) (1emale) C•peptide --------0.9-4.3 ng/ml (0.30·1 .42 nmol/l)
International normaHzed ratio -----------u.. 8 ·1 .2 C·reactlve protein------0.8-3.1 mg/I.. (7.62·29.52 nmol/l.)
Mean c:orpt.1scular volume (MCV)----80·100 µm3 {80·100 fl) Cross·linked N·teiopeplide of type 1 collagen··-······-·-···-··········
Platelet count-------150-460 x 103/µL (150-450 x 10'/l) 5.4·24.2 nmol BCE/mmol creat (male):
Protein (total)•·-·······-----····--6.3-7.9 g/dl (63-79 gA.) 6.2-19.0 nmol BCE/mmol creat (female)
Reticuloeyte count•······· 0.5%·1.5% of red blood cells (0.005-0.015) Oehydroepiandrosterone sulfate (DHEA·S)
White blood ceH count ··----4500·11,000/µL (4.5·11.0 x 1O '/l) Patient Age Female Male
18-29 years 44·332 µg/dl 89·457 µg.td L
Thyroid ValLNtS (1.19-9.00 µmolll) (2.41-12.38 µmol/l)
Thyroglobulin •-3·42 ng/mL (3-42 µg/L) {after surgery and radioactive 30·39 years 31 ·228 )J~dl 65-334 IJ9,'dL
iodine trealment: <1.0 ng/ml [<1.0 1,1g/LD (0.84-6.78 µmoVL) (1.76•9.05 µmoll~
Thyroglobulin antibodies --------s4.0 IU/mL ("4.0 klU/l) 40-49 years 1B-244 µgldL 48•244 µg.tdL
Thyrotropin (TSH) •··· •-·-··--•-0.5-5.0 mlU/L (0.49·6.61 µmol/L) (1.30-6. 61 µ mol/L)
6 ESAP 2018
Patient Age Female Male Patient Age Female Male
50-69 years 15-200 µg/dl 35-179 µg/dl 26-30 years 117-321 ng/ml 117-321 ng/ml
(0.41-5.42 µmol/L) (0.95-4.85 11moVL) {15.3-42.1 nmoVL) (15.3-42.1 nmoVL)
;,60 )'&ars 15-157 µg/dl 25-131 µg/dL 31 ·35 years 113-297 ng/mL 113-297 ng/ml
(0.41-4.25 µmoVL) (0.68-3.55 µmoVL) (14.8-38.9 nmol/l..) (14.8-38.9 nmol/L.)
Deo,i.ycorticQsterone---<10 ng/dL (<0.30 nmol/l) (>18 years) 36-40 years 106-277 ng/mL 106-277 ng/ml
1,25-0ihydroxyvitamin D, ---•----16-65 pg/ml (41.6--169.0 pmoVL) (13.9 -36. 3 nmol/1...) (13.9-36.3 nmoVL)
Estradlol -----------10-40 pg/mL (36.7-146.6 pmol/L) (male); 41-45 years 96·261 ng/ml 98-261 ng/ml
10-180 pg/ml (36.7-660.8 pmol/l..) (follicular, female); (12.8-342 nmol/L) (12.8-34.2 nmol/l..)
100-300 pg/ml (367 .1-1101.3 pmol/L) (midcycle, female); 46-50 years 91-246 ng/mL 91-246 ng/ml
40-200 pg/ml (146.8-734.2 pmol/L) (luteal, female): (11.9-32.2 nmol/L) (1l.9-a2.2 nmol/l..)
<20 pg/ml (<73.4 pmoVL) (pOstmenopausal, female) 51·55 years 64·233 ng/ml 84-233 ng/ml
Estrone---------------10-60 pg/ml (37.0-221.9 pmoVI..) (male); (11.0-30.5 nmol/l) (11.()-30.5 nmol/L)
17-200 pg/ml (62.9-739.6 pmol/l) (premenopausal female): 56-60 years 78-220 ng/ml 78-220 ng/ml
7-40 pg/ml (25.9-147.9 pmol/L) (postmenopausal female) (10.2•28.8 nmol/L) (10.2•28.8 nmol/L)
a-Fetoproteln-----------------<6 ng/mL (<6 µg/l) 61-65 years 72•207 ng/ml 72-207 ng/ml
Foll!cie-stlmulating hormone (FSH) -------- (9. 4-27. 1 nmoVL) (9.4-27. 1 nmol/L)
1.0-13.0 mtU/ml (1.0-13.0 JU/L) (male); 66-70years 67-195 ng/ml 67-195 ng/mL
<3.0 mlU/mL (<3.0 lU/l.) (prepllberty, female): (8.8-25.5 nmoVL) (6.8-25.5 nmol/L)
2.0-12.0 mlU/mL (2.0-12.0 IU/L) (foll!eular, female); 71-75 years 62-184 ng/mL 62·184 ng/mL
4.0-36.0 mlU/ml (4.0-36.0 IU/L) (midcycle, female); (8.1-24.1 nmoVI..) (8.1-24.1 nmol/L)
1.0-9.0 mlU/mL (1.0-9.0 JU/L) (luteal, female); 76-80 years 57-172 ng/ml 57-172 ng/ml
>30 mlU/ml (>30 IU/l.) (postmenopausal, female) (7. 5•22.5 nmol/l.) (7.5-22.5 nmol/L)
Free fatty acids----- 10.6-18.0 mgldl {0.4-0.7 nmoVl) >=130 years 53-162 ng/ml 53-162 ng/mL
Gastrin --------------------------------<100 pg/ml (<100 ng/l) (6.9-21.2 nmoVL) (6.9-21.2 nmol/1.)
Grow1h hormone (GH) ----0.01 -0.97 ng/ml (0.01-0.97 µg/l) (male); lnsulinlike growth factor binding protein 3--------------2.5-4.8 mg.IL.
0.01-3.61 ng/mL (0.01-3.61 µg/l) (female) Insulin ---------1.4-14.011IU/mL (9.7-97.2 pmoVL)
Homocystelne•-··-----·-··-··--••.:1.76 mg/L (,;;13 µmol/L) Islet-cell antibody assay----·-··· 0 Juvenile Diabetes Foundation units
J3-Human chorionic gonadotropin (!3-hCGJ------------- Luteinizing hormone (LH)----1.0-9.0 mlU/mL (1.0-9.0 IU/L) (male):
<3.0 mlU/ml (<3.0 IU/L) (nonpregnant female); <:1.0 mlU/ml {<:1 .D IU/t) (prepuberty, female);
>25 mlU/mL (>25 IU/I..) Indicates a positive pregnancy test 1.0-18.0 mlU/ml (1.0-18.0 IU/L} (foltlculer, female);
J3-Hydro)(}lbutyrate -----------<3.0 mg/dl (<300 µmol/l) 20.0-80.0 mlU/mL (20.0-80.0 IU/L) (midcycle, female);
17-Hydroxypregnenolone -----29-189 ng/dL (0.87-5.69 nmol/L) 0.5-18.0 mlU/ml (0.5-18.0 IU/L) (ILJ!eal, female);
17a-Hydroxyprogestercne ----<220 ng./dl (<6.67 nmol/L) (adult male); >30 mlU/mL (>30 IU/L) (postmenopausal, female)
<80 ng/dl (<2.42 nmoVL) (fOIIIC\Jlar, female); Metanephnnes (plasma fractionated)
<285 ng/dL {<8.64 nmol/l) (luteal, female); Metanephrine --------·---------<57 pg/ml (<289 pmo!/L)
<51 ng/dl (1 .55 nmoVL) (postmeoopausal, female) Normetanephrine-----------<148 pg/ml (<808 pmol/L)
25-Hydroxyvitamln D --<10 ng/mL (<25.0 nmol/L) (severe deficiency); 75-g oral glucose tol«ance test-60-100 mg/dL (3.3-5. 6 rrvnoUW (fasting)
10-24 ng/mL {25.0-59.9 nmol/L) (mlld to moderate deficiency); Blood glucose values ----·-··<200 mg/dL (<1 1.1 mmoVL) (1 hour);
25-80 ng/ml (62.4-199.7 nmol/L) (optimum levels); -c:140 mg/dl (<:7.8 mmol/l) (2 hour)
>80 ng/mL (>199.7 nmollt) {toxlelty possible) Between 140-200 mg/dl (7.8-11.1 mmoVL) Is considered
lnhibin B ---- -----15-300 pg/ml (15-300 ng/L) Impaired glucose tolerance or prediabeles. Greater than
lnsullnlike growth factor 1 (IGF-1) 200 mg/dl (11.1 mmol/L) Is a slgn of diabetes mellitus.
Patient Age Female Male 50-g oral glucose tolerance test tor gestational diabetes ---------··
1B years 162-541 ng/ml 17o-640 ng/ml <140 mg/dl(<7.8 mmol/l..) (1 hour)
(21.2-70.9 nmol/L) (22.3-83.8 nmol/l) 10D•g oral glucose tolerance test for gestational diabetes---
19 years 138-442 ng/ml 147-527 ng/mL <95 mg/dL (<5.3 mmol/LJ (fasting);
(18.1-57.9 nmol/L) (19.3·69.0 nmol/L) <:180 mgtdl (<:10.0 mmoVL) (1 hour);
20yaars 122-384 ng/ml 132-457 ng/mL <155 m~dl (<8.6 mmol/l..) (2 hour);
(16.0-50.3 nmol/l) (17.3-59.9 nmoVL) <140 mg/dL (<7.8 mmol/L) {3 hour)
21-25 years 116-341 ng/mL 116-341 ng/ml Osteocalcin -------------------------------9.0-42.0 ng/ml (9.0-42.0 \J9l'L)
(15.2•44.7 nmol/l) (15.2-44.7 nmol/L) Parathyroid hoonone, intact (f'TH)------·-· 10·65 pg/ml (10-65 ng/L)
Parathyroid honnorMH'Blated protein (PTHrP) 14-27 pg/ml (14-27 ng/1..)
ESAP2018 7
Progesterone ------------··s1 .2 ng/mL (s3.8 nmol/L) (male); Creatinine --------0. 7 -1.3 mg/dL (61.9-114.9 µmol/L) {male);
s1.0 ng/ml (s3.2 nmol/L) (follicular, female): 0.6-1.1 mg/dl (53.0-97.2 µmoVL) (female)
2.0-20.0 nl}l'mL (6.4-63.6 nmol/L) Quteal, female); Ferr1tin-------·-------15-200 ng/ml (33.7-449.4 pmol/L)
s1.1 ng/mL ("3.5 nmoVL) (postmenopausal, female): Folate •······----- -----·24.0 ng/mL (:,A.0 µg/l)
> 10.0 ng/mL (>31.8 nmol/L) {evi<fence of ovulatoiy adequacy) Gluco:.e ------------------·-·-70-99 mg/dl (3.9-5.5 mmoVLJ
Proinsulln •----------26.5-176.4 pg/ml (3.0-20.0 pmol/L) y-Glutamyltransferase -·--···---------····-·2-30 U/l (0.03-0.50 µkaVL)
Prolactin -------4·23 ng.tmL (0.17-1.00nmol/L) (male); Iron ------·-------50-150 µg/dl (9.0-26.8 µmol/L) (male);
4-30 ng/mL (0.17-1.30 nmol/l.J {nonlllciating female); 35·1 45 µg/dL (6.3-26.0 µmol/l) (female)
10-200 ng/mL (0.43-8.70 nmol/l) Qactatlng female) Leet.rte dehydrogenase ······-··········-· 100-200 UA. (1.7-3.3 µkat/L)
Prostate-specific antigen-•--···---<2.0 ng/ml (<2.0 µg/1.) (s40 years); Lactic acid-------------·--···----·-·· 5.4-20.7 mg/dl (0.6-2.3 mmol/L)
<2.8 ng/ml (<2.8 µg/1.) (sSO years); Llpase----------------10-73 U/L (0.17-1.22 µkat/1..)
<3.8 ng/ml (<3.8 µg/l) ("60 years); Magnesium --------1.5•2.3 mg/dL (0.6-0.9 mmoVL)
<5.3 ng/ml (<5.3 ~ (s70 years); Osmolality ---·-·-············---275-295 mOsm/kg (275-295 mmol/kg)
<7.0 ng/ml {<7.0 µg/l) (s79 years): Phosphorus-----·--·-···--------2.3-4.7 mg/dl (0.7-1.5 mmoVL)
<7.2 ng/ml (<7.2 µg/l) (:d!0years) Potassium -------·-···--3.5-5.0 mEqA. (3.5•5.0 mmol/L)
Renin activity, plasma, sodium replete, embulatO(}' -0.6-4.3 ng/mL per h Prothrombln time----···············-····-·········· 8.3·1 O .B s
Renin, direct concentration•-·------··30-40 pg/ml (0.7-1.0 pmol/L) Serum urea nitrogen -------···-·-8-23 mg/dl (2.9-8.2 mmoVl)
Sex hormon&-blndlng globulln--1.1-6.7 IJQ!ml (10-60 nmol/L) (male); Sodium•--------·----·-----136-142 mEqA.. (136-142 mmoVL)
2.2•1 4.6 µg/mL (20-130 nmolll.) {female) Transferrin saturation ----·--·-·-···--·-··········-··-·1 4%-50%
a-Subunit of pituitary glycoprotein hormones·-<1.2 ng/mL (<1.2 IJg/l.J Troponin I •·······-----···-·-····· <0.6 ng/mL (<0.6 µgll)
Testosterone (bioavallable) -···-----0.8-4.0 ng/dL (0.03·0.14 nmol/l) Tryptase-----------·---·-······-·-··-·-··-·----<11.5 ng/mL (<11.51-1g/L)
(20-50 years, female on oral estrogen): Uric acid -----·-------------·3.5-7.0 mg/dl (208.2-416.41,1mol/L)
0.B-10.0 ng/dL (0.03-0.35 nmol/L)
{20·50 years, female not on oral estrogen~ Urine
83.0-257.0 ng/dL (2.88-8.92 nmol/l.) (male 20-29 years); Albumin ·-··---~--30-300 µg/mg crest (3.4-33.9 µg/mol creat)
72.0·235.0 ng/dL (2.50-8.15 nmolll) (male 30·39 years): Albumln-to-creatlnine ratio-·--------·---·----·----··--··-<30 mg/g creat
61.0·213.0 ng/dL (2.12-7. 39 nmolll.} (male 40-49 years); Aldosterone--· -----·-----3-20 µg/24 h (8.3-55.4 nmoVd)
50.0-190.0 ng/dL (1. 74·6.59 nmol/l) (male 50·59 years); (should be <12 JJg/24 h [<33.2 nmol/d] with oral sodium loadlng
40.0-168.0 ng/dl (1.39-5.83 nmol/l) (male 60-69 years) confirmed with 24-hour urinary sodium >200 mEq)
Testosterone (free) ---9.0-30.0 ng/dl (0.31 •1.04 nmol/L) (male); Calcium •··------------100·300 mg/24 h (2.5-7.5 mmoVd)
0.3-1.9 ng/dL (0. 01-0.07 nmoVL) (female) Catecholamine fractionation
Testosterone {total)---300·900 ng/dL {10.4·31.2 nmoVLJ (male); Nomiotens!ve normal ranges:
8-60 ng/dl (0.3-2.1 nmol/L) (female) Dopamine --------····--<700 1-19/24 h (<4567 nmoVd)
Vitamin B12--------180·914 pg/ml (180-914 ng/L) Epinephrine---······-·----·--· <35µg/2411 (<191 nmol/d)
Norepinephrlne -·----·-· <170 IIQ/24 h (<1005 nmol/d)
Chemistry Values Cortisol·-··-······----·-····-·-· 4.50 µg/24 h (1M38 nmol/d)
Alanine aminotransferase..-----···-·- --•· 10 -40 UA. (0 .17-0.67 1-1kat/l...) Cortiso4 fohowlng deXamethasone suppression test-----<101,1g/24 h
Albumin --------·········-·· 3.5-5.0 g/dL (35-50 g/l) (<27.6 nmol/d) (low-dose: 2 day, 2 mg dally)
Amylase----------26-102 U/L (0.43-1.70 µkatll) Creatinlne----·-----------1.0-2.D g/24 h (8.B-17.7 mmoVd)
Aspartate aminotransferase-----·-···--·-· 20-48 U/\. (0.33-0.80 1-1kat11.) G1omerular fihratlon rate (estimated) •····-···· >l!O mUmln per 1.73 m'
Bicarbonat-------····---·--···21-28 mEQ/l (21-28 mmoVL) 5-Hydroxyindole acetic acid •----··-·--2-9 mg/24 h (10.5-47.1 µmol/d)
Blllrubin (total) -------0.3-1.2 mg/dl (5.1-20.5 µmol/1..) Iodine (random)----- ----·----·-->100 IJ9,'t.
Blood gases 17-Ketoateroids ---6.0-21.0 mg/24 h (20.8-72.9 µmol/d) (male);
Po1, arteriel blood----- 80-100 mm Hg (10.6·13.3 kPa) 4.0-17.0 mg/24h(13.9-59.01JrnoVd) (female)
Pco2, arterial blood-----·····-----------35-45 mm Hg (4.7-6.0 kPa) Metanephrine fractionation
Blood pH---------------7.35-7.45 Metanephrlne-----·-······-<4001-1!)1'24 h (<2028 nmol/d)
Calcium--------··· B.2-10.2 mg/dl (2. 1-2.6 mmol/1..) Normetanephrtne----------<9001-'!1124 h (<4914 nmol/d)
Calcium (ionized)-- ----- ---------4.60-5.08 mg/dl (1.2-1.3 mmol/L) Total metanephrine·-··-·········-·-·· <1000 µg,'24 h (<5260 nmol/d)
Carbon dioxide------------------22-28 mEq/l (22-28 mmol/L) Osmolality --------150-1150 mOsm/kg (150-1150 mmoi/kg)
CD, cell count----------•-500•1400/µL (0,5-1.4 x 10"A.) Oxalate------ •····---<40 mg/24 h (<456 mmol/d)
Chloride-----·-··---·-·96·106 mEq/L (96-106 mmol/L) Phosphate ----·----- -·--0.9-1.3 g/24 h (29.1-42.0 mmol/d)
Creatine kinase--------------50-200 UA. (0.84·3.34 µkat/1..) Potassium -·-····-·-··--····-····-·-··-17-77 mEq/24 h (17-77 mmol/d)
8 ESAP 2018
Sodiwn•-----··----------····-···---40-217 mEq/24 h (40-217 mmoVd)
Uric acid---------·< 800 mg/24 h (<4.7 mmol/d)
Saliva
Cortisol (salivary), midnight-----··--··------<0.13 µg/dL (<3.6 nmoVL)
Semen
Semen analysis----->20 million sperm/mL; >50% motility
Abbreviations
ACTH----------------cortleotropln
ACE inhibitor -----·· angk,tensin-cooverting en~e inhibitor
ALT ---------alanine aminotransferase
AST ----aspartate aminotransferase
BMI body mass Index
CNS ----------···-·----------····---central nervous system
CT-·----·-----·······-·······-·---computed tomograi:,tiy
DHEA-----······--····-·--------dehydroepiendroaterone
DHEA•S -·--·--··--dehydroeplandrosterone sulfate
DNA--·-· ---··-----deoxyribonucleic acid
DXA •·····---· •------dual-energy x-my ebsotptlometry
FDA······· •· Food and Drug Administration
FNAB···--·----· ·--fine-needle aspiration biopsy
FSH • •· ·-• - •· folllcle--sti mulating hormone
GH ••••• -·• .• --growth hormone
GHRH -----------growth l'lolmon&-releasing hormone
GnRH·----------·---------·------gonadotropin·releasing hormone
hCG ········----------lhuman chorionlc gonadotropin
HDL -------------high-density llpoprotein
HIV •·--···--------human immunodeficiency virus
HMG-CoA 111ductase inhibitor ----3-hydro)()'·3-methylg1utaryl
coenzyrne A reductase inhibitor
IGF-1 ----···---------insulinllke growth factor 1
LDL low·density llpoproteln
LI-i ----------------- luteinizing hormone
--------mean
MCV-- corpuscular volume
MRI---- --------magnetic resonance Imaging
NPH insulin----····------···-----·· neutral protamine Hagedorn insulin
PET---- -------positron emission tomography
PTH1---------------parathyrolcl hormorlfl
PTHrP ·-····•--parathyroid hormone-related protein
T, -- lriiOdothyronine
T• ---------··-· thyroxirlB
TPO antlbodies--------1myioperoxldase antibodies
TRH ----- thyrotropin-releasing hormooe
TSt1-----········-·------------------thyrotropin
VLDL very low-deflSity llpoprotein
ESAP2018 9