Type: #

Test 383

SuperUser Account — Tue, 16 Sep 2008 21:44:52 GMT

Test: 5′ Nucleotidase
Number: 001701
CPT: 83915
Specimen: Serum
Volume: 2 mL
Minimum Volume: 0.2 mL
Container: Red-top tube or gel-barrier tube
Collection: To avoid delays in turnaround time when requesting multiple tests on frozen samples, please submit separate frozen specimens for each test requested.
Storage Instructions: Serum may be stored up to 1 week refrigerated at 2°C to 8°C or 2 weeks frozen at -20°C.
Causes for Rejection: Hemolysis; plasma specimen
Reference Interval: 0-10 IU/L
Use: 5′ nucleotidase is used to investigate the origin of increased serum alkaline phosphatase. It is a liver-related enzyme used to work up cholestatic/biliary obstruction. It parallels the increases of alkaline phosphatase and leucine aminopeptidase in hepatobiliary diseases, but is not usually elevated in skeletal disorders such as Paget disease of bone. It is increased with metastatic neoplasia in liver and in primary biliary cirrhosis, biliary obstruction from calculi and tumor.
Methodology: Kinetic - 340 nm

Test 601

SuperUser Account — Tue, 16 Sep 2008 21:49:32 GMT

Test: 17-Ketogenic Steroids and 17-Ketosteroids, 24-Hour Urine
Number: 004002
CPT: 83582; 83586
Synonyms: 17-Ketosteroids and 17-Ketogenic Steroids ; 17-KGS and 17-KS ; 17-KS and 17-KGS
Test Includes: 17-ketogenic steroids; 17-ketosteroids, total
Special Instructions: Indicate patient´s sex and total 24-hour urine volume on the request form.
Specimen: Urine (24-hour)
Volume: 100 mL aliquot
Minimum Volume: 40 mL aliquot
Container: Plastic urine container with 1 g boric acid per liter of urine. 30 mL 6N HCl may also be used as a preservative.
Collection: Add 1 g boric acid to the container prior to starting collection. Instruct the patient to void at 8 AM and discard the specimen. Then collect all urine including the final specimen voided at the end of the 24-hour collection period (ie, 8 AM the next morning). Label container with patient´s name, date and time collection started, and date and time collection finished.
Storage Instructions: Refrigerate
Patient Preparation: If possible, all drugs should be held for 72 hours prior to and during collection of urine.
Causes for Rejection: Preservative not added to container
Reference Interval: See individual tests.
Use: Adrenal function tests; diagnose Cushing syndrome; adrenogenital syndrome; virilization; collectively measures most derivatives of the adrenal glucocorticoids. Useful in the evaluation of androgenic adrenal and testicular function in normal males and primarily adrenal androgenic secretion in normal females.
Methodology: Rutherford/Nelson/Zimmerman reaction, spectrophotometry (17-KGS); Drekter/Zimmerman modified reaction (17-KS)

Test 605

SuperUser Account — Tue, 16 Sep 2008 21:49:39 GMT

Test: 17-Ketogenic Steroids, 24-Hour Urine
Number: 004010
CPT: 83582
Synonyms: 17-KGS, Urine
Special Instructions: Indicate patient´s sex and total 24-hour urine volume on the request form.
Specimen: Urine (24-hour)
Volume: 100 mL aliquot
Minimum Volume: 20 mL aliquot
Container: Plastic urine container with 1 g boric acid per liter of urine. 30 mL 6N HCl may also be used as a preservative.
Collection: Add 1 g boric acid to the container prior to starting collection. Instruct the patient to void at 8 AM and discard the specimen. Then collect all urine including the final specimen voided at the end of the 24-hour collection period (ie, 8 AM the next morning). Label container with patient´s name, date and time collection started, and date and time collection finished.
Storage Instructions: Refrigerate
Patient Preparation: If possible all drugs should be withheld for 72 hours prior to and during collection of urine.
Causes for Rejection: Failure to add preservative
Reference Interval:

Pediatrics¹ and adults:

0-11 months: <1.0 mg/24 hours
1-10 years: <5.0 mg/24 hours
11-14 years: <12.0 mg/24 hours
>14 years: male: 5.0-23.0 mg/24 hours, female: 3.0-15.0 mg/24 hours

Use: Adrenal function test; increased with stress, Cushing syndrome, and some cases of adrenogenital syndrome; decreased with Addison disease and hypopituitarism
Methodology: Spectrophotometry - Rutherford/Nelson/Zimmerman reaction
Additional Information: Total 17-ketogenic steroids (17-KS, C21, 17-hydroxycorticosteroids) are composed of four groups of compounds. Group 1 includes cortisol and cortisone; group 2 includes cortisols and cortolones; group 3 includes pregnanetriol and derivatives; and group 4 includes 17-hydroxyprogesterone and 17-hydroxypregnenolone which is significantly increased in certain forms of adrenogenital syndrome. 17-KGS are also increased in Cushing syndrome. 17-KGS are decreased in Addison disease, hypopituitarism, and cretinism.
Footnotes:

Tietz NW, ed, Clinical Guide to Laboratory Tests, 3rd ed, Philadelphia, PA: WB Saunders Co, 1995, 380

Test 607

SuperUser Account — Tue, 16 Sep 2008 21:49:42 GMT

Test: 17-Ketosteroids, Total, 24-Hour Urine
Number: 004028
CPT: 83586
Synonyms: 17-KS, Urine ; Neutral 17-Ketosteroids, Urine
Special Instructions: State patient´s sex and total 24-hour urine volume on the request form.
Specimen: Urine (24-hour)
Volume: 100 mL aliquot
Minimum Volume: 20 mL aliquot
Container: Plastic urine container with 1 g boric acid preservative per liter of urine. 30 mL 6N HCl may also be used as a preservative.
Collection: Add 1 g boric acid to the container prior to starting collection. Instruct the patient to void at 8 AM and discard the specimen. Then collect all urine including the final specimen voided at the end of the 24-hour collection period (ie, 8 AM the next morning). Label container with patient´s name, date and time collection started, and date and time collection finished.
Storage Instructions: Refrigerate
Patient Preparation: If possible all drugs should be withheld for 72 hours prior to and during collection of urine.
Causes for Rejection: Preservative not added to container
Reference Interval:

Pediatrics¹ and adults:

0-4 years: <2.0 mg/24 hours
5-9 years: <3.0 mg/24 hours
10-11 years: 1.0-5.0 mg/24 hours
12-13 years: 1.0-6.0 mg/24 hours
14-16 years: male: 3.0-13.0 mg/24 hours, female: 2.0-8.0 mg/24 hours
>16 years: male: 10.0-25.0 mg/24 hours, female: 6.0-14.0 mg/24 hours

Use: Assess adrenal androgens. 17-Ketosteroids are elevated in Cushing syndrome, adrenogenital syndrome, some adrenal and gonadal tumors, pregnancy, and female pseudohermaphrodism.
Limitations: Increased with obesity. Numerous drugs in common use cause spurious increase or decrease including carbamazepine, cephalothin, and tiaprofenic acid.² Excretion of the 17-ketosteroids is variable over time. Although often used to evaluate androgenic status, this test essentially does not detect the major androgens, testosterone and dihydrotestosterone. If low androgens are anticipated, serum testosterone is the test of choice, not 17-KS.
Methodology: Drekter/Zimmerman modified reaction
Additional Information: The major precursors of 17-KS are DHEA and DHEA-S. DHEA-S is the only substance in blood which can replace 17-KS in work-up for hirsutism. 17-KS are metabolites of androstenedione, testosterone, and other compounds. In men, about one-third of 17-KS are of gonadal origin; in women and children, the adrenal is the predominant source.³ Cortisol, estrogens, pregnanediol, pregnanetriol, testosterone, and dihydrotestosterone are not 17-KS. The adrenogenital syndromes, virilizing entities, include adrenal tumors and congenital hyperplasias. The latter include partial 21-hydroxylase deficiency, complete 21-hydroxylase deficiency (salt-losing) and 11-beta-hydroxylase deficiency (mostly hypertensive). Other types of congenital adrenal hyperplasia exist as well. With the availability of specific hormone and hormone metabolite tests, this assay is less useful.
Footnotes:

Tietz NW, ed, Clinical Guide to Laboratory Tests, 3rd ed, Philadelphia, PA: WB Saunders Co, 1995, 220.
Howanitz JH and Howanitz PJ, “Evaluation of Endocrine Function,” Todd-Sanford-Davidsohn Clinical Diagnosis and Management by Laboratory Methods, 17th ed, Henry JB, ed, Philadelphia, PA: WB Saunders Co, 1984, 299-345.
Powsner ER, Epstein E, Feldcamp CS, et al, “Testis,” Gradwohl´s Clinical Laboratory Methods and Diagnosis, 8th ed, Sonnenwirth AC and Jarett L, eds, St Louis, MO: Mosby-Year Book Inc, 1980, 567-75

Test 619

SuperUser Account — Tue, 16 Sep 2008 21:50:01 GMT

Test: 5-Hydroxyindoleacetic Acid (HIAA), Quantitative, 24-Hour Urine
Number: 004069
CPT: 83497
Synonyms: 5-HIAA, Quantitative, 24-Hour Urine ; Serotonin Metabolite, 24-Hour Urine
Special Instructions: Measure and record total 24-hour urine volume on the request form.
Specimen: Urine (24-hour)
Volume: 30 mL aliquot
Minimum Volume: 1 mL aliquot
Container: Plastic urine container, no preservative (Note: 30 mL 6N HCl or 1 g/L boric acid may be added as a preservative for other tests without harm to 5-HIAA.)
Collection: Instruct the patient to void at 8 AM and discard the specimen. Then collect all urine including the final specimen voided at the end of the 24-hour collection period (ie, 8 AM the next morning). Screw the lid on securely. Label container with patient´s name, date, and time. Measure and record total urine volume. Mix well; send aliquot.
Storage Instructions: Refrigerate at 2°C to 8°C.
Patient Preparation: Avoid bananas, avocados, plums, eggplant, tomatoes, plantain, pineapples, walnuts, and interfering drugs (see Interfering Substances Appendix) for a 72-hour period prior to and during the collection.
Reference Interval: 0.0-8.0 mg/24 hours

If a borderline elevation of 5-HIAA is found, sample should be recollected following withdrawal of dietary and medication sources that might elevate 5-HIAA (see Patient Preparation). Nontropical sprue may cause a slight increase in urinary 5-HIAA. 5-HIAA levels are lowered by renal insufficiency and after small bowel resection. When a patient strongly suspected for carcinoid syndrome shows normal or borderline increases of 5-HIAA, two possibilities should be considered: one, that large amounts of serotonin produced are not being metabolized, in which case blood levels of serotonin are required to document the diagnosis; and two, that secretion of 5-HIAA by the tumor is intermittent, in which case repeat timed specimen collections are needed to demonstrate the abnormality.

Use: A serotonin analysis is most frequently performed for the diagnosis of carcinoid tumors of the enterochromaffin (Kultschitzsky) cells of the small intestine. These tumor cells release large amounts of serotonin, which can produce the clinical syndrome of flushing, diarrhea, and right-sided heart failure. The most frequently used diagnostic test for carcinoid tumors is 5-HIAA, the final metabolite of serotonin. Diagnose carcinoid tumors and syndrome; values >25 mg/24 hours (higher if the patient has malabsorption) are strong evidence for carcinoid.
Limitations: 5-HIAA may be normal with nonmetastatic carcinoid tumor and may be normal even with the carcinoid syndrome, particularly in subjects without diarrhea. Some patients with the carcinoid syndrome excrete nonhydroxylated indolic acids, not measured as 5-HIAA.¹ Midgut carcinoids are most apt to produce the carcinoid syndrome with 5-HIAA elevation. Patients with renal disease may have falsely low 5-HIAA levels in the urine.² 5-HIAA is increased in untreated patients with malabsorption, who have increased urinary tryptophan metabolites. Such patients include those with celiac disease, tropical sprue, Whipple disease, stasis syndrome, and cystic fibrosis. It is increased in those with chronic intestinal obstruction.³ Poor correlation exists between 5-HIAA level and the clinical severity of the carcinoid syndrome.³ Recent studies confirm its use as a prognostic factor in this disease.⁴
Methodology: High-pressure liquid chromatography (HPLC) with electrochemical (EC) detection
Additional Information: 5-HIAA is the major urinary metabolite of serotonin, a ubiquitous bioactive amine. Serotonin, and consequently 5-HIAA, are produced in excess by most carcinoid tumors, especially those producing the carcinoid syndrome of flushing, hepatomegaly, diarrhea, bronchospasm, and heart disease. Quantitation of urinary 5-HIAA is the best test for carcinoid, but scrupulous care must be taken that specimen collection and patient preparation have been correct. Carcinoid tumors may cause increased excretion of tryptophan, 5-hydroxytryptophan and histamine as well as serotonin. Serum serotonin assay may detect some carcinoids missed by 5-HIAA assay.

The production and metabolism of serotonin is dependent upon the tissue of origin of the tumor. Tumors from midgut cells, such as ileal carcinoid usually contain and release large quantities of serotonin. These amounts may not be fully reflected in the amount of the metabolite (5-HIAA) in urine, because little is metabolized. Tumors derived from foregut cells (bronchial, pancreatic, duodenal, or biliary carcinoid) produce large amounts of serotonin, which is oxidized within the tumor to 5-HIAA. With these tumors, urinary excretion of 5-HIAA is often much higher than would be expected from clinical presentation. Tumors derived from hindgut cells (rectal carcinoid) rarely produce excess serotonin or 5-HIAA.

Of 75 patients with carcinoid tumors, 75% had above normal urinary 5-HIAA excretion and 64% had above normal serotonin excretion.⁵

Carcinoid tumors are enterochromaffin neoplasms containing amine precursor uptake and decarboxylation cells (APUDomas). They occur in the multiple endocrine neoplasia syndrome (MEN) I or II but are often not a part of those entities. Occasional carcinoids secrete other substances, including ACTH, gastrin, insulin, VIP, and calcitonin.

Footnotes:

Johnson HC Jr, “Urine Tests,” Bockus Gastroenterology, 4th ed, Volume 1, Berk JE, ed, Philadelphia, PA: WB Saunders Co, 1985, 342-7.
Schultz AL, “5-Hydroxyindoleacetic Acid,” Methods in Clinical Chemistry, Pesce AJ and Kaplan LA, eds, St Louis, MO: Mosby-Year Book Inc, 1987, 714-20.
Warner RR, “Carcinoid Tumor,” Bockus Gastroenterology, 4th ed, Volume 3, Berk JE, ed, Philadelphia, PA: WB Saunders Co, 1985, 1874-6.
Agranovich AL, Anderson GH, Manji M, et al, “Carcinoid Tumour of the Gastrointestinal Tract: Prognostic Factors and Disease Outcome,” J Surg Oncol, 1991, 47(1):45-52.
Feldman JM, “Urinary Serotonin in the Diagnosis of Carcinoid Tumors,” Clin Chem, 1986, 32(5):840-4

Test 636

SuperUser Account — Tue, 16 Sep 2008 21:50:31 GMT

Test: 17-Hydroxycorticosteroids, Urine
Number: 004242
CPT: 83491
Synonyms: 17-OHCS ; 17-OHCS, Urine ; Porter-Silber Chromogens, Urine
Special Instructions: State patient´s sex and total 24-hour urine volume on the request form.
Specimen: Urine (24-hour)
Volume: 100 mL aliquot
Minimum Volume: 20 mL aliquot
Container: Plastic urine container with 1 g/L boric acid or 30 mL of 6N HCl
Collection: Instruct the patient to void at 8 AM and discard the specimen. Then collect all urine including the final specimen voided at the end of the 24-hour collection specimen (ie, 8 AM the next morning). Label container with patient´s name, date, and time. Measure and record total urine volume on the request form.
Storage Instructions: Refrigerate urine if assay is not to be performed within 72 hours of collection. Freeze if longer storage is needed.
Patient Preparation: All drugs should be withheld for 72 hours prior to collection of urine, if possible without doing harm to the patient. Avoid patient stress.
Causes for Rejection: Preservative not added to container
Reference Interval:

0-1 year: 0.5-1.0 mg/24 hours
2-18 years: 1.0-5.6 mg/24 hours
Older than 18 years: male: 3.0-10.0 mg/24 hours, female: 2.0-8.0 mg/24 hours

Use: Adrenal function test useful in evaluation of glucocorticoid production; increased in ectopic ACTH syndrome, Cushing syndrome, and stress; decreased in Addison disease, adrenogenital syndrome, pituitary insufficiency¹
Limitations: Subject to interferences and variability due to unreliable 24-hour urine collections. Now that they are available, serum or urine cortisol measurements are preferred. Urinary free cortisol is a more sensitive and specific test for hypercortisolism.²
Methodology: Porter-Silber method (measures tetrahydro derivatives of cortisone, cortisol, and 11-deoxycortisol)
Additional Information: The Porter-Silber color reaction detects steroids with a dihydroxyacetone group at carbon 17, including major glucocorticoid metabolites.
Footnotes:

Zeiger MA, Nieman LK, Cutler GB, et al, “Primary Bilateral Adrenocortical Causes of Cushing´s Syndrome,” Surgery, 1991, 110(6):1106-15.
Flack MR, Oldfield EH, Cutler GB Jr, et al, “Urine Free Cortisol in the High-Dose Dexamethasone Suppression Test for the Differential Diagnosis of the Cushing Syndrome,” Ann Intern Med, 1992, 116(3):211-7

Test 714

SuperUser Account — Tue, 16 Sep 2008 21:52:48 GMT

Test: 17-Alfa -Hydroxyprogesterone
Number: 004713
CPT: 83498
Synonyms: 17-OHP
Special Instructions: See the Endocrine Appendix for instructions on multiple specimen testing.
Specimen: Serum or plasma
Volume: 0.3 mL
Minimum Volume: 0.2 mL (Note: This volume does not allow for repeat testing.)
Container: Red-top tube, gel-barrier tube, or lavender-top (EDTA) tube
Collection: If tube other than a gel-barrier tube is used, transfer separated serum or plasma to a plastic transport tube.
Storage Instructions: Refrigerate
Reference Interval: See table.^1,2

Age?	Male (ng/dL)?	Female (ng/dL)?
0-60 days	0-440?	0-440?
2 mo - 10 y?	0-120?	0-120?
11-16 y?	0-240?	0-240?
Adults?	5-160?	?
Follicular?	?	30-100?
Luteal?	?	20-290?
Pregnant?	?	40- 1540?

Use: Markedly elevated in patients with congenital adrenal hyperplasia (adrenogenital syndrome) due to 21-hydroxylase deficiency; evaluate hirsutism and/or infertility; assess certain adrenal or ovarian tumors with endocrine activity
Methodology: Enzyme immunoassay (EIA)
Additional Information: 17-OH-progesterone is the substrate for subsequent 21- and 11-hydroxylation to produce cortisol. The two critical enzymes, 21-hydroxylase and 11-beta-hydroxylase, participate in cortisol generation. If hydroxylation, at either position, cannot take place because of enzyme deficiency, cortisol synthesis decreases, accompanied by increased ACTH. Congenital adrenal hyperplasia and adrenogenital syndrome result from lack of normal glucocorticoids and buildup of precursors (mostly virilizing). Lack of 21-hydroxylase is the most common cause of adrenogenital syndrome. Congenital adrenal hyperplasia caused by 21-hydroxylase deficiency is the most common cause of female hermaphroditism.³ It is an autosomal recessive disorder. Basal 17-hydroxyprogesterone levels can be normal in late-onset 21-hydroxylase deficiency presenting as hirsutism. Such patients are described as having dramatically increased 17-hydroxyprogesterone response to ACTH.⁴ Patients with 21-hydroxylase deficiency have increased 17-ketosteroids, urine pregnanetriol, as well as high 17-hydroxyprogesterone. Prenatal diagnosis of congenital adrenal hyperplasia is possible by HLA typing, by DNA analysis, or by hormone measurements from amniotic fluid, including 17-hydroxyprogesterone.³ Some nonspecificity is seen when amniotic fluid analysis is used.⁵ Congenital adrenal hyperplasia with adult onset is among the causes of hirsutism and/or infertility.
Footnotes:

Soldin SJ, Bailey J, Beatey J, et al, “Pediatric Reference Ranges for 17 Alpha-Hydroxy Progesterone,” Clin Chem, 1995, 41:S92.
Tietz NW, ed, Clinical Guide to Laboratory Tests, 3rd ed, Philadelphia, PA: WB Saunders Co, 1995, 348.
Pang SI, Pollack MS, Marshall RN, et al, “Prenatal Treatment of Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency,” N Engl J Med, 1990, 322(2):111-5.
Chrousos GP, Loriaux DL, Mann DL, et al, “Late-Onset 21-Hydroxylase Deficiency Mimicking Idiopathic Hirsutism or Polycystic Ovarian Disease,” Ann Intern Med, 1982, 96(2):143-8.
Lee A and Ellis G, “Serum 17-Alpha-Hydroxyprogesterone in Infants and Children as Measured by a Direct Radioimmunoassay Kit,” Clin Biochem, 1991, 24(6):505-11

References:

Check JH, Vaze MM, Epstein R, et al, “17-Hydroxyprogesterone Level as a Marker for Corpus Luteum Function in Aborters Versus Nonaborters,” Int J Fertil, 1990, 35(2):112-5.

DiGeorge AM, “Adrenogenital Syndrome,” Nelson Textbook of Pediatrics, 13th ed, Behrman RE, Vaughn VI, and Nelson WE, eds, Philadelphia, PA: WB Saunders Co, 1987, 1220-4.

Loriaux DL, “Hirsutism,” Cecil Textbook of Medicine, 18th ed, Volume 2, Wyngaarden JB and Smith LH Jr, eds, Philadelphia, PA: WB Saunders Co, 1988, 1446-8.

New MI, “Clinical and Endocrinological Aspects of 21-Hydroxylase Deficiency,” Ann N Y Acad Sci, 1985, 458:1-27.

Pang S, Pollack MS, Loo M, et al, “Pitfalls of Perinatal Diagnosis of 21-Hydroxylase Deficiency Congenital Adrenal Hyperplasia,” Ann N Y Acad Sci, 1985, 458:111-29.

Robboy SJ, Lombardo JM, and Welch WR, “Disorders of Abnormal Sexual Development,” Blaustein´s Pathology of the Female Genital Tract, 3rd ed, Kurman RJ, ed, New York, NY: Springer-Verlag, 1987, 15-35.

Test 1466

SuperUser Account — Tue, 16 Sep 2008 22:24:10 GMT

Test: 17-Alfa -Hydroxyprogesterone, 8 Specimens
Number: 015789
CPT: 83498 (x8)
Special Instructions: Please refer to the Endocrine Appendix of the LabCorp Directory of Services for instructions on multiple specimen testing.

Test 1467

SuperUser Account — Tue, 16 Sep 2008 22:24:11 GMT

Test: 17-Alfa -Hydroxyprogesterone, 5 Specimens
Number: 015790
CPT: 83498 (x5)
Special Instructions: Please refer to the Endocrine Appendix of the LabCorp Directory of Services for instructions on multiple specimen testing.

Test 1468

SuperUser Account — Tue, 16 Sep 2008 22:24:13 GMT

Test: 17-Alfa -Hydroxyprogesterone, 6 Specimens
Number: 015791
CPT: 83498 (x6)
Special Instructions: Please refer to the Endocrine Appendix of the LabCorp Directory of Services for instructions on multiple specimen testing.

Test 1469

SuperUser Account — Tue, 16 Sep 2008 22:24:14 GMT

Test: 17-Alfa -Hydroxyprogesterone, 7 Specimens
Number: 015793
CPT: 83498 (x7)
Special Instructions: Please refer to the Endocrine Appendix of the LabCorp Directory of Services for instructions on multiple specimen testing.

Test 1577

SuperUser Account — Tue, 16 Sep 2008 22:29:44 GMT

Test: 17-Hydroxycorticosteroids and 17-Ketosteroids
Number: 020966
CPT: 83491; 83586
Synonyms: 17-Hydroxycorticosteroids ; 17-Ketosteroids ; 17-Ketosteroids and Porter-Silber Chromogens ; 17-KS and 17-OHCS ; 17-OHCS and 17-KS ; Porter-Silber Chromogens and 17-Ketosteroids
Test Includes: 17-hydroxycorticosteroids, total, urine; 17-ketosteroids, total, urine
Special Instructions: State patient´s sex and total 24-hour urine volume on the request form.
Specimen: Urine (24-hour)
Volume: 100 mL aliquot
Minimum Volume: 40 mL aliquot
Container: Plastic urine container with 1 g boric acid per liter of urine. 30 mL 6N HCl may also be used as a preservative.
Storage Instructions: Refrigerate
Patient Preparation: If possible, all drugs should be withheld for 72 hours prior to and during collection of urine.
Causes for Rejection: Preservative not added
Use: Adrenal function test; useful in the evaluation of glucocorticoid production and neuroendocrine function; useful in the evaluation of androgenic adrenal and testicular function in normal males and primarily adrenal androgenic secretion in normal females. Urinary metabolites of glucocorticoids can be measured by 17-ketogenic steroids and 17-hydroxycorticosteroids. More metabolites are measured by the former.¹
Methodology: 17-OHCS: Porter-Silber; 17-KS: Drekter-Zimmerman modified reaction
Additional Information: The Porter-Silber color reaction detects steroids with a dihydroxyacetone group at carbon 17, including major glucocorticoid metabolites. By pretreating with a strong reducing agent one increases the number of metabolites detected (ie, 17-ketogenic steroids). Either 17-hydroxysteroid or 17-ketogenic steroid measurements can be used as an estimate of adrenal steroid production, either as baseline values or in stimulation or suppression tests. Deoxycorticosterone (DOC), corticosterone (compound B) and aldosterone lack a 17-hydroxyl group and are not measured in 17-KG and 17-OHCS procedures.¹
Footnotes:

Speroff L, Glass RH, and Kase NG, Clinical Gynecologic Endocrinology and Infertility, 4th ed, Baltimore, MD: Williams & Wilkins, 1989

Test 1662

SuperUser Account — Tue, 16 Sep 2008 22:33:26 GMT

Test: 17-Alfa -Hydroxyprogesterone, 3 Specimens
Number: 047522
CPT: 83498 (x3)
Special Instructions: Please refer to the Endocrine Appendix of the LabCorp Directory of Services for instructions on multiple specimen testing.

Test 1671

SuperUser Account — Tue, 16 Sep 2008 22:33:50 GMT

Test: 17-Alfa -Hydroxyprogesterone, 4 Specimens
Number: 049742
CPT: 83498 (x4)
Special Instructions: Please refer to the Endocrine Appendix of the LabCorp Directory of Services for instructions on multiple specimen testing.

Test 1715

SuperUser Account — Tue, 16 Sep 2008 22:36:13 GMT

Test: 17-Alfa -Hydroxyprogesterone, 2 Specimens
Number: 057232
CPT: 83498 (x2)
Special Instructions: Please refer to the Endocrine Appendix of the LabCorp Directory of Services for instructions on multiple specimen testing.

Test 2786

SuperUser Account — Tue, 16 Sep 2008 23:45:35 GMT

Test: 17-Hydroxycorticosteroids and Creatinine Ratio, 24-Hour Urine
Number: 120998
CPT: 82570; 83491
Synonyms: 17-OHCS ; 17-OHCS, Urine ; Porter-Silber Chromogens, Urine
Special Instructions: State patient´s sex and total 24-hour urine volume on the request form.
Specimen: Urine (24-hour)
Volume: 100 mL aliquot
Minimum Volume: 20 mL aliquot
Container: Plastic urine container with 1 g/L boric acid or 30 mL of 6N HCl
Collection: Instruct the patient to void at 8 AM and discard the specimen. Then collect all urine including the final specimen voided at the end of the 24-hour collection specimen (ie, 8 AM the next morning). Label container with patient´s name, date, and time. Measure and record total urine volume on the request form.
Storage Instructions: Refrigerate urine if assay is not to be performed within 72 hours of collection. Freeze if longer storage is needed.
Patient Preparation: All drugs should be withheld for 72 hours prior to collection of urine, if possible without doing harm to the patient. Avoid patient stress.
Causes for Rejection: Preservative not added to container
Reference Interval: 2.0-6.5 mg/g creatinine
Use: Adrenal function test useful in evaluation of glucocorticoid production; increased in ectopic ACTH syndrome, Cushing syndrome, and stress; decreased in Addison disease, adrenogenital syndrome, pituitary insufficiency.¹ The Porter-Silber color reaction detects steroids with a dihydroxyacetone group at carbon 17, including major glucocorticoid metabolites.
Limitations: Subject to interferences and variability due to unreliable 24-hour urine collections. Now that they are available, serum or urine cortisol measurements are preferred. Urinary free cortisol is a more sensitive and specific test for hypercortisolism.²
Methodology: Porter-Silber method (measures tetrahydro derivatives of cortisone, cortisol, and 11-deoxycortisol)
Footnotes:

Zeiger MA, Nieman LK, Cutler GB, et al, “Primary Bilateral Adrenocortical Causes of Cushing´s Syndrome,” Surgery, 1991, 110(6):1106-15.
Flack MR, Oldfield EH, Cutler GB Jr, et al, “Urine Free Cortisol in the High-Dose Dexamethasone Suppression Test for the Differential Diagnosis of the Cushing Syndrome,” Ann Intern Med, 1992, 116(3):211-7

Test 3044

SuperUser Account — Wed, 17 Sep 2008 00:07:26 GMT

Test: 5Alfa -Androstane-3Alfa , 17Beta -Diol Glucuronide, Serum
Number: 140442
CPT: 82154
Synonyms: 3α-Diol G
Specimen: Serum
Volume: 0.3 mL
Minimum Volume: 0.2 mL (Note: This volume does not allow for repeat testing.)
Container: Red-top tube or gel-barrier tube
Collection: If a red-top tube is used, transfer separated serum to a plastic transport tube.
Storage Instructions: Refrigerate
Patient Preparation: No isotopes administered 24 hours prior to venipuncture
Causes for Rejection: Recently administered isotopes
Reference Interval:

Pediatrics: See table.¹
Adults: male: 340-2200 ng/dL; female: premenopausal: 50-540 ng/dL, postmenopausal: 10-600 ng/dL

Age (y)	Male (ng/dL)	Female (ng/dL)
0-3	<80	<60
4-5	<70	<155
6-7	<399	<330
8-9	<220	<140
10-11	<311	<340
12-13	<737	78-441
14-15	131-1395	73-760
16-20	103-2603	113-732
Tanner Stage
I (<8)	<400	<330
I (>8)	<513	<144
II	<707	66-174
III	94-568	96-441
IV	284-1205	79-854
V	103-2630	73-732

Use: 3-α-diol G has been shown to be a useful measurement in assessing hirsutism and acne in women and androgen target organ activation in hypogonadal men.
Methodology: Radioimmunoassay (RIA)
Additional Information: Androstanediol (5α-androstande-3α, 17β-diol) and androstanediol glucuronide are metabolites of testosterone and dihydrotestosterone, which may reflect peripheral androgen metabolism. They are of interest for evaluating women with idiopathic hirsutism. Androstanediol glucuronide is not secreted by adrenals, ovaries, or testes. It is formed in peripheral tissues, at the sites of androgen action, the hair follicle being one such site. Women with hirsutism have been reported to show elevated levels of androstanediol glucuronide in both serum and urine. Approximately 96% of patients with idiopathic hirsutism have increased levels of this marker.
Footnotes:

Rittner HL, Lee PD, Blum WF, et al, “Developmental Patterns of Serum 3 Alpha-Androstanediol Glucuronide,” J Endocrinol Invest, 1997, 20(5):245-50

References:

Horton R, Hawks D, and Lobo R, et al, “3α, 17β-Androstanediol Glucuronide in Plasma. A Marker of Androgen Action in Idiopathic Hirsutism”, J Clin Invest, 1982, 69(5):1203-6.

Morimoto I, Edmiston A, Hawks D, et al, “Studies on the Origin of Androstanediol and Androstanediol Glucuronide in Youth and Elderly Man,” J Clin Endocrinol, 1981, 52(4):772-8.

Test 3100

SuperUser Account — Wed, 17 Sep 2008 00:12:37 GMT

Test: 17-Hydroxypregnenolone, Mass Spectrometry
Number: 140715
CPT: 84143
Special Instructions: Testing is performed at Esoterix Endocrinology Laboratory: ES#500262.
Specimen: Serum or plasma. frozen
Volume: 1 mL
Minimum Volume: 0.3 mL adult; 0.1 mL pediatric (Note: This volume does not allow for repeat testing).
Container: Red-top tube, gel-barrier tube, or lavender-top (EDTA) tube
Collection: Transfer the serum or plasma into a LabCorp PP transpak frozen purple tube with screw cap (LabCorp N^o 49482) and freeze. To avoid delays in turnaround time when requesting multiple tests on frozen samples, please submit separate frozen specimens for each test requested.
Storage Instructions: Freeze. Stable up to 2 years. Stable at room temperature for up to 6 hours or when refrigerated for up to 2 days.
Patient Preparation: The patient need not be fasting.
Causes for Rejection: Nonserum or non-EDTA plasma specimen received.
Reference Interval:

Premature (26-28 weeks): day 4: 375-3559 ng/dL
Premature (31-35 weeks): day 4: 64-2380 ng/dL
3 days: 10-829 ng/dL
1-5 months: 36-763 ng/dL
6-11 months: 42-540 ng/dL
12-23 months: 14-207 ng/dL
24 months to 5 years: 10-103 ng/dL
6-9 years: 10-186 ng/dL
Pubertal: 44-235 ng/dL
Adults: 53 - 357 ng/dL

Methodology: High-pressure liquid chromatography (HPLC) tandem mass spectrometry.
Additional Information: In humans, the adrenal glands and the gonads produce steroid hormones.^1,2 The formation of pregnenolone from cholesterol is the first step in steroidogenisis. Steroidogenisis continues along two paths from pregnenolone. 17-Hydroxypregnenolone is produced from pregnenolone through the enzymatic action of 17-α-hydroxylase (17α-H). 3-β-hydroxysteroid dehydrogenase (3β-HSD) mediates the conversion of 17-hydroxypregnenolone to 17-hydroxyprogesterone. Alternatively, the enzyme 17,20 lyase can convert 17-hydroxypregnenolone to dehydroepiandrosterone (DHEA). 17α-H and 17,20 lyase activity are both mediated by a single microsomal cytochrome P450 complex.

17-hydroxypregnenelone levels have been shown to remain in the normal range in patients with Cushing.³ Levels can be suppressed with dexamethasone inhibition and increased with exogenous ACTH stimulation.³ Levels during the follicular phase of the menstrual cycle tend to be higher than during the luteal phase.³ 17-hydroxypregnenelone levels have been shown to be elevated in patients with idiopathic hirsutism.⁴

Footnotes:

Demers LM and Whitley R, “Function of the Adrenal Cortex,” Tietz Textbook of Clinical Chemistry, 3rd ed, Burtis CA and Ashwood ER, eds, Philadelphia, PA: WB Saunders Co, 1999, 1530-69.
Donohoue PA, Parker K, and Migeon CJ, “Congenital Adrenal Hyperplasia,” The Metabolic and Molecular Bases of Inherited Disease, Scriver CR, Beaudet AL, Sly WS, et al, eds, 1995, 2929-66.
McKenna TJ and Brown RD, “Pregnenolone in Man: Plasma Levels in States of Normal and Abnormal Steroidogenesis,” J Clin Endocrinol Metab, 1974, 38(3):480-5.
McKenna TJ, Miller RB, and Liddle GW, “Plasma Pregnenolone and 17-OH-Pregnenolone in Patients With Adrenal Tumors, ACTH Excess, or Idiopathic Hirsutism,” J Clin Endocrinol Metab, 1977, 44(2):231-6

Test 4196

SuperUser Account — Wed, 17 Sep 2008 02:20:35 GMT

Test: 5-Hydroxyindoleacetic Acid (HIAA), Quantitative, Random Urine (Pediatric)
Number: 316205
CPT: 82570; 83497
Synonyms: 5-HIAA, Quantitative, Random Urine ; Serotonin Metabolite, Random Urine
Specimen: Urine (random)
Volume: 1 mL aliquot
Minimum Volume: 0.3 mL aliquot
Container: Plastic urine container, no preservative (Note: 6N HCl or boric acid may be added as a preservative for other tests without harm to 5-HIAA.)
Collection: Screw the lid on securely. Label container with patient´s name, date, and time. Mix well; send aliquot. If specimen is to be collected for other assays requiring 6N HCl, use random urine transport tube containing 6N HCl. Container is also known as ´´Urine Monovette® with pH Stabilizer´´ (LabCorp ID 56015). Monovette® instructions accompany units.
Storage Instructions: Refrigerate at 2°C to 8°C.
Patient Preparation: Avoid bananas, avocados, plums, eggplant, tomatoes, plantain, pineapples, walnuts, and interfering drugs (see Interfering Substances Appendix) for a 72-hour period prior to collection.
Reference Interval:

Pediatrics:¹

0-3 years: not established
3-8 years: 1.2-16.2 mg/g creatinine
9-12 years: 2.4-8.7 mg/g creatinine
13-17 years: 1.8-5.5 mg/g creatinine

Use: A serotonin analysis is most frequently performed for the diagnosis of carcinoid tumors of the enterochromaffin (Kultschitzsky) cells of the small intestine. These tumor cells release large amounts of serotonin, which can produce the clinical syndrome of flushing, diarrhea, and right-sided heart failure. The most frequently used diagnostic test for carcinoid tumors is 5-HIAA, the final metabolite of serotonin. Diagnose carcinoid tumors and syndrome; values >25 mg/24 hours (higher if the patient has malabsorption) are strong evidence for carcinoid.
Limitations: 5-HIAA may be normal with nonmetastatic carcinoid tumor and may be normal even with the carcinoid syndrome, particularly in subjects without diarrhea. Some patients with the carcinoid syndrome excrete nonhydroxylated indolic acids, not measured as 5-HIAA.² Midgut carcinoids are most apt to produce the carcinoid syndrome with 5-HIAA elevation. Patients with renal disease may have falsely low 5-HIAA levels in the urine.³ 5-HIAA is increased in untreated patients with malabsorption, who have increased urinary tryptophan metabolites. Such patients include those with celiac disease, tropical sprue, Whipple disease, stasis syndrome, and cystic fibrosis. It is increased in those with chronic intestinal obstruction.⁴ Poor correlation exists between 5-HIAA level and the clinical severity of the carcinoid syndrome.⁴ Recent studies confirm its use as a prognostic factor in this disease.⁵
Methodology: High-pressure liquid chromatography (HPLC) with electrochemical (EC) detection
Additional Information: 5-HIAA is the major urinary metabolite of serotonin, a ubiquitous bioactive amine. Serotonin, and consequently 5-HIAA, are produced in excess by most carcinoid tumors, especially those producing the carcinoid syndrome of flushing, hepatomegaly, diarrhea, bronchospasm and heart disease. Quantitation of urinary 5-HIAA is the best test for carcinoid, but scrupulous care must be taken that specimen collection and patient preparation have been correct. Carcinoid tumors may cause increased excretion of tryptophan, 5-hydroxytryptophan and histamine as well as serotonin. Serum serotonin assay may detect some carcinoids missed by 5-HIAA assay.

Of 75 patients with carcinoid tumors, 75% had above normal urinary 5-HIAA excretion and 64% had above normal serotonin excretion.⁶

Footnotes:

Soldin SJ, et al, eds, Pediatric Reference Ranges, 2nd ed, Washington, DC: AACC Press, 1997, 89.
Johnson HC Jr, “Urine Tests,” Bockus Gastroenterology, 4th ed, Volume 1, Berk JE, ed, Philadelphia, PA: WB Saunders Co, 1985, 342-7.
Schultz AL, “5-Hydroxyindoleacetic Acid,” Methods in Clinical Chemistry, Pesce AJ and Kaplan LA, eds, St Louis, MO: Mosby-Year Book Inc, 1987, 714-20.
Warner RR, “Carcinoid Tumor,” Bockus Gastroenterology, 4th ed, Volume 3, Berk JE, ed, Philadelphia, PA: WB Saunders Co, 1985, 1874-6.
Agranovich AL, Anderson GH, Manji M, et al, “Carcinoid Tumour of the Gastrointestinal Tract: Prognostic Factors and Disease Outcome,” J Surg Oncol, 1991, 47(1):45-52.
Feldman JM, “Urinary Serotonin in the Diagnosis of Carcinoid Tumors,” Clin Chem, 1986, 32(5):840-4

Test 4577

SuperUser Account — Wed, 17 Sep 2008 03:12:14 GMT

Test: 11-Desoxycortisol
Number: 500550
CPT: 82634
Synonyms: 11-Deoxycortisol; Compound S
Special Instructions: Testing is performed at Esoterix Endocrinology Laboratory: ES#500136.
Specimen: Serum, frozen
Volume: 0.5 mL
Minimum Volume: 0.2 mL (Note: This volume does not allow for repeat testing.)
Container: Red-top tube or gel-barrier tube
Collection: Transfer the serum into a LabCorp PP transpak frozen purple tube with screw cap (LabCorp N^o 49482). Freeze immediately and maintain frozen until tested. To avoid delays in turnaround time when requesting multiple tests on frozen samples, please submit separate frozen specimens for each test requested.
Storage Instructions: Freeze. Stable for up to 2 years. Stable at room temperature or when refrigerated for up to 24 hours.
Use: Evaluate hypothalamic-pituitary-adrenal axis and pituitary ACTH reserve
Methodology: Liquid chromatography tandem mass spectrometry (LC/MS/MS) after chromatography and solvent extraction
Additional Information: 11-Deoxycortisol is the immediate precursor of cortisol and follows the same catabolic pathways as cortisol. The conversion of 11-deoxycortisol to cortisol is inhibited by metyrapone, which acts on 11-β-hydroxylase. The metyrapone test (see the Endocrine Appendix ) serves as a reliable and sensitive indicator of pituitary ACTH secretory reserve. The 11-deoxycortisol levels normally increase to 100 times the control value following metyrapone administration. Reduced response occurs in patients with hypoadrenalism or with hypopituitarism and in some patients with diseases of the hypothalamus. Patients with myxedema, some pregnant patients, and those on oral contraceptives respond poorly.
References:

Sindler BH, Griffing GT, and Melby JC, et al, “The Superiority of the Metyrapone Test Versus the High-Dose Dexamethasone Test in the Differential Diagnosis of Cushing´s Syndrome,” Am J Med, 1983, 74(4):657-62.

Spark RF, “Simplified Assessment of Pituitary-Adrenal Reserve: Measurement of Serum 11-Deoxycortisol After Metyrapone,” Ann Intern Med, 1971, 75(5):717-23.

Test 4585

SuperUser Account — Wed, 17 Sep 2008 03:13:17 GMT

Test: 18-Hydroxycorticosterone, Serum
Number: 500778
CPT: 82542
Special Instructions: Testing is referred to Esoterix Endocrinology Laboratory: ES#500088.
Specimen: Serum (preferred) or plasma, frozen
Volume: 3 mL
Minimum Volume: 1 mL (Note: This volume does not allow for repeat testing.)
Container: Gel-barrier tube, lavender-top (EDTA) tube, or green-top (heparin) tube
Collection: Separate serum/plasma from cells within 45 minutes of collection. Send serum in a plastic transport tube. To avoid delays in turnaround time when requesting multiple tests on frozen samples, please submit separate frozen specimens for each test requested.
Storage Instructions: Freeze. Stable for up to 90 days. Stable at room temperature or when refrigerated for up to 24 hours.
Reference Interval:

Premature (26-28 weeks): day 4: 10-670 ng/dL
Premature (31-35 weeks): day 4: 57-410 ng/dL
Full-term (31 days to 11 months): 5-220 ng/dL
12-23 months: 18-155 ng/dL
24 months to 9 years: 6-85 ng/dL
10-14 years: 10-72 ng/dL
Adults: 9-58 ng/dL
8 AM supine upright: 5-46 ng/dL

Methodology: Mass spectrometry (MS)

Test 4588

SuperUser Account — Wed, 17 Sep 2008 03:13:42 GMT

Test: 11-Dehydrothromboxane B₂
Number: 501620
CPT: 82570; 83520
Synonyms: 11dhTxB2; AspirinWorks?
Special Instructions: Testing is performed at Esoterix Coagulation Laboratory: UY#300353
Specimen: Urine, random, frozen
Volume: 9 mL
Container: Please contact Esoterix for special urine collection tube, or order through PeopleSoft #*23711.
Collection: Chlorostat tablet must be added to urine within four hours of collection.
Storage Instructions: Freeze
Stability: Freeze on arrival (in house); Refrigerate up to 24 hours
Methodology: Enzyme-linked immunosorbent assay (ELISA)

Test 5192

SuperUser Account — Wed, 17 Sep 2008 04:44:03 GMT

Test: 6-Acetylmorphine, Urine
Number: 716159
CPT: 80102
Synonyms: 6-MAM ; 6-Monoacetylmorphine, Heroin
Test Includes: 6-Acetylmorphine
Special Instructions: Chain-of-custody documentation is required for samples submitted for pre-employment, random employee testing, and forensic purposes. For other applications, use the standard request form. Please mark chain-of-custody test number on the request form.
Specimen: Urine
Volume: 20 mL
Container: Use plastic urine drug bottle and tamper-evident seal for forensic specimen. Collection kits are available by request from the laboratory.
Collection: Urine temperature monitoring is recommended for samples to be tested for medicolegal purposes.
Storage Instructions: Maintain specimen at room temperature unless arrival at the laboratory will extend beyond 7 days. If arrival extends beyond 7 days, then refrigerate.
Causes for Rejection: Quantity not sufficient for analysis; improper specimen (serum, plasma, blood); incomplete chain-of-custody documentation; incomplete specimen identification
Reference Interval: Detectability: 10 ng/mL
Use: Detection of heroin use
Methodology: Gas chromatography/mass spectrometry (GC/MS). See drug profiles for multidrug testing.