Detecting patients with Cushing's syndrome: The importance of initial test selection.

Background And Objectives: The recommended initial tests for suspected Cushing's syndrome are late-night salivary cortisol (LNSC), 24-hour urinary free cortisol (UFC) and the 1 mg overnight dexamethasone suppression test (ONDST). These tests have higher sensitivity and specificity than serum cortisol. The aim of this study was to determine the relative frequency of these requested tests in primary care.

Approach to the diagnosis of secondary hypertension in adults.

Presentations that should raise suspicion of secondary hypertension include early-onset, severe or resistant hypertension. A suggestive family history or clinical clues can point to a specific secondary cause. The most common causes and associations are renal disease, primary aldosteronism and obstructive sleep apnoea.

The Role of PINP in Diagnosis and Management of Metabolic Bone Disease.

Serum procollagen type I N-propeptide (PINP) is designated the reference marker of bone formation in osteoporosis; the reference marker for resorption is C-terminal telopeptide of type I collagen (CTX). PINP has very low circadian and biological variation, is not affected by food intake, and is very stable in serum after venepuncture. The two automated commercial assays for PINP provide similar results in subjects with normal renal function, allowing reference intervals to be used interchangeably.

A case of pseudohyperchloraemia caused by sodium nitrate ingestion.

Emergency department presentations of sodium nitrate poisoning are increasing in frequency. Point-of-care blood gas analysis is useful for identifying methaemoglobinaemia and other abnormalities in such patients. Topically applied nitrate is known to positively interfere with chloride measurement in both point-of-care instruments and automated analysers of the clinical chemistry laboratory.

Faecal Calprotectin.

Calprotectin is a calcium- and zinc-binding protein of the S-100 protein family which is mainly found within neutrophils and throughout the human body. The presence of calprotectin in faeces is a consequence of neutrophil migration into the gastrointestinal tissue due to an inflammatory process. Faecal calprotectin concentrations demonstrate good correlation with intestinal inflammation and faecal calprotectin is used as a biomarker in gastrointestinal disorders.

The challenge of improving the diagnostic yield from metanephrine testing in suspected phaeochromocytoma and paraganglioma.

Background Plasma-free metanephrines (PFM) or urinary fractionated metanephrines (UFM) are the preferred biochemical tests for the diagnosis of phaeochromocytoma and paraganglioma (PPGL). Borderline increased results should be followed up to either exclude or confirm diagnosis. Methods We extracted all PFM and UFM results reported by our laboratory over a six-month period from the laboratory information system.

Improved technical success and radiation safety of adrenal vein sampling using rapid, semi-quantitative point-of-care cortisol measurement.

Unlabelled: Objective Primary aldosteronism is a curable cause of hypertension which can be treated surgically or medically depending on the findings of adrenal vein sampling studies. Adrenal vein sampling studies are technically demanding with a high failure rate in many centres. The use of intraprocedural cortisol measurement could improve the success rates of adrenal vein sampling but may be impracticable due to cost and effects on procedural duration.

Quantifying the intraindividual variation of antimüllerian hormone in the ovarian cycle.

Objective: To quantify intraindividual variability of antimüllerian hormone (AMH) as analytical and biological coefficients of variation and assess the effects of variation on clinical classification.

Design: Retrospective cohort study.

Setting: Not applicable.

Serum 25-hydroxyvitamin D levels in vitamin D-insufficient hip fracture patients after supplementation with ergocalciferol and cholecalciferol.

Vitamin D insufficiency is commonly associated with hip fracture. However, the equipotency of ergocalciferol and cholecalciferol supplementation in this patient group has not been studied in a randomized trial using high-performance liquid chromatography (HPLC) measurement of serum 25-hydroxyvitamin D (25OHD). The objective of this study was to determine if ergocalciferol and cholecalciferol are equipotent therapies in vitamin D-insufficient hip fracture patients.

Directions for clinical practice improvement in HFE gene mutation testing.

Objective: To audit the clinical indications for HFE gene mutation testing in a consecutive series of requests.

Design: Retrospective audit of reasons prompting 187 HFE test requests received between June 2003 and June 2005, by examination of the request form, hospital notes (when available) and, when required, information from the referring doctor.

Setting: A tertiary care public teaching hospital laboratory, Perth, Western Australia.

Clomiphene-associated combined hyperlipidemia: a case report.

Background: Hyperlipidemia associated with clomiphene use is an uncommon but potentiallly serious complication of this therapy. Clomiphene is structurally similar to other synthetic estrogen analogs, which are known to induce marked hypertriglyceridemia. There is a paucity of data regarding the effects of clomiphene on lipid metabolism in humans.

Small changes in thyroxine dosage do not produce measurable changes in hypothyroid symptoms, well-being, or quality of life: results of a double-blind, randomized clinical trial.

Context: In patients with primary hypothyroidism, anecdotal evidence suggests that well-being is optimized by fine adjustment of T(4) dosage, aiming for a serum TSH concentration in the lower reference range. This has not been tested in a clinical trial.

Objective: Our objective was to test whether adjustment of T(4) dosage aiming for a serum TSH concentration less than 2 mU/liter improves well-being compared with a serum TSH concentration in the upper reference range.

Urinary NTX results rarely alter the clinical management of patients with osteoporosis in the tertiary hospital.

Aim: Urinary levels of cross-linked N-terminal telopeptide of type I collagen (NTX) are used as a marker of bone resorption and are useful for monitoring response of patients treated with anti-resorptive agents. We aimed to determine how urinary NTX results alter clinical decision making by physicians treating patients with osteoporosis in a tertiary hospital setting.

Methods: We reviewed patient notes of all new NTX requests in 2002 and 2003 with at least one subsequent repeat measurement.

Thyrotoxic, hypokalaemic periodic paralysis.

Thyrotoxic, hypokalaemic periodic paralysis is an uncommon, potentially life-threatening endocrine emergency. Because of the acute onset of neurological symptoms patients often initially present to hospital ED. To reduce patient morbidity and costs of unnecessary investigations, early recognition and appropriate treatment is required.

Alcohol-associated severe hyperhomocysteinaemia.

We report the cases of three men with severe hyperhomocysteinaemia that was associated with high alcohol intake and which resolved on reduction of alcohol intake. Investigation to identify other obvious causes of the hyperhomocysteinaemia excluded renal failure and vitamin deficiencies. Alcohol as a possible cause of significantly increased plasma homocysteine may be under-recognized by clinicians.

Prospective evaluation of carotid bruit as a predictor of first stroke in type 2 diabetes: the Fremantle Diabetes Study.

Background And Purpose: We sought to examine prospectively the relationship between asymptomatic carotid bruit and stroke in type 2 diabetes.

Methods: We studied 1181 (91.3%) of a community-based sample of 1294 patients with type 2 diabetes.