Main description:

Endocrinology is perhaps, the only branch of medicine where stimulation and suppression testing are required as the initial step for biochemical confirmation of the clinical condition as hormone secretion is pulsatile. One of the primary needs for an endocrinologist is a pocketbook that can serve as a guide for performing and interpreting these tests. Unfortunately, there is no single source of these protocols, procedures, and interpretation of these tests in the country or even in the Southeast Asia region. This protocol manual is designed to be a 'ready reckoner' for endocrinologists for performing these tests.

Disorders of various endocrine glands, including pituitary, thyroid, pancreas, adrenal, gonads, and bone and mineral disorders, have been addressed. The book includes prerequisites and indications of a given test, principles of the testing, detailed procedure, and interpretation. Participant information and instruction sheets have been included, when applicable, to be given as a handout to patients prior to these tests. The manual contains algorithms (e.g., for approaching cases with hypoglycemia) and interpretation provided in a tabular format. It also lists troubleshooting measures for specific tests, when applicable. Further, clinical case scenarios substantiated by clinical and radiological images have been incorporated in the manual to highlight the procedure and interpretation of these tests in the management of challenging clinical cases. The manual is designed to be a comprehensive yet concise document covering all these aspects. Besides blood-based investigations, procedures which are undertaken in challenging endocrine scenarios, including inferior petrosal sinus sampling, and adrenal venous sampling have been elucidated in a crisp and practical manner.

Contents:

I. Protocol for testing in diabetes, thyroid and related disorders

i) Standard oral glucose tolerance test

ii) Evaluation of gestational diabetes mellitus

iii) Glucagon-stimulated c-peptide test

iv) Mixed meal test

v) Prolonged supervised fast

vi) Selective arterial calcium stimulation test

vii) TRH releasing test

viii) T3 suppression test

II. Protocol for testing in pituitary disorders

i) Insulin induced hypoglycaemia/Insulin tolerance test

ii) Clonidine stimulation test

iii) Glucagon stimulation test

iv) Levodopa stimulation test

v) Oral glucose tolerance test for acromegaly

vi) Bilateral inferior petrosal sinus sampling

vii) IV CRH stimulation test

viii) IV AVP stimulation test

ix) Low dose dexamethasone suppression test

x) High dose dexamethasone suppression test

xi) Patient instruction sheet for dexamethasone suppression test

xii) Patient instruction sheet for 24 hour urinary free cortisol estimation

xiii) Patient instruction sheet for 2300 h awake cortisol

xiv) Water deprivation test

xv) Prolonged water deprivation test

III. Protocol for testing of adrenal disorders

i) Test for adrenal insufficiency - synacthen stimulation test

ii) 1g ACTH stimulation test

iii) Acton prolongatum test

iv) Confirmatory test for hyperaldosteronism

v) Adrenal venous sampling

vi) Dexamethasone androgen suppression test

vii) Test to differentiate between Cushing's and pseudo Cushing's syndrome

viii) Test for AIMAH - Lacroix protocol

IV. Protocol for testing of gonadal disorders

i) Gonadotropin release hormone agonist test

a) Triptorelin stimulation test

b) Leuprolide stimulation test

ii) hCG stimulation test

iii) Cosyntropin stimulation test for congenital adrenal hyperplasia (CAH)

V. Protocol for testing in metabolic bone disease

i) Ammonium chloride loading test

ii) Bicarbonate loading test

iii) Measurement of TmP/GFR

VI. Protocol for testing in special situations

i) Evaluation in pregnancy

ii) Evaluation in chronic kidney disease

VII. Appendices

i) Reference ranges

ii) Consent forms