And It's About Time There Was Some Support For Cushing's!
Lab Values M-Z from tests commonly used in Cushing's Testing.
Adapted from http://www.medowbraun.com/WWAWP/WWAWP.EXE/CONNECT/emper4
| M | O | P | R | S | T | U |
| Test Name | Normal Values | Notes | Higher can mean: | Lower can mean: |
|---|---|---|---|---|
| Magnesium | magnesium: >2.4mg/dL; SI: >1.0mmol/L {adult} magnesium: < 1.7mg/dL; SI: < 0.7mmol/L {adult} |
Function in the body: magnesium assists in the formation and maintenance of
strong bones and teeth. Magnesium also assists in the utilization of sugar,
regulation of body temperature, contraction of muscle and transmission of nerve
impulses. Dietary sources include: green, leafy vegetables, nuts, soybeans, and
seafood. Pregnancy and breast feeding require an additional amount of 150mg. Symptoms of long term deficiency: include: anxiety, restlessness, tremors, confusion, depression, cramp-like spasms of the hands and feet, seizures. Adverse effects associated with excessive intake are rare and occur more so in those with kidney dysfunction. Manifestations may include: vomiting, dizziness, muscle weakness. |
Addison's disease alcoholism hyperaldosteronism hyperparathyroidism hypothyroidism renal failure renal failure {acute} dehydration dietary intake {excessive} hypermagnesemia DRUGS: antacids {overdose} lithium magnesium |
Addison's
disease alcoholism biliary fistula cancer celiac disease Crohn's disease diabetes diabetic ketoacidosis glomerulonephritis hepatic disease hyperaldosteronism hyperparathyroidism hyperthyroidism hypomagnesemia {primary} interstitial nephritis intestinal fistula malabsorption pancreatitis pyelonephritis renal failure {acute} renal failure with magnesium wasting {chronic} renal magnesium wasting {idiopathic} renal tubular acidosis sepsis SIADH thermal injury ulcerative colitis alkalemia cardiopulmonary bypass surgery diarrhea {severe} hypercalcemia hyperglycemia hypomagnesemia hypophosphatemia hypoproteinemia hypothermia IV therapy {excessive} intestinal resection lactation {excessive} metabolic acidosis nasogastric suction {excessive} pregnancy starvation transfusions with citrated blood vomiting DRUGS: amino acids aminoglycosides amphotericin B catecholamines cisplatin corticosteroids cyclosporine diuretics glucose insulin laxative {overdose} vitamin D {overdose} |
| Test Name | Normal Values | Notes | Higher can mean: | Lower can mean: |
|---|---|---|---|---|
| Osmolality | osmolality > 295mOsm/L; SI: >295mOsm/L osmolality < 285mOsm/L; SI: < 285mOsm/L |
diabetes insipidus polycythemia vera uremia dehydration diarrhea fever hypercalcemia hyperglycemia hypernatremia hyperventilation vomiting DRUGS: alcohol {overdose} ethylene glycol methanol |
Addison's disease cirrhosis congestive heart failure pyelonephritis SIADH burns diarrhea hyponatremia overhydration vomiting |
| Test Name | Normal Values | Notes | Higher can mean: | Lower can mean: |
|---|---|---|---|---|
| pH {blood} | pH >7.45; SI: >7.45 {blood} pH< 7.35; SI: < 7.35 {blood} |
a decrease in pH can cause a right shift in the hemoglobin oxygen dissociation curve |
Cushing's disease hyperventilation metabolic alkalosis respiratory alkalosis vomiting |
Addison's disease diabetic acidosis diabetic ketoacidosis milk-alkali syndrome diarrhea {severe} hypoventilation metabolic acidosis respiratory acidosis |
| Phosphorus | phosphorus >4.3mg/dL; SI: >1.4mmol/L {adult} phosphorus < 2.3mg/dL; SI: < 0.7mmol/L {adult} |
acromegaly cancer {bone} Cushing's disease hemolysis hypoparathyroidism pseudohypoparathyroidism renal disease rhabdomyolysis sarcoidosis tumor lysis syndrome failure to separate clot hypomagnesemia immobilization transfusion DRUGS: etidronate phosphate phosphate administration {oral} phosphate laxatives xanthine derivatives |
amyloidosis asthma COPD diabetic ketoacidosis hepatic coma hyperaldosteronism hyperparathyroidism hypophosphatasia {familial} malabsorption milk-alkali syndrome rapid tumor growth refeeding syndrome renal tubular disease sepsis thyrotoxicosis alcohol withdrawal burns {third-degree} carbohydrate administration diarrhea gastrectomy hypokalemia hypomagnesemia metabolic acidosis recovery metabolic alkalosis nasogastric suction respiratory alkalosis trauma vitamin D deficiency vomiting DRUGS: acetazolamide antacids {aluminum containing} beta 2 adrenergic agonists corticosteroids diuretics {loop} diuretics {thiazide} glucose mannitol phosphate laxatives salicylates {overdose} sucralfate xanthine derivatives |
|
| Prolactin | prolactin >18.5ng/mL; SI: >18.5mcg/L prolactin <more than 18.5ng/mL; SI: <more than 18mcg/L |
serum prolactin levels >200ng/ml are highly associated with a pituitary tumor |
craniopharyngioma galactorrhea-amenorrhea pituitary stalk compression pituitary tumor renal failure sarcoidosis {nervous system} syndrome of infertility-impotence {males} testosterone {decreased} DRUGS: alcohol amphetamines chlorpromazine cimetidine estrogen haloperidol methyldopa morphine oral contraceptives phenothiazines reserpine |
DRUGS: apomorphine ergot alkaloids levodopa |
| PTH | PTH >65pg/mL PTH< 10pg/m |
parathyroid hormone regulates plasma concentrations of calcium and phosphorus. A decrease in serum calcium stimulates PTH and a increases in serum calcium inhibits PTH release. |
hyperparathyroidism hyperparathyroidism {primary} hyperparathyroidism {secondary} osteomalacia pseudohypoparathyroidism pseudoidiopathic hypoparathyroidism renal failure rickets hypomagnesemia lactation pregnancy vitamin D deficiency {severe} DRUGS: anticonvulsants |
cancer DiGeorge's syndrome hypoparathyroidism hypoparathyroidism {primary} Wilson's disease parathyroidectomy thyroid surgery |
| Test Name | Normal Values | Notes | Higher can mean: | Lower can mean: |
|---|---|---|---|---|
| Rheumatoid factor {RF; RA} | normal value US: <80 IU/ml normal value SI: <80 kIU/L |
high levels of rheumatoid factor present in a pleural fluid indicated rheumatoid
effusion rheumatoid factor is present in approximately 65% of patients with rheumatoid arthritis rheumatoid factor may be positive in patients without rheumatoid arthritis |
cancer dermatomyositis Felty's syndrome hepatic disease hepatitis {viral} Kala-azar leprosy polyarteritis nodosa renal disease rheumatoid arthritis sarcoidosis scleroderma scleroderma {progressive} Sjogren's syndrome syphilis systemic lupus erythematosus thyroid disease tuberculosis elderly mononucleosis {infectious} myocardial infarction |
| Test Name | Normal Values | Notes | Higher can mean: | Lower can mean: | ||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Sodium {serum} |
|
symptoms of long term deficiency are rare: lethargy, muscle cramps, dizziness,
confusion, adverse effects associated with excessive intake: increase blood pressure, increased fluid retention, swelling of the legs and face. Lithium levels can be adversely affected by alterations in sodium intake. |
adipsia Conn's syndrome Cushing's disease diabetes diabetes insipidus diabetes insipidus {nephrogenic} enteric disease hyperaldosteronism nephritis obstructive uropathy renal dysplasia burns dehydration diarrhea hypernatremia hypertonic IV fluids sea water sweating {excessive} water intake {inadequate} DRUGS: clonidine corticosteroids diuretics {osmotic} methyldopa NSAID oral contraceptives sodium bicarbonate administration {excessive} sodium chloride |
cirrhosis congestive heart failure enteric disease hyperlipidemia hyperproteinemia intermittent porphyria {acute} porphyria renal disease SIADH burns diarrhea hyperglycemia hyponatremia metabolic alkalosis overhydration vomiting DRUGS: carbamazepine diuretics glycerol mannitol sulfonylureas triamterene vasopressin |
| Test Name | Normal Values | Notes | Higher can mean: | Lower can mean: | ||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Testosterone {male} | testosterone >8ng/ml; SI: >28nmol/L {male} testosterone < 4ng/ml; SI: < 14nmol/L {male |
testosterone levels in males are helpful in the diagnosis, of hypogonadism, infertility, impotence, ambiguous genitalia, and precocious puberty |
hyperthyroidism hypopituitarism polycystic ovarian disease syndrome of androgen resistance DRUGS: testosterone |
hypopituitarism Klinefelter's syndrome testicular failure DRUGS: estrogen |
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| Thyroid stimulating hormone {TSH} | normal value US: 2 - 11 microU/L normal value SI: 2 - 11 microU/L |
TSH is produced by the anterior pituitary gland, and stimulates the secretion of
thyroxine T4 and triiodothyronine T3 secretion of TSH is stimulated by thyrotropin releasing hormone TRH from the hypothalamus |
hypothyroidism pituitary tumor pregnancy DRUGS: |
hyperthyroidism hypopituitarism DRUGS: |
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| Thyroxine-binding globulin capacity {TBG} | normal value US: 16 - 24 mcg/dL normal value SI: 206 - 309 mmol/L |
TBG is a glycoprotein and its abnormalities are not clinical diseases. TBG normally binds to approximately 70% of total T4 and an even higher fraction of serum T3. |
hepatic disease hypothyroidism thyroxine-binding globulin increase {congenital} pregnancy DRUGS: estrogen oral contraceptives perphenazine phenothiazines |
acromegaly hepatic disease hyperthyroidism hypoproteinemia nephrotic syndrome thyroxine-binding globulin deficiency {congenital} malnutrition metabolic acidosis {severe} DRUGS: androgens aspirin {overdose} phenytoin prednisone steroids |
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| Thyroxine, Total {T4} |
|
anti-T4
antibodies cancer {thyroid} hepatitis hyperthyroidism thyroxine-binding proteins {increased} pregnancy DRUGS: clofibrate estrogen methadone oral contraceptives perphenazine |
acromegaly hypothyroidism nephritis renal failure thyroxine-binding proteins deficiency malnutrition DRUGS: androgens corticosteroids heparin lithium phenylbutazone phenytoin propranolol salicylates {overdose} sulfonamides |
| Test Name | Normal Values | Notes | Higher can mean: | Lower can mean: | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Uric acid |
|
uric acid is the end product of purine degradation uric acid is said to serve no physiological purpose the average uric acid production is 600 to 800mg/d approximately 2/3 of the uric acid produced each day is excreted in the urine. |
alcoholism anemia {hemolytic} anemia {megaloblastic} cancer {metastatic} congestive heart failure diabetes Down syndrome eclampsia glycogen storage disease gout hyperparathyroidism hypoparathyroidism hypothyroidism leukemia lymphoma multiple myeloma myeloproliferative diseases polycythemia vera psoriasis renal failure tissue necrosis dehydration exercise {excessive} inflammation lactic acidosis malnutrition metabolic acidosis mononucleosis {infectious} shock starvation DRUGS: alcohol aspirin caffeine chemotherapy cisplatin cytotoxic agents diuretics {loop} diuretics {thiazide} epinephrine ethambutol lead levodopa methyldopa nicotinic acid phenothiazines pyrazinamide radiation salicylates theophylline vincristine |
biliary obstruction cystinosis Fanconi's syndrome galactosemia hemochromatosis hepatic disease heaptic disease {alcoholic} intermittent porphyria {acute} SIADH Wilson's disease xanthine oxidase deficiency DRUGS: acetazolamide allopurinol ascorbic acid aspirin azathioprine clofibrate corticosteroids estrogen guaifenesin mannitol probenecid radio contrast media salicylates {overdose} warfarin |
| Test Name | Normal Values | Notes | Higher can mean: | Lower can mean: |
|---|---|---|---|---|
| Vitamin B12 {cobalamin} | normal value US: 200 - 800 pg/ml normal value SI: 147 - 590 pmol/L |
Strict vegetarians are at risk of developing B12 deficiency. Function in the
body: vitamin B12 is need for the formation of nucleic acids, red blood cells,
and the overall growth and development of the central nervous system. Vitamin
B12 is also necessary for the utilization of folic acid and carbohydrates.
Dietary sources include: liver, meats, eggs, fish, chicken, milk, dairy. Pregnancy and breastfeeding require an additional 1.0mcg. Symptoms of long term deficiency: anemia, mouth and tongue soreness, numbness and tingling of the limbs. |
cirrhosis congestive heart failure diabetes hepatitis leukemia {chronic myeloid} myeloproliferative diseases obesity polycystic ovarian disease polycythemia vera renal failure uremia dietary intake {excessive} leukocytosis Drugs: oral contraceptives |
anemia pernicious bacterial overgrowth cancer {gastric} celiac disease Crohn's disease cystic fibrosis hyperthyroidism ileal bypass intrinsic factor production {defective} malabsorption multiple myeloma pancreatitis {chronic} transcobalamin II deficiency tropical sprue diet {vegetarian} folic acid deficiency gastrectomy intestinal resection malnutrition pregnancy vitamin B12 deficiency DRUGS: alcohol aminosalicylic acid anticonvulsants colchicine metformin neomycin |
