GROWTH HORMONEGH EXCESSGH DEFICIENT

SERUM GH

SERUM OGTT, no change or slight decreaseNo response

SERUM IGF 1

RADIOLOGYSellar enlargement: pituitary tumor: arrowhead tufting of the hand(-)

THYROID FUNCTION TESTTSHFT4

PRIMARY HYPOTHYROIDISM

PRIMARY HYPERTHYROIDISM

T3 THYROTOXICOSIS FT3

HYPERTHYROIDISMTSHT4OTHERS

GRAVES DSETS Ig

TOXIC MULTINODULAR GOITERRadioactive iodine uptake and thyroid scan

TOXIC ADENOMARadioactive iodine uptake and thyroid scan

SUBACUTE THYROIDITIS ESR Radioactive iodine uptake

CHRONIC THYROIDITISN ESR radioactive Iodine uptake

HYPOTHYROIDISMTSHT4T3RT3OTHERS

HASHIMOTOS THYROIDITIS-NORMALAnti-thyroid peroxidase, anti-thyroglobulin

ABLATIVE THYROIDITISFollowed by ablation therapy

INFANTILESeen in newborn and infants

EUTHYROID SICK SYNDROMEMODATELY ILL

SEVERELY ILL

NORMAL

NORMAL

Abnormal hormone production, transport and metabolism

PARATHYROID GLAND FUNCTIONTEST1 HYPERPARA2 HYPERPARAHYOPARAHYPERCALCEMIA OF MALIGNANCY

SERUM PTH/UNDETECTABLE- NORMAL

SERUM/ IONIZED CA- NORMAL

SERUM 1,25(OH)D,NORMAL,- NORMAL

SERUM PHOSPHORUS- NORMAL

ALDOSTERONE1 HYPERALDO2 HYPERALDO1 HYPOALDO2 HYPOALDO

K

NA/ NORMAL

ALDOSTERONE

PLASMA RENIN ACTIVITY/ NORMAL

HYPERSECRETION OF CORTISOLTESTPITIUTARY CUSHINGS DSE ADRENAL CUSHINGS SYNDECTOPIC ACTH CUSHINGS SYND

24 HR URINE FREE/SALIVARY CORTISOL

LOW DOSE DEXAMETHASONE SUPPRESSION TESTNO ACTH SUPPRESSION

PLASMA ACTH- NORMAL

IMAGING STUDYPitiutary tumorAdrenal tumorExtra-adrenal tumor

ADDISONS DSE1 ADRENAL INSUFFICIENCY2 ADRENAL INSUFFICIENCY

ACTH STIMULATION TESTNO CORTISOL STIMULATION

SERUM CORTISOL

PLASMA ACTH

SERUM ALDOSTERONENORMAL

CRH STIMULATIONNOT USEFUL ACTH AND CORTISOL

ADRENAL AUTOANTIBODY TEST(+)NOT USEFUL

MALE REPRODUCTIVE DISEASESFSHLHTESTOSTERONE

HYPOGONADOTROPIC HYPOGONADISM (decreased gonadal stimulation)

HYPERGONADOTROPIC HYPOGONADISM (defective organ, aging process, injury)

TESTICULAR FEMINIZATION (androgen insensitivity syndrome, very severe inhibition of androgen action)/ occ NORMAL

FEMALE REPRODUCTIVE DISEASEDISORDERCONSIDERATION WITH LAB EVALUATION

1 AMMENORRHEA (totally zero)Turners syndrome: pure gonadal dysgenesisKaryotype analysisCongenital adrenal hyperplasia: adrenal hormone and enzyme activity measurementHypothyroidism: thyroid hormoneHypopituitarism: pituitary hormone

2 AMMENORRHEA (amenorrhea for 6 mos then returns to normal)Pregnancy: HCG testProlactinoma: Serum prolactinPCOS: Serum hormone test, radiologyCushings syndrome: adrenal hormone assayAdult onset congenital adrenal hyperplasia: adrenal hormone enzyme activityHypothyroidism, hypopituitarism: thyroid and pituitary hormone

ADHSERUM NA & OSMOLARITYURINE NA & OSMOLARITYSERUM ADH

NEUROGENICNORMAL-

NEPHROGENICNORMAL-NORMAL-

PSYCHOGENNIC POLYDIPSIANORMAL-

SIADHNORMAL-