clinical
biochemistry
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content
Cortisol
ACTH
Aldosterone
Renin
01
CORTISOL
AMAL AYMAN BADER 6191225
CORTISOL
DIAGNOSIS
For indication of an adrenal disorder
HYPERCORTISOLISM
˃23 mcg/dL in the morning
˃11 mcg/dL at afternoon
Cushing’s Syndrome
PROGNOSIS
- Adrenal Disorder
- Pituitary Problem
- Tumor
HYPOCORTISOLISM
˂6 mcg/dL in the morning
˂2 mcg/dL at afternoon
Addison's Disease
01
sAMPLING
PRECAUTIONS
Blood Sample drawn at lab, urine or
saliva at home.
plain Red top or Serum Separator tube.
At least 8 hour of fasting
Highest in the morning & lowest at night.
Require refrigeration before testing.
02
CO-ADMINISTERED DRUGS THAT
MIGHT AFFECT THE RESULTS:
Glucorticoids
Estrogen-containing drugs
Androgen-containing
drugs
Antidepressants
Anticonvulsants
03
EFFECT OF AGE AND SEX:
Age
• Cortisol level tend to decrease with age.
• Normal range may be different for different
age groups.
Sex
Women tend to have higher level than men.
Cortisol level changes during menstrual
cycle, pregnancy, and menopause.
02
ACTH
MOHAMED KANDIL ABDELFATTAH 6191252
ACTH
ACTH is a hormone made by the pituitary gland, a
small gland at the base of the brain. ACTH controls
the production of another hormone called cortisol.
Cortisol is made by the adrenal glands, two small
glands located above the kidneys. Cortisol plays an
important role in helping you to: ACTH stimulate
melanocytes When increase:hyperpigmintion
When decrease:hypopigmintion
Respond to stress
Maintain blood pressure
Regulate metabolism, the process of how your
body uses food and energy
Too much or too little cortisol can cause serious
health problems.
ACTH TEST
DIAGNOSIS
An ACTH test is
often done along
with a cortisol
test to diagnose
disorders of the
pituitary or
adrenal glands.
PROGNOSIS
A decline in the concentration
in the blood leads to a
reduction in the secretion of
adrenal hormones, resulting
in adrenal insufficiency
(hypoadrenalism). Adrenal
insufficiency leads to weight
loss, lack of appetite
(anorexia), weakness, nausea,
vomiting, and low blood
pressure (hypotension).
HYPER
If High ACTH and high
cortisol levels: This
may mean Cushing's
disease
High ACTH and low
cortisol levels: This
may mean Addison
disease.
HYPO
IfLow ACTH and high
cortisol levels: This may
mean Cushing's
syndrome or a tumor of
the adrenal gland.
Low ACTH and low
cortisol levels. This may
mean hypopituitarism.
SAMPLING PRECAUTIONS
Sample tube : lavander top EDTA
You may need to fast (not eat or drink)
overnight before testing. Tests are
usually done early in the morning
because cortisol levels change
throughout the day.
There is very little risk to having a blood test. You may
have slight pain or bruising at the spot where the needle
was put in, but most symptoms go away quickly.
Packing:
Preserve in single-dose or multiple-dose containers
of Type-1 glass.
Storage:
Store in cold place..
CO-ADMINISTERED DRUG THAT
MIGHT AFFECT TEST
If you take steroids, you’ll need to stop for up to 48 hours
before the test. Steroids can affect the test results.
Your doctor might ask you to limit your carbohydrates in t
he 48 hours leading up to the test as well.
Also:
Avoid eating or drinking after midnight.
Get a good night’s sleep.
Avoid exercise in the 12 hours before the test.
Avoid emotional stress in the 12 hours before the test.
Make sure your doctor knows about any prescription or nonprescription medicine, supplements,
vitamins, herbs, and recreational or illicit drugs you’re taking.
EFFECT OF AGE AND SEX ON RENIN TEST
Age:
In general, the level of ACTH in the blood tends to decrease with age. However, this may not
always be the case, as certain conditions such as adrenal insufficiency can cause an increase
IN ACTH levels regardless of age.
Sex:
There is no significant difference in ACTH levels between males and females. However, certain
conditions such as Cushing's syndrome may be more common in females, which can affect the
interpretation of the ACTH test results.
03
ALDOSTERONE
MAYA MOHAMED SAMIR 6191246
ALDOSTERONE
DIAGNOSIS
diagnose primary or
secondary
aldosteronism,
disorders that cause the
adrenal glands to make
too much ALD
-diagnose adrenal
insufficiency, a disorder
that causes the adrenal
glands to not make
enough ALD
PROGNOSIS
hyperaldosteronism
hypoaldosteronism
Patients with primary
aldosteronism can be
managed with
medications. If the
aldosterone is coming
from a tumor in one
gland they can
potentially be cured
by surgery to remove
adrenal gland tumors.
<25microgram per 24
hours
HYPOALDOSTIRONISM
˂Addison's disease, also
called adrenal
insufficiency, is an
uncommon illness that
occurs when the body
doesn't make enough
of certain hormones. In
Addison's disease, the
adrenal glands make
too little cortisol and,
often, too little of
another hormone,
aldosterone
HYPERALDOSTIRONISM
Conn's syndrome is a
hormonal condition
in which one or both
adrenal glands
produce more of the
hormone
aldosterone than
normal.
01
sAMPLING
PRECAUTIONS
type of the sample.
measures the level of the hormone aldosterone in blood. Aldosterone can
also be measured using a urine test
Sampling tube
Preferred collection container:6 mL red-top (plain, non-serum separator)
tube
Alternate Collection Container:
4 mL green/green-top (sodium heparin) tube 3 mL lavender-top (K2
EDTA) tube
You don't need to fast for a cortisol test.
Cortisol levels vary throughout the day but are usually highest in the
morning. Your doctor will usually request that the test be done in the
morning.
Store your urine container in the refrigerator or a cooler with ice
02
CO-ADMINISTERED DRUGS THAT
MIGHT AFFECT THE RESULTS:
High blood pressure
medicines
Heart medicines
Hormones, such as
estrogen or progesterone
Diuretics (water pills)
Antacid and ulcer
medicines
03
EFFECT OF AGE AND SEX:
Age
• We conclude that aldosterone secretion
declines with advancing age.
Sex
Aldosterone was significantly higher in men
than in women
04
RENIN
ABDELHALIM ELSEDDICK MOTAWIE 6191249
RENIN
RENIN TEST
DIAGNOSIS
is used to find out if
the adrenal glands
are making too
much or too little
aldosterone.
The test is
especially useful in
diagnosing primary
aldosteronism (PA),
a disease that
happens from
having too much
aldosterone
PROGNOSIS
Investigation of primary
aldosteronism (e.g., adrenal
adenoma/carcinoma and
adrenal cortical
hyperplasia) and secondary
aldosteronism
(renovascular disease, salt
depletion, potassium
loading, cardiac failure with
ascites, pregnancy, Bartter’s
syndrome).
HYPERENINEMIA
If your results show a
higher than normal amount
of renin, it may mean you
have:
Addison disease, a
condition in which your
adrenal glands don't
make enough of certain
hormones
Cirrhosis, scarring of
the liver
Dehydration
HYPORENINEMIA
If your results show a lower
than normal amount of
renin, it may mean you
have:
Primary aldosteronism
(PA)
Kidney disease
SAMPLING PRECAUTIONS
Specimen Type: Whole blood
Container:
Chilled syringe and transfer to a chilled Lavender top (EDTA) tube
collection
Routine venipuncture using a chilled syringe. Transfer specimen into a chilled Lavender top
tube. Mix chilled lavender top tube gently by inversion and place in an ice-water bath. Transport
promptly to laboratory.
special processing Lab Staff: Do Not leave blood at room temperature. Centrifuge for
approximately 5 minutes in a refrigerated centrifuge. Remove plasma aliquot into a
screw-capped round bottom plastic vial and freeze immediately. Ship frozen.
Forward promptly.placed in an ice bath for transport to the labYour levels of renin
and aldosterone are highest in the morning and can change during the day.
patient preparation
Your levels of renin and aldosterone are highest in the morning and can change during the
day.It also can make a difference if you’re sitting up or lying down when your blood is taken.
rejection
Clotted sample or any specimen other than EDTA plasma; gross hemolysis; mislabeled or
unlabeled specimens
RENIN REFFERENCE RANGE
CO-ADMINISTERED DRUG THAT
MIGHT AFFECT TEST
You may be asked to stop taking certain medicines two to four
weeks before your test. These include:
Birth control pills
Blood pressure medicines
Diuretics (water pills)
You may also be asked to follow a low-salt diet for three days
before your test.
EFFECT OF AGE AND SEX ON RENIN TEST
Age
can affect the renin test results. Renin levels tend to decrease with age, so older
individuals
may have lower renin levels than younger individuals.
Sex
can also affect the renin test results. Women tend to have higher renin levels than men,
especially during pregnancy. However, the difference in renin levels between men and
women
is not significant enough to affect the interpretation of the test results.
REFFERENCES
Clinical Biochemistry - Concepts and Laboratory Methods A Text Book for
Medical, Paramedical, Medical Laboratory Technology and Bioscience
students
THIRD EDITION
CLINICAL BIOCHEMISTRY METABOLIC AND CLINICAL ASPECTS
William ]. Marshall Marta Lapsley Andrew P. Day Ruth M. Ayling
Case Studies in Clinical Laboratory Science
Linda Graves Ed.D. MT (ASCP), Elizabeth Gockel-Blessing
Marks' Basic Medical Biochemistry: A Clinical Approach
5th Edition michael Lieberman and 1 more
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