Greenspan’s Basic & Clinical Endocrinology, 9e

Appendix: Normal Hormone Reference Ranges

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Normal Hormone Reference Rangesa,b

Test

Source

Ages, Conditions, etc

Conventional Units

Conversion Factor

SI Units

Comments

Adrenocorticotropic hormone (ACTH) stimulation test (cosyntropin test): 0.25 mg of synthetic ACTH1-24 (cosyntropin) is administered IV or IM, and serum cortisol is measured at 0, 30, and 60 min. Normal response: peak cortisol >20 μg/dL (>540 nmol/L). A dose of 1 μg of ACTH will give a similar response in the normal individual (see Chapter 9).

ACTH

Plasma

Men

7-50 pg/mL

0.222

1.55-11.1 pmol/L

Collect in silicone-coated EDTA-containing tubes. Keep iced. Avoid contact with glass during collection and separation. Process immediately. Separate and freeze plasma in plastic tube at −20°C.

Women

5-27 pg/mL

1.11-6 pmol/L

Children

Prepubertal

7-28 pg/mL

1.55-6.2 pmol/L

Postpubertal

2-49 pg/mL

0.44-10.78 pmol/L

Post-dexamethasone suppression

2-5 pg/mL

0.4-1.1 pmol/L

Aldosterone

Serum (fasting)

Sodium intake

–

27.7

300 mmol/d:

Adult

Levels in pregnant patients are three to four times higher.

Upright am

<28 ng/dL

<776 pmol/L

Upright pm

<21 ng/dL

<582 pmol/L

Supine am

3-16 ng/dL

83.1-443 pmol/L

Adrenal vein

200-400 ng/dL

5540-11,080 pmol/L

Urine

Sodium diet

–

Collect 24-h specimen in 10 g boric acid to maintain pH <7.5. Refrigerate during collection.

(100-300 mmol/d)

Children:

2-7 y

≤5.7 μg/d

8-11 y

≤10.2 μg/d

12-16 y

≤15.6 μg/d

Adult

≤2.3-21 μg/d

Post-fludrocortisone or intravenous saline infusion

≤5.0 μg/d

Alkaline phosphatase, bone specific

Serum

2-24 mo

25.4-124.0 μg/L

–

IRMA; collect following an overnight fast; useful in Paget disease and osteoporosis; assay also known as Ostase; increased levels seen in states of high bone turnover (Paget disease, hyperthyroidism, osteoporosis).

6-9 y

41-134.6 μg/L

10-13 y

Males

43.8-177.4 μg/L

Females

24.2-154.2 μg/L

14-17 y

Males

3.7-128 μg/L

Females

110.5-75.2 μg/L

Adult males

18-29 y

8.4-29.3 μg/L

30-39 y

7.7-21.3 μg/L

40-49 y

7.0-18.3 μg/L

60-68 y

7.6-14.9 μg/L

Adult females

18-29 y

4.7-17.8 μg/L

30-39 y

5.3-19.5 μg/L

40-49 y

5.0-18.8 μg/L

50-76 y

5.6-29 μg/L

Alpha subunit

Serum

Men

<0.6 ng/mL

–

RIA; used to assess gonadotropin hormone subunit secretion in pituitary adenomas.

Women

Premenopausal

<1.5 ng/mL

Postmenopausal

0.9-3.3 ng/mL

Hypothyroid

<3.7 ng/mL

Pregnant or hCG-producing tumor

1.8-360 ng/mL

3α-Androstenediol glucuronide

Serum

Prepubertal children

0.1-0.6 ng/mL

2.14

0.2-1.3 nmol/L

Freeze serum and store at −20°C.

Tanner II-III

Male

0.19-1.64 ng/mL

0.41-3.51 nmol/L

Female

0.33-2.44 ng/mL

0.71-5.22 nmol/L

Adult

Male

2.6-15 ng/mL

5.6-32.1 nmol/L

Female

0.6-3.0 ng/mL

1.3-6.4 nmol/L

Androstenedione

Serum

Men

3.49

18-30 y

50-220 ng/dL

175-768 nmol/L

31-50 y

40-190 ng/dL

140-663 nmol/L

51-60 y

50-220 ng/dL

175-768 nmol/L

Women

Follicular

35-250 ng/dL

122-873 nmol/L

Midcycle

60-285 ng/dL

209-995 nmol/L

Luteal

30-235 ng/dL

105-820 nmol/L

Postmenopausal

20-75 ng/dL

70-262 nmol/L

Children

1-12 mo

6-78 ng/dL

21-272 nmol/L

1-4 y

5-51 ng/dL

17-178 nmol/L

5-9 y

6-115 ng/dL

21-401 nmol/L

10-13 y

12-221 ng/dL

42-771 nmol/L

14-17 y

22-225 ng/dL

77-785 nmol/L

Tanner II-III

Male

17-82 ng/dL

59-286 nmol/L

Female

43-180 ng/dL

150-628 nmol/L

Tanner IV-V

Male

57-150 ng/dL

199-523 nmol/L

Female

7-68 ng/dL

24-237 nmol/L

Antidiuretic hormone (ADH; vasopressin)

Plasma

If serum osmolality >290 mOsm/kg

1-13 pg/mL

0.925

0.9-12 pmol/L

Collect in EDTA tubes. Keep iced. Centrifuge refrigerated. Store at −70°C within 2 h. 1 μU = 2.5 pg

If serum osmolality <290 mOsm/kg

<2 pg/mL

<1.85 pmol/L

Angiotensin II

Plasma

Adults

10-50 ng/L

–

Collect in EDTA. Centrifuge refrigerated. Store frozen at −70°C.

C peptide of insulin

Serum

Fasting

0.8-3.1 ng/mL

0.331

0.26-1.03 nmol/L

Freeze serum at −20°C; stable for 1 d at room temperature and 1 wk at −20°C.

Calcitonin

Serum

Male

<10 pg/mL

0.293

<2.93 pmol/L

Fasting, nonlipemic specimen. Refrigerate, spin down immediately. Store at −20°C.

Female

<5 pg/mL

<1.46 pmol/L

Child

<6 mo

<41 pg/mL

<12 pmol/L

6 mo-3 y

<14 pg/mL

<4.1 pmol/L

3-17 y

<6 ng/mL

<1.76 pmol/L

Calcitonin stimulation test utilizing calcium infusion: 2 mg/kg of calcium in the form of calcium gluconate is administered IV over 1 min. Blood samples for calcitonin are obtained at 1, 2, 5, and 10 min after the infusion. Normal peak values for calcitonin 2 min after calcium infusion: female; <70 ng/L (<20.5 pmol/L); male: <491 ng/L (<144 pmol/L).

Calcium, 24-h urinary

Urine

Calcium

–

Collect in 25 mL of 6N HCl. Refrigerate during collection; elevated in primary hyperparathyroidism, Paget disease, multiple myeloma, vitamin D toxicity; reduced in rickets, osteomalacia, familial hypocalciuric hypercalcemia.

Men

50-300 mg/24 h

Women

50-250 mg/24 h

Calcium

–

Men

30-210 mg/g creatinine

Women

30-275 mg/g creatinine

Calcium, ionized

Serum

Adults

4.8-5.6 mg/dL

–

Refrigerated serum must be collected anaerobically in gel barrier tube; elevated in primary hyperparathyroidism, vitamin D toxicity, cancer; reduced in pseudo-hypoparathyroidism, hypoparathyroidism, and severe vitamin D deficiency.

Children

8 mo-10 y

4.9-5.4 mg/dL

11-17 y

4.8-5.3 mg/dL

Calcium, total

Serum

Adults

8.6-10.2 mg/dL

–

Overnight fasting preferred; used to diagnose parathyroid and vitamin D disorders; elevated in primary hyperparathyroidism, vitamin D toxicity; reduced in hypoparathyroidism and vitamin D deficiency.

Children

<1 mo

8.4-10.6 mg/dL

1-11 mo

8.7-10.5 mg/dL

1-3 y

8.5-10.6 mg/dL

4-19 y

8.9-10.4 mg/dL

Catecholamines (fractionated by HPLC)

Plasma

Adults:

- Norepinephrine

–

0.00591

–

Collect by intravenous catheter after patient has rested 30 min. Collect and centrifuge under refrigeration; freeze in plastic tube at −20°C.

Supine

112-658 pg/mL

0.66-3.89 nmol/L

Ambulatory

212-1109 pg/mL

1.28-6.55 nmol/L

Epinephrine

–

0.00546

–

Supine

<50 pg/mL

<0.27 nmol/L

Ambulatory

<95 pg/mL

<0.52 nmol/L

Dopamine

–

0.00654

–

Supine

<10 ng/mL

<0.065 nmol/L

Ambulatory

<20 ng/mL

<0.13 nmol/L

Total (N+E) Supine Upright

123-671 pg/mL 242-1125 pg/mL

0.00591

0.73-3.97 nmol/L 1.43-6.64 nmol/L

Children (age 3-15 y):

–

Epinephrine

–

Supine

<464 pg/mL

0.00546

<2.54 nmol/L

Norepinephrine

–

Supine

< 1251pg/mL

0.00591

< 7.4 nmol/L

Dopamine

<60 pg/mL

0.00654

0.39 nmol/L

Urine

Norepinephrine

–

5.91

–

24-h urine preservative: 25 mL of 6N HCl. Freeze aliquot promptly at −20°C.

3-8 y

5-41 μg/24 h

–

29.5-242.3 nmol/24 h

9-12 y

5-50 μg/24 h

29.5-295.8 nmol/24 h

13-17 y

12-88 μg/24 h

70.9-526 nmol/24 h

>17 y

15-100 μg/24 h

89-591 nmol/24 h

Epinephrine

–

5.46

3-8 y

1-7 μg/24 h

–

5.46-38.2 nmol/24 h

9-12 y

<8 μg/24 h

<43.7 nmol/24 h

13-17 y

<11 μg/24 h

<60 nmol/24 h

>17 y

2-24 μg/24 h

11-131 nmol/24 h

Total (N + E)

5.91

3-8 y

9-51 μg/24 h

53-301 nmol/24 h

9-12 y

9-71 μg/24 h

53-420 nmol/24 h

13-17 y

13-90 μg/24 h

77-532 nmol/24 h

>17 y

26-121 μg/24 h

154-715 nmol/24 h

Dopamine

6.54

3-8 y

80-378 μg/24 h

–

523-2472 nmol/24 h

9-12 y

51-474 μg/24 h

334-3100 nmol/24 h

13-17 y

51-645 μg/24 h

334-4218 nmol/24 h

>17 y

52-480 μg/24 h

340-3139 nmol/24 h

Cholecystokinin

Plasma (fasting)

3.9 ng/mL

0.26

1 pmol/L

–

Chorionic gonadotropin, beta subunit (β-hCG)

Serum

Men

<5 mIU/mL

1.00

<5 mIU/mL

See Chapter 16 for further details and interpretation.

Women

Premenopausal, Nonpregnant

<5 mIU/mL

Postmenopausal

<10 mIU/mL

Females postconception

<1 wk

5-50 mIU/mL

1-2 wk

50-500 mIU/mL

–

50-500 mIU/mL

2-3 wk

100-5000 mIU/mL

–

100-5000 mIU/mL

3-4 wk

500-10,000 mIU/mL

–

500-10,000 mIU/mL

4-5 wk

1000-50,000 mIU/mL

5-6 wk

10,000-100,000 mIU/mL

10,000-100,000 mIU/L

6-8 wk

15,000-200,000 mIU/mL

2-3 mo

10,000-100,000 mIU/mL

Chromogranin A

Serum

Adults

<36.4 ng/mL

1.00

<36.4 μg/L

–

Collagen type 1 C-telopeptide (CTx)

Serum

Adults

–

Men

–

Frozen serum, collected between 8 am and 10 am. Used to evaluate osteoporosis and Paget disease.

18-29 y

87-100 pg/mL

30-39 y

70-780 pg/mL

40-49 y

60-700 pg/mL

50-68 y

87-345 pg/mL

Women

18-29 y

64-640 pg/mL

30-39 y

60-650 pg/mL

40-49 y

40-465 pg/mL

Collagen cross-linked N-telopeptide (NTx), serum or urine

1.0 mL refrigerated serum; 2 mL refrigerated urine

Men

–

Monitor response to treatment in patients with osteoporosis; diagnose high bone turnover state; possibly elevated in Paget disease of bone, hyperthyroidism, osteoporosis.

Serum

10.7-22.9 nmol BCE/L

Second am voided urine

18-29 y

12-99 nmol BCE/mmol creatinine

30-59 y

9-60 nmol BCE/mmol creatinine

24-h urine

5-87 nmol BCE/mmol creatinine

Women

Premenopausal

8.7-19.8 nmol BCE/L

Serum

Second am

4-64 nmol BCE/mmolcreatinine

Urine

24-h urine

5-79 nmol BCE/mmol creatinine

Corticotropin-releasing hormone (CRH) test: Ovine CRH in a dose of 1 μg/kg is administered IV. Blood samples for ACTH and cortisol determinations are taken at 15, 30, and 60 min. The peak ACTH response of >10 pg/mL (>2.2 pmol/L) occurs at 15 min. The peak cortisol response of >10 μg/dL (>280 nmol/L) occurs at 30-60 min (see Chapter 4).

Corticotropin-releasing hormone

Plasma

Men and nonpregnant women

<34 pg/mL

2.0

<68 pmol/L

Markedly elevated at term pregnancy.

Pregnant women

1st trimester

<40 pg/mL

<80 pmol/L

2nd trimester

<153 pg/mL

<306 pmol/L

3rd trimester

<847 pg/mL

<1694 pmol/L

Cord blood

<338 pg/mL

<676 pmol/L

Cortisol

Serum

Adult

27.59

Collect and process under refrigeration. Spin down immediately. Salivary cortisol is in equilibrium with free cortisol and may be used as an index to free cortisol. Reference range may vary with method and laboratory.

Total

8-10 am

5-21 μg/dL

138-579.4 nmol/L

4-6 pm

2-14 μg/dL

55.2-386.3 nmol/L

Peak post-ACTH

>20 μg/dL

551.8 nmol/L

Children

Premature (31-35 wk)

<15 μg/dL

<414 nmol/L

Term Infants (3 d)

<14 μg/dL

<386 nmol/L

1-17 y

2-17 μg/dL

55-469 nmol/L

Free

0.4-1.92 μg/dL

11-53 nmol/L

0.2-0.9 μg/dL

5-25 nmol/L

Urine (free)

24-h specimen RIA

2.76

Collect 24-h specimen with 8 g of boric acid or 10 mL of 6N HCl as preservative. Liquid chromatography/tandem mass spectrometry.

Adults

4-50 μg/24 h

11-138 nmol/24 h

Children

1-4.9 y

0.9-8.2 μg/24 h

2.5-22.6 nmol/24 h

5-9.9 y

1-30 μg/024 h

2.8-82.8 nmol/24 h

10-13.9 y

1-45 μg/24 h

2.8-124.2 nmol/24 h

14-17.9 y

3-55 μg/24 h

8.3-151.8 nmol/24 h

Dehydroepiandrosterone (DHEA)

Serum (fasting preferred)

Men

180-1250 ng/dL

0.347

62.5-433.8 nmol/L

Separate serum immediately and store at −20°C.

Women

130-980 ng/dL

45.1-340 nmol/L

Pregnancy

135-810 ng/dL

46.8-281 nmol/L

Post-ACTH stimulation in men and women

545-1845 ng/dL

189-640.2 nmol/L

Children

Premature (31-35 wk)

<3343 ng/dL

<1160 nmol/L

Term (1 wk)

<761 ng/dL

<246 nmol/L

Tanner II-III

Male

25-300 ng/dL

8.7-104 nmol/L

Female

69-605 ng/dL

23.9-209.9 nmol/L

Tanner IV-V

Male

100-400 ng/dL

34.7-138.8 nmol/L

Female

165-690 ng/dL

57.3-239.4 nmol/L

Dehydroepiandrosterone sulfate (DHEAS)

Serum (fasting preferred)

Male

0.0272

Stable 72 h at 40°C. Store at −20 °C.

0-1 mo

<316 μg/dL

<8.6 μmol/L

1-6 mo

<58 μg/dL

<1.6 μmol/L

7-12 mo

<26 μg/dL

<0.7 μmol/L

1-3 y

<15 μg/dL

<0.4 μmol/L

4-6 y

<27 μg/dL

<0.7 μmol/L

7-9 y

<91 μg/dL

<2.4 μmol/L

10-13 y

<138 μg/dL

<0.6 μmol/L

14-17 y

38-340 μg/dL

1.0-9.2 μmol/L

18-29 y

110-510 μg/dL

3.0-13.9 μmol/L

30-39 y

110-370 μg/dL

3.0-10.1 μmol/L

40-49 y

45-345 μg/dL

1.2-9.4 μmol/L

50-59 y

25-240 μg/dL

0.7-6.5 μmol/L

60-69 y

25-95 μg/dL

0.7-2.6 μmol/L

70-90 y

<75 μg/dL

<2.0 μmol/L

Female

0.0272

0-1 mo

15-261 μg/dL

0.4-7.1 μmol/L

1-6 mo

<74 μg/dL

<2.0 μmol/L

7-12 mo

<26 μg/dL

<0.7 μmol/L

1-3 y

<22 μg/dL

<0.6 μmol/L

4-6 y

<34 μg/dL

<0.9 μmol/L

7-9 y

<92 μg/dL

<2.5 μmol/L

10-13 y

<148 μg/dL

<4.0 μmol/L

14-17 y

37-307 μg/dL

1.0-10.1 μmol/L

18-29 y

45-320 μg/dL

1.2-8.7 μmol/L

30-39 y

40-325 μg/dL

1.1-8.8 μmol/L

40-49 y

25-220 μg/dL

0.7-6.0 μmol/L

50-59 y

15-170 μg/dL

0.4-4.6 μmol/L

60-69 y

<185 μg/dL

<5.0 μmol/L

70-90 y

<90 μg/dL

<2.5 μmol/L

Deoxycorticosterone (DOC)

Serum (fasting preferred)

Male

30.26

Process immediately. Store at −20 °C.

Adult

3.5-11.5 ng/dL

106-333 pmol/L

Female

Follicular phase

1.5-8.5 ng/dL

45-257 pmol/L

Luteal phase

3.5-13 ng/dL

91-393

Pregnancy

1st trimester

5-25 ng/dL

151-757 pmol/L

2nd trimester

10-75 ng/dL

303-2270 pmol/L

3rd trimester

30-110 ng/dL

908-3329 pmol/L

Children

<1 y

7-57 ng/dL

212-1725 pmol/L

1-5 y

4-49 ng/dL

121-1483 pmol/L

6-12 y

Male

9-34 ng/dL

272-1029 pmol/L

Female

2-13 ng/dL

61-393 pmol/L

11-Deoxycortisol

Serum

Male

0.02887

Process immediately. Store at −20°C. Early morning specimen preferred.

18-29 y

<119 ng/dL

<3.4 nmol/L

30-39 y

<135 ng/dL

<3.9 nmol/L

40-49 y

<76 ng/dL

<2.2 nmol/L

50-59 y

<42 ng/dL

<1.2 nmol/L

Female

18-29 y

<107 ng/dL

<3.1 nmol/L

30-39 y

<51 ng/dL

<1.5 nmol/L

40-49 y

<62 ng/dL

<1.8 nmol/L

50-66 y

<37 ng/dL

<1.1 nmol/L

Children

Cord blood

295-554 ng/dL

8.5-16 nmol/L

Premature infants

<235 ng/dL

<6.8 nmol/L

Full-term infants

<170 ng/dL

<4.9 nmol/L

1-12 mo

10-200 ng/dL

0.3-5.8 nmol/L

1-4 y

7-210 ng/dL

0.2-6.1 nmol/L

5-9 y

<122 ng/dL

<3.5 nmol/L

10-13 y

<245 ng/dL

<7.1 nmol/L

14-17 y

<302 ng/dL

<8.7 nmol/L

Dexamethasone suppression test (low dose) for the diagnosis of Cushing syndrome (see Chapter 9): Obtain a baseline serum cortisol at 0700-0800 h. Administer 1 mg dexamethasone orally at 2300 h that evening and obtain another serum cortisol at 0700-0800 h the following morning. Interpretation: A normal response (normal suppressibility) is a reduction of the post-dexamethasone serum cortisol to <1.8 μg/dL (<50 nmol/L).

Dexamethasone suppression test (high dose) for the differential diagnosis of Cushing syndrome (see Chapter 9): Obtain a baseline serum cortisol at 0700-0800 h. Administer 8 mg dexamethasone orally at 2300 h that evening and obtain another serum cortisol at 0700-0800 h the following morning. Interpretation: A reduction of the post-dexamethasone serum cortisol to <50% of the baseline cortisol indicates suppressibility.

Dexamethasone-CRH test: Administer dexamethasone, 0.5 mg every 6 h orally for eight doses, followed by CRH, 1 μg/kg IV 2 h after the last dose of dexamethasone. Plasma cortisol is obtained 15 min after CRH. Normal: <1.4 μg/dL (<38.6 nmol/L). (See Chapter 9.)

Dihydrotesterone (male)

Serum

Cord blood

<2-8 ng/dL

0.0344

<0.07-0.28 nmol/L

Separate serum within 1 h after collection and store at −20°C.

1-6 mo

12-85 ng/dL

<0.41-2.9 nmol/L

Prepubertal

<5 ng/dL

<0.2 nmol/L

Tanner II-III

3-33 ng/dL

0.1-1.1 nmol/L

Tanner IV-V

22-75 ng/dL

0.8-2.6 nmol/L

Adult

25-75 ng/dL

0.9-2.6 nmol/L

Dihydrotesterone (female)

Serum

Cord blood

<2-5 ng/dL

0.0344

<0.07-0.17 nmol/L

1-6 mo

<5 ng/dL

<0.2 nmol/L

Prepubertal

<5 ng/dL

<0.2 nmol/L

Tanner II-III

5-19 ng/dL

0.2-0.7 nmol/L

Tanner IV-V

3-30 ng/dL

0.1-1 nmol/L

Adult

5-30 ng/dL

0.2-1 nmol/L

Erythropoietin

Serum

Adult

4.1-19.5 mU/mL

1.00

4.1-19.5 mU/mL

Child

3 wk-2 mo

5.0-13.0 mU/mL

3 mo-16 y

9.0-28.0 mU/mL

Estradiol

Serum

Male

3.67

1-9 y

<4 pg/mL

<15 pmol/L

10-11 y

<12 pg/mL

<44 pmol/L

12-14 y

<24 pg/mL

<88 pmol/L

15-17 y

<31 pg/mL

<114 pmol/L

>17 y

<29 pg/mL

<106 pmol/L

Female

1-9 y

<16 pg/mL

<59 pmol/L

10-11 y

<65 pg/mL

<239 pmol/L

12-14 y

<142 pg/mL

<521 pmol/L

15-17 y

<283 pg/mL

<1039 pmol/L

Follicular

39-375 pg/mL

143-1376 pmol/L

Midcycle peak

96-762 pg/mL

352-2797 pmol/L

Luteal

48-440 pg/mL

176-1614 pmol/L

Postmenopausal

<10 pg/mL

<37 pmol/L

Estradiol, free

Adult male

<0.45 pg/mL

3.67

<1.7 pmol/mL

Adult female

Follicular

0.43-5.03 pg/mL

1.6-18.5 pmol/mL

Midcycle

0.72-5.89 pg/mL

2.6-21.6 pmol/mL

Luteal

0.40-5.55 pg/mL

1.5-20.4 pmol/mL

Postmenopausal

<0.38 pg/mL

<1.4 pmol/mL

Estrone

Serum

Adult male

<68 ng/L

3.70

<251 pmol/L

Postpubertal female

Follicular phase

10-138 ng/L

37-511 pmol/L

Midcycle

49-268 ng/L

181-992 pmol/L

Luteal phase

16-173 ng/L

59-640 pmol/L

Postmenopausal

<65 ng/L

<240 pmol/L

Follicle-stimulating hormone

Serum or plasma (heparin)

Adult males (>18 y)

1.6-8 IU/L

1.00

1.6-8 IU/L

Adult females (>18 y)

Follicular phase

2.5-10.2 IU/L

Midcycle peak

3.1-17.7 IU/L

Luteal phase

1.5-9.1 IU/L

Postmenopausal

23-116 IU/L

Boy

0-9 y

<3.0 IU/L

10-13 y

0.3-4.0 IU/L

14-17 y

0.4-7.4 IU/L

Girls

0-8 y

0.5-4.5 IU/L

9-13 y

0.4-6.5 IU/L

14-17 y

0.8-8.5 IU/L

Gastrin

Serum

Adults Children 5-7 y

<100 pg/mL 13-64 pg/mL

0.475

<48 pmol/L 6.2-30 pmol/L

Overnight fast required. Store at −20°C.

Glucagon

Plasma

Adults

<60 pg/mL

0.287

<17.2 pmol/L

Centrifuge immediately under refrigeration. Store in plastic vial with 0.5 mL aprotinin (10,000 KIU/mL) at −20°C. Overnight fast required.

Children

Cord blood

<215 pg/mL

<62 pmol/L

Day 1

<240 pg/mL

<69 pmol/L

Day 2

<400 pg/mL

<115 pmol/L

Day 3

<420 pg/mL

<121 pmol/L

Day 4-14

<148 pg/mL

<42 pmol/L

Growth hormone

Serum

Fasting

46.5

Store at −20°C. Note: GH values fluctuate widely, and functional tests must be utilized for diagnosis of GH deficiency or excess. See Chapter 4 for details of suppression and stimulation tests for GH excess or deficiency.

Children

<13 ng/mL

<604 pmol/L

Adults

<10 ng/mL

<465 pmol/L

Post-75-g glucose load

<1 ng/mL

<46 pmol/L

Growth hormone–binding protein

Serum

Adults

400-4260 pmol/L

1.0

400-4260 pmol/L

Store at −20°C.

Children

3-8 y

320-3820 pmol/L

9-13 y

240-2890 pmol/L

14-17 y

290-3140 pmol/L

Growth hormone–releasing hormone

Plasma

Adults

<49 pg/mL

1.0

<49 pg/mL

Store at −20°C.

Children (4-14 y)

6.8-19 pg/mL

Hemoglobin A1C

Whole blood

Nondiabetic

<6%

Collection in EDTA. Keep refrigerated.

Homovanillic acid

Urine

3-8 y

0.5-6.7 mg/24 h

5.49

2.7-36.8 μmol/24 h

Preservative: 10 mL of 6N HCl. Avoid alcohol, coffee, tea, tobacco, and strenuous exercise for 2 wk pretest.

9-12 y

1.1-6.8 mg/24 h

6.0-37.3 μmol/24 h

13-17 y

1.4-7.2 mg/24 h

7.7-39.5 μmol/24 h

>17 y

1.6-7.5 mg/24 h

8.8-41.2 μmol/24 h

17-Hydroxycorticoids

Urine

Males, age 1-20 y

0.5-10 mg/24 h

2.76

1.4-28 μmol/24 h

Preservative: 10 mL of 6N HCl

Adult males

3-10 mg/24 h

8.3-28 μmol/24 h

Females, age 1-20 y

0.5-7 mg/24 h

1.4-19 μmol/24 h

Adult females

2-6 mg/24 h

5.5-16.6 μmol/24 h

5-Hydroxyindoleacetic

Urine

Age 2-10 y

<8 mg/24 h

5.23

<41.8 μmol/24 h

Preservative: 10 mL of 6N HCl. Refrigerate during 24-h collection. For 48 h prior to and during collection, avoid avocados, and alcohol.

Age >10 y

<6 mg/24 h

<31.4 μmol/24 h

18-Hydroxycorticosterone

Serum

Adult

- Supine (8-10 am)

4-37 ng/dL

27.51

110-1018 pmol/L

Refrigerate.

Ambulatory (8-10 am)

5-80 ng/dL

138-2201 pmol/L

Children

Premature infants (31-35 wk)

<380 ng/dL

<10,454 pmol/L

Term infants (3 d)

<942 ng/dL

<25,914 pmol/L

17-Hydroxypregnenolone

Serum

Adults

20-450 ng/dL

0.0301

0.6-13.5 nmol/L

Process immediately. Store at −20°C.

Post-ACTH

290-910 ng/dL

8.7-27.4 nmol/L

Children

Premature infants

<2409 ng/dL

<72.5 nmol/L

Term infants

<830 ng/dL

25 nmol/L

1-12 mo

14-830 ng/dL

0.4-25 nmol/L

1-5 y

10-100 ng/dL

0.3-3 nmol/L

6-12 y

11-190 ng/dL

0.3-5.7 nmol/L

Tanner II-III

Males

20-360 ng/dL

0.6-10.8 nmol/L

Females

58-450 ng/dL

1.7-13.5 nmol/L

Tanner IV-V

Males

32-300 ng/dL

1-9 nmol/L

Females

53-540 ng/dL

1.6-16.3 nmol/L

17-Hydroxy-progesterone

Serum (fasting preferred)

Males

0.0303

18-30 y

32-307 ng/dL

1-9.3 nmol/L

31-40 y

42-196 ng/dL

1.3-5.9 nmol/L

41-50 y

33-195 ng/dL

1-5.9 nmol/L

51-60 y

37-129 ng/dL

1.1-3.9 nmol/L

Females

Follicular phase

<185 ng/dL

<5.6 nmol/L

Midcycle phase

<225 ng/dL

<6.8 nmol/L

Luteal phase

<285 ng/dL

<8.6 nmol/L

Postmenopausal

<45 ng/dL

<1.4 nmol/L

Children

Premature infants

<360 ng/dL

<10.9 nmol/L

Term infants

<420 ng/dL

<12.7 nmol/L

1-12 mo

11-170 ng/dL

0.3-5.2 nmol/L

1-4 y

4-115 ng/dL

0.1-3.5 nmol/L

5-9 y

<90 ng/dL

<2.7 nmol/L

10-13 y

<169 ng/dL

<5.1 nmol/L

14-17 y

16-283 ng/dL

0.5-8.6 nmol/L

Post-ACTH

1-12 mo

85-465 ng/dL

2.6-14.1 nmol/L

1-5 y

50-350 ng/dL

1.5-10.6 nmol/L

6-12 y

75-220 ng/dL

2.3-6.7 nmol/L

Tanner II-III

Males

12-130 ng/dL

0.4-3.9 nmol/L

Post-ACTH

69-310 ng/dL

2.1-9.4 nmol/L

Females

18-220 ng/dL

0.5-6.7 nmol/L

Post-ACTH

80-420 ng/dL

2.4-12.7 nmol/L

Tanner IV-V

Males

51-190 ng/dL

1.5-5.8 nmol/L

Post-ACTH

105-230 ng/dL

3.2-7 nmol/L

Females

36-200 ng/dL

1.1-6.1 nmol/L

Post-ACTH

80-225 ng/dL

2.4-6.8 nmol/L

Insulin, total (free and bound)

Serum

Fasting

≤20 μU/mL (≤;0.8 ng/mL)

172.1 (ng/mL → pmol/L)

⩽137.6 pmol/L

Cold centrifuge. Freeze at −20°C. Must always be evaluated in light of simultaneous plasma glucose measurement.

Insulin with oral glucose tolerance test

Serum

1 h

50-130 μU/mL (2-5.2 ng/mL)

172.1 (ng/mL → pmol/L)

344-895 pmol/L

Cold centrifuge. Freeze at −20°C.

2 h

<30 μU/mL (<1.2 ng/mL)

<207 pmol/L

Insulin-like growth factor-I (IGF-I)

Serum

Male

1.0

Store refrigerated. Elevated in acromegaly and gigantism; reduced in isolated GH deficiency.

1-7 d

≤31 ng/mL

≤31 μg/L

8-14 d

≤43 ng/mL

≤43 μg/L

15 d-1 y

25-265 ng/mL

25-265 μg/L

1-2 y

45-222 ng/mL

45-222 μg/L

3-4 y

36-202 ng/mL

36-202 μg/L

5-6 y

32-259 ng/mL

32-259 μg/L

7-8 y

65-278 ng/mL

65-278 μg/L

9-10 y

52-330 ng/mL

52-330 μg/L

11-12 y

80-723 ng/mL

80-723 μg/L

13-14 y

142-855 ng/mL

142-855 μg/L

15-16 y

176-845 ng/mL

176-845 μg/L

17-18 y

152-668 ng/mL

152-668 μg/L

19-30 y

126-382 ng/mL

126-382 μg/L

31-40 y

106-255 ng/mL

106-255 μg/L

41-50 y

86-220 ng/mL

86-220 μg/L

51-60 y

87-225 ng/mL

87-225 μg/L

61-70 y

75-228 ng/mL

75-228 μg/L

71-80 y

31-187 ng/mL

31-187 μg/L

81-88 y

68-157 ng/mL

68-157 μg/L

>88 y

Not established

Male

Tanner stage I

59-296 ng/mL

59-296 μg/L

Tanner stage II

56-432 ng/mL

56-432 μg/L

Tanner stage III

135-778 ng/mL

135-778 μg/L

Tanner stage IV

230-855 ng/mL

230-855 μg/L

Tanner stage V

181-789 ng/mL

181-789 μg/L

Female

1-7 d

≤31 ng/mL

≤31 μg/L

8-14 d

≤43 ng/mL

≤43 μg/L

15 d-1 y

25-265 ng/mL

25-265 μg/L

1-2 y

99-254 ng/mL

99-254 μg/L

3-4 y

36-202 ng/mL

36-202 μg/L

5-6 y

57-260 ng/mL

57-260 μg/L

7-8 y

97-352 ng/mL

97-352 μg/L

9-10 y

49-461 ng/mL

49-461 μg/L

11-12 y

101-580 ng/mL

101-580 μg/L

13-14 y

199-658 ng/mL

199-658 μg/L

15-16 y

236-808 ng/mL

236-808 μg/L

17-18 y

165-526 ng/mL

165-526 μg/L

19-30 y

138-410 ng/mL

138-410 μg/L

31-40 y

126-291 ng/mL

126-291 μg/L

41-50 y

88-249 ng/mL

88-249 μg/L

51-60 y

92-190 ng/mL

92-190 μg/L

61-70 y

87-178 ng/mL

87-178 μg/L

71-80 y

25-171 ng/mL

25-171 μg/L

81-88 y

31-162 ng/mL

31-162 μg/L

> 88 y

Not established

Female

Tanner stage I

45-358 ng/mL

45-358 μg/L

Tanner stage II

111-426 ng/mL

111-426 μg/L

Tanner stage III

169-644 ng/mL

169-644 μg/L

Tanner stage IV

297-627 ng/mL

297-627 μg/L

Tanner stage V

142-868 ng/mL

142-868 μg/L

Insulin-like growth factor-II (IGF-II)

Serum

Children

1.0

Store refrigerated. Elevated in mesenchymal tumors with hypoglycemia; overnight fasting preferred.

0-4 y

Not established

5-9 y

754-1216 ng/mL

754-1216 μg/L

10-13 y

610-1217 ng/mL

610-1217 μg/L

14-17 y

649-1225 ng/mL

649-1225 μg/L

Adult

18-30 y

546-1260 ng/mL

546-1260 μg/L

31-40 y

460-1240 ng/mL

460-1240 μg/L

41-50 y

414-1230 ng/mL

414-1230 μg/L

51-60 y

414-1248 ng/mL

414-1248 μg/L

Insulin-like growth factor–binding protein-III (IGFBP III)

Serum

1-7 d

< 0.7 mg/L

1.0

<0.7 mg/L

Separate serum within 1 h. Free serum in plastic vial at −20°C. Major carrier of IGFs, transporting ~95% of IGF-I and IGF-II. IGF-BP3 is GH-responsive and reflects GH actions: elevated in acromegaly and low in hypopituitarism and GH deficiency. Can be used to discriminate among causes of short stature.

8-15 d

0.5-1.4 mg/L

16 d-1 y

0.7-3.6 mg/L

2 y

0.8-3.9 mg/L

3 y

0.9-4.3 mg/L

4 y

1.0-4.7 mg/L

5 y

1.1-5.2 mg/L

6 y

1.3-5.6 mg/L

7 y

1.4-6.1 mg/L

8 y

1.6-6.5 mg/L

9 y

1.8-7.1 mg/L

10 y

2.1-7.7 mg/L

11 y

2.4-8.4 mg/L

12 y

2.7-8.9 mg/L

13 y

3.1-9.5 mg/L

14 y

3.3-10 mg/L

15 y

3.5-10 mg/L

16 y

3.4-9.5 mg/L

17 y

3.2-8.7 mg/L

18 y

3.1-7.9 mg/L

19-20 y

2.9-7.3 mg/L

21-40 y

3.4-7.8 mg/L

41-60 y

3.3-6.9 mg/L

61-70 y

3.0-6.6 mg/L

71-80 y

2.5-5.7 mg/L

81-85 y

2.2-4.5 mg/L

Males

Tanner I

1.4-5.2 mg/L

Tanner II

2.3-6.3 mg/L

Tanner III

3.1-8.9 mg/L

Tanner IV

3.7-8.7 mg/L

Tanner V

2.6-8.6 mg/L

Females

Tanner I

1.2-6.4 mg/L

Tanner II

2.8-6.9 mg/L

Tanner III

3.9-9.4 mg/L

Tanner IV

3.3-8.1 mg/L

Tanner V

2.7-9.1 mg/L

Islet cell antibody (ICA)

Serum

Adults and children

Negative (<1.25 JDF units)

1.0

Negative (<1.25 JDF units)

Refrigerated serum sample. ICA includes antibodies directed against GAD (glutamic acid decarboxylase), IA-2, insulin, GM2-1, and other cell surface proteins. ICA is present during the prediabetic phase and predicts the development of type 1 diabetes. Titers are compared to a single international reference standard reported in JDF (Juvenile Diabetes Foundation) units.

17-Ketosteroids

Urine

Males

3.47

Collect urine with 10 g of boric acid, 30 mL of 6N HCl or 25 mL 50% acetic acid and refrigerate during collection.

17-20 y

9-22 mg/d

31.23-76.34 μmol/d

>20 y

8-20 mg/d

27.76-69.4 μmol/d

Females

>16 y

6-15 mg/d

20.82-52.05 μmol/d

Children

<1 y

<1.0 mg/d

<3.47 μmol/d

1-4 y

<2.0 mg/d

<6.94 μmol/d

5-8 y

<3.0 mg/d

<10.41 μmol/d

9-12 y

3-10 mg/d

10.41-34.7 μmol/d

13-16 y

5-12 mg/d

17.35-41.64 μmol/d

Leptin

Serum

Adult males (BMI 18-25)

1.2-9.5 ng/mL

1.0

1.2-9.5 μg/L

Refrigerated serum sample required for RIA.

Adult females (BMI 18-25)

4.1-25.0 ng/mL

4.1-25.0 μg/L

Children

Prepubertal males

1.6-10.8 ng/mL

1.6-10.8 μg/L

Tanner II-III males

2.1-11.6 ng/mL

2.1-11.6 μg/L

Tanner IV-V males

3.4-10.2 ng/mL

3.4-10.2 μg/L

Prepubertal females

1.7-10.6 ng/mL

1.7-10.6 μg/L

Tanner II-III females

2.6-11.5 ng/mL

2.6-11.5 μg/L

Tanner IV-V females

3.4-13.0 ng/mL

3.4-13.0 μg/L

Luteinizing hormone

Plasma or serum

Males

1.0

Test measures the sum of LH and hCG; high hCG levels in pregnancy or trophoblastic disease cross-react in the assay, giving falsely high LH levels. Third-generation LH assay is sensitive to 0.03 mIU/mL and is more appropriate for use in children. Freeze specimen at −20°C.

1-7 y

≤0.10 mIU/mL

≤0.10 IU/L

8-9 y

≤0.44 mIU/mL

≤0.44 IU/L

10-11 y

≤2.28 mIU/mL

≤2.28 IU/L

12-14 y

0.31-5.29 mIU/mL

0.31-5.29 IU/L

15-17 y

0.15-5.33 mIU/mL

0.15-5.33 IU/L

Adults

1.5-9.3 mIU/mL

1.5-9.3 IU/L

Females

1-7 y

≤0.45 mIU/mL

≤0.45 IU/L

8-9 y

≤3.36 mIU/mL

≤3.36 IU/L

10-11 y

≤5.65 mIU/mL

≤5.65 IU/L

12-14 y

≤11.00 mIU/mL

≤11.00 IU/L

15-17 y

≤15.80 mIU/mL

≤15.80 IU/L

Adults

Follicular phase

1.9-12.5 mIU/mL

1.9-12.5 IU/L

Midcycle peak

8.7-76.3 mIU/mL

8.7-76.3 IU/L

Luteal phase

0.5-16.9 mIU/mL

0.5-16.9 IU/L

Postmenopausal

5.0-52.3 mIU/mL

5.0-52.3 IU/L

Metanephrines, fractionated, urine

Urine

Metanephrines

5.07

5 mL aliquot of urine; abstain from medication, tobacco, tea, and coffee for 3 d prior to collection.

3 mo-4 y

25-117 μg/24 h

126.8-593.2 nmol/24 h

5-9 y

11-139 μg/24 h

55.8-704.7 nmol/24 h

10-13 y

51-275 μg/24 h

258.6-1394.3 nmol/24 h

14-17 y

40-189 μg/24 h

202.8-958.2 nmol/24 h

18-29 y

25-222 μg/24 h

126.8-1125.6 nmol/24 h

30-39 y

36-190 μg/24 h

182.5-963.3 nmol/24 h

40-49 y

58-203 μg/24 h

294.1-1029.2 nmol/24 h

≥50 y

90-315 μg/24 h

456.3-1597.1 nmol/24 h

Normetanephrines

3 mo-4 y

54-249 μg/24 h

273.8-1262.4 nmol/24 h

5-9 y

31-398 μg/24 h

157.2-2018 nmol/24 h

10-13 y

67-503 μg/24 h

339.7-2550 nmol/24 h

14-17 y

69-531 μg/24 h

349.8-2692 nmol/24 h

18-29 y

40-412 μg/24 h

202.8-2089 nmol/24 h

30-39 y

35-482 μg/24 h

177.4-2444 nmol/24 h

40-49 y

88-649 μg/24 h

446.2-3290 nmol/24 h

≥50 y

122-676 μg/24 h

618.5-3427 nmol/24 h

Metanephrines, total

3 mo-4 y

79-345 μg/24 h

400.5-1749 nmol/24 h

5-9 y

49-408 μg/24 h

284.4-2069 nmol/24 h

10-13 y

110-714 μg/24 h

557.7-3620 nmol/24 h

14-17 y

107-741 μg/24 h

542.5-3757 nmol/24 h

18-29 y

94-604 μg/24 h

476.6-3062 nmol/24 h

30-39 y

115-695 μg/24 h

583.1-3524 nmol/24 h

40-49 y

182-739 μg/24 h

922-3747 nmol/24 h

≥50 y

224-832 μg/24 h

1136-4218 nmol/24 h

Metanephrines, fractionated, plasma

Plasma

Metanephrine

≤57 pg/mL

≤0.29 nmol/L

Assay by liquid chromatography, tandem mass spectrometry (LC/MS/MS). Requires minimum of 1.5 mL refrigerated EDTA plasma. Patient should refrain from alcohol, coffee, tea, tobacco, and strenuous exercise. Patient should be seated and relaxed before the sample is collected. Overnight fasting is recommended. Increased in pheochromocytoma, neuroblastoma, and stress.

Normetanephrine

≤148 pg/mL

≤0.75 nmol/L

Total metanephrines

≤205 pg/mL

≤1.04 nmol/L

Metyrapone stimulation test: Metyrapone in a dose of 30 mg/kg is administered orally at midnight. The 8 am plasma 11-deoxycortisol is >7 μg/dL (>0.2 nmol/L) and plasma ACTH is >100 pg/mL (22 pmol/L). (See Chapter 4.)

Osmolality

Serum

Random specimen

278-305 mOsm/kg

1.00

278-305 mOsm/kg

0.2-mL room temperature serum.

Urine

50-1200 mOsm/kg

1-mL refrigerated urine.

Osteocalcin

Serum

Males and females

1.0

Overnight fast preferred. Store refrigerated.

6-9 y

40.2-108.0 ng/mL

10-13 y

35.8-165.5 ng/mL

14-17 y

Males

27.8-194.1 ng/mL

27.8-194.4 ng/mL

Females

16.3-68.7 ng/mL

Adults

Males

11.3-35.1 ng/mL

11.3-35.4 ng/mL

Females

7.2-27.9 ng/mL

Pancreatic polypeptide

Plasma

Adults

0.246

Collect with EDTA present, process immediately, and freeze plasma at −60°C.

18-29 y

≤480 pg/mL

≤118.1 nmol/L

30-39 y

70-400 pg/mL

17.2-98.4 nmol/L

40-49 y

70-430 pg/mL

17.2-105.8 nmol/L

50-62 y

100-780 pg/mL

24.6-191.9 nmol/L

>62 y

Not established

Children

Cord blood

Term infants

≤163 pg/mL

≤40.1 nmol/L

Preterm infants

≤180 pg/mL

≤44.3 nmol/L

Term infants (6 d)

≤276 pg/mL

≤67.9 nmol/L

1 mo-2 y

≤644 pg/mL

≤158.4 nmol/L

3-7 y

≤685 pg/mL

≤168.5 nmol/L

>7 y

80-270 pg/mL

19.7-66.4 nmol/L

Parathyroid hormone

Serum

Adults

10-65 pg/mL

0.100

1.0-6.5 pmol/L

Intact hormone measured by immunochemiluminometric assay. Freeze serum at −20°C.

Children

6-9 y

9-59 pg/mL

10-13 y

11-74 pg/mL

14-17 y

9-69 pg/mL

Parathyroid hormone-related protein

Plasma

≤4.7 pmol/L

Immunoradiometric assay. Collect blood in syringe and transfer to cold special collection tube and mix thoroughly. Centrifuge in refrigerated centrifuge and store plasma frozen.

Pregnanetriol

24-h urine

Males

71-1000 mg/d

2.97

211-2970 μmol/d

Refrigerate urine during the collection and collect without preservatives. Gas chromatography/mass spectrometry (GC/MS) method. Accumulates in urine when 17-hydroxyprogesterone levels are high.

Females

47-790 mg/d

140-1436 μmol/d

Pregnenolone

Serum

Adult males

10-200 ng/dL

0.0318

0.3-6.4 nmol/L

Useful in the diagnosis of congenital adrenal hyperplasia and in virilizing adrenal tumors.

Adult females

10-230 ng/dL

0.3-7.3 nmol/L

Progesterone

Serum

Adults

0.0318

Freeze at −20°C. Early morning specimen is preferred. Liquid chromatography, tandem mass spectrometry (LC/MS/MS) method.

Males

18-29

≤0.3 ng/mL

≤0.954 nmol/L

30-39

≤0.2 ng/mL

≤0.636 nmol/L

40-49

≤0.2 ng/mL

≤0.636 nmol/L

50-59

≤0.2 ng/mL

≤0.636 nmol/L

Females

Early follicular phase

≤0.6 ng/mL

≤1.908 nmol/L

Late follicular phase

≤14.5 ng/mL

≤46.11 nmol/L

Midcycle

≤16.1 ng/mL

≤51.2 nmol/L

Luteal phase

≤31.4 ng/mL

≤99.9 nmol/L

Postmenopausal

≤0.2 ng/mL

≤0.636 nmol/L

Children

Males

5-9 y

≤0.7 ng/mL

≤2.23 nmol/L

10-13 y

≤1.2 ng/mL

≤3.82 nmol/L

14-17 y

<0.8 ng/mL

≤2.54 nmol/L

Females

5-9 y

≤0.6 ng/mL

≤1.908 nmol/L

10-13 y

≤10.2 ng/mL

≤32.43 nmol/L

14-17 y

≤11.9 ng/mL

≤37.84 nmol/L

Proinsulin

Serum

Adults

≤18.8 pmol/L

1.0

≤18.8 pmol/L

Radioimmunoassay on frozen serum. Useful in the diagnosis of insulinoma.

Prolactin

Serum

Adult

0.045

Freeze serum at −20°C.

Men

2.0-18.0 ng/mL

0.09-0.81 nmol/L

Women

Nonpregnant

3.0-30.0 ng/mL

0.14-1.35 nmol/L

Pregnant

10.0-209.0 ng/mL

0.45-9.4 nmol/L

Postmenopausal

2.0-20.0 ng/mL

0.09-0.9 nmol/L

Children

Males

Tanner I

≤10 ng/mL

≤0.45 nmol/L

Tanner II-III

≤6.1 ng/mL

≤0.3 nmol/L

Tanner IV-V

2.8-11.0 ng/mL

0.13-0.5 nmol/L

Females

Tanner I

3.6-12.0 ng/mL

0.03-0.54 nmol/L

Tanner II-III

2.6-18.0 ng/mL

0.117-0.81 nmol/L

Tanner IV-V

3.2-20.0 ng/mL

0.144-0.9 nmol/L

Renin

Plasma

Normal sodium diet (75-150 mmol/d)

0.278

Draw in cold tube, separate plasma, and freeze in plastic within 15 min after collection.

0800 recumbent

0.3-3.0 μg/L/h

0.09-0.9 ng/L/s

1200 upright

0.4-8.8 μg/L/h

0.12-2.7 ng/L/s

upright/sitting

0.65-5.0 μg/L/h

0.18-1.39 ng/L/s

Sex hormone–binding globulin

Serum

Adults

1.0

Store refrigerated, collect room temperature serum sample. Immunochemi-luminometric assay.

Males

18-29 y

7-49 nmol/L

30-39 y

8-48 nmol/L

40-49 y

9-45 nmol/L

50-59 y

18-47 nmol/L

60-69 y

17-54 nmol/L

70-79 y

23-65 nmol/L

80-91 y

20-63 nmol/L

Females

18-29 y

6-112 nmol/L

30-39 y

14-102 nmol/L

40-49 y

11-100 nmol/L

50-59 y

17-78 nmol/L

60-69 y

17-95 nmol/L

70-79 y

21-90 nmol/L

80-91 y

26-77 nmol/L

Children

Males and females

3-9 y

18-136 nmol/L

10-13 y

17-123 nmol/L

14-17 y

11-71 nmol/L

Tanner stage

Males

39-155 nmol/L

33-135 nmol/L

III

21-72 nmol/L

11-92 nmol/L

11-54 nmol/L

Females

38-114 nmol/L

24-90 nmol/L

III

22-112 nmol/L

22-69 nmol/L

18-76 nmol/L

Somatostatin

Plasma

Adults

10-22 pg/mL

0.426

4.26-9.37 pmol/L

Draw in prechilled tube, separate plasma, and freeze immediately.

Testosterone, total

Serum

Male

0.0347

Freeze at −20°C.

Cord blood

17-61 ng/dL

0.59-2.11 nmol/L

1-10 d

≤187 ng/dL

≤6.49 nmol/L

1-3 mo

72-344 ng/dL

2.5-11.9 nmol/L

3-5 mo

≤201 ng/dL

≤6.97 nmol/L

5-7 mo

≤59 ng/dL

≤2.05 nmol/L

7-12 mo

≤16 ng/dL

≤0.56 nmol/L

1-5.9 y

≤5 ng/dL

≤0.17 nmol/L

6-7.9 y

≤25 ng/dL

≤0.87 nmol/L

8-10.9 y

≤42 ng/dL

≤1.46 nmol/L

11-11.9 y

≤260 ng/dL

≤9.022 nmol/L

12-13.9 y

≤420 ng/dL

≤14.57 nmol/L

14-17.9 y

≤1000 ng/dL

≤34.7 nmol/L

Tanner stage I

≤5 ng/dL

≤0.17 nmol/L

Tanner stage II

≤167 ng/dL

≤5.79 nmol/L

Tanner stage III

21-719 ng/dL

0.73-24.95 nmol/L

Tanner stage IV

5-70 ng/dL

0.17-2.43 nmol/L

Tanner stage V

110-975 ng/dL

3.82-33.83 nmol/L

Adults

18-69 y

250-1100 ng/dL

8.68-38.17 nmol/L

70-89 y

90-890 ng/dL

3.12-30.88 nmol/L

Female

Cord blood

16-44 ng/dL

0.56-1.53 nmol/L

1-10 d

≤24 ng/dL

≤0.83 nmol/L

1-3 mo

≤17 ng/dL

≤0.59 nmol/L

3-5 mo

≤12 ng/dL

≤0.42 nmol/L

5-7 mo

≤13 ng/dL

≤0.45 nmol/L

7-12 mo

≤11 ng/dL

≤0.38 nmol/L

1-5.9 y

≤8 ng/dL

≤0.28 nmol/L

6-7.9 y

≤20 ng/dL

≤0.69 nmol/L

8-10.9 y

≤35 ng/dL

≤1.21 nmol/L

11-17.9 y

≤40 ng/dL

≤1.38 nmol/L

Tanner stage I

≤8 ng/dL

≤0.28 nmol/L

Tanner stage II

≤24 ng/dL

≤0.83 nmol/L

Tanner stage III

≤28 ng/dL

≤0.97 nmol/L

Tanner stage IV

≤31 ng/dL

≤1.08 nmol/L

Tanner stage V

≤33 ng/dL

≤1.15 nmol/L

Adult

18-69 y

2-45 ng/dL

0.069-1.56 nmol/L

70-94 y

2-40 ng/dL

0.069-1.38 nmol/L

Pregnancy

1st trimester

20-135 ng/dL

0.69-4.68 nmol/L

2nd trimester

11-153 ng/dL

0.38-5.31 nmol/L

3rd trimester

11-146 ng/dL

0.38-5.07 nmol/L

Testosterone, free

Serum

Male

3.47

Freeze at −20°C. Tracer equilibrium dialysis.

5-9 y

≤5.3 pg/mL

≤18.4 pmol/L

10-13 y

0.7-52.0 pg/mL

2.4-180 pmol/L

14-17.9 y

18.0-111 pg/mL

62.5-385 pmol/L

Adults

18-69 y

35-155 pg/mL

121.4-5379 pmol/L

70-89 y

30-135 pg/mL

104.1-468.4 pmol/L

Female

5-9 y

0.2-5.0 pg/mL

0.69-17.3 pmol/L

10-13 y

0.1-7.4 pg/mL

0.35-25.7 pmol/L

14-17 y

0.5-3.9 pg/mL

1.73-13.5 pmol/L

Adults

18-69 y

0.1-6.4 pg/mL

0.35-22.2 pmol/L

70-89 y

0.2-3.7 pg/mL

0.69-12.8 pmol/L

Pregnancy

1st trimester

0.5-6.0 pg/mL

1.73-20.8 pmol/L

2nd trimester

0.2-3.1 pg/mL

0.69-10.8 pmol/L

3rd trimester

0.2-4.1 pg/mL

0.69-14.2 pmol/L

Thyroglobulin

Serum

Adult

2.0-35 ng/mL

1.00

2.0-35 ng/mL

Freeze at −20°C. Presence of thyroglobulin autoantibodies in the patient's serum may falsely lower the result.

Thyroid antibodies

Serum

Thyroperoxidase antibodies

<35 IU/mL

Serum collected and refrigerated.

Thyroglobulin antibodies

<20 IU/mL

Thyroid-stimulating hormone (TSH) ultra sensitive

Serum

Adult

–

Sensitivity: 0.01 mU/mL. TSH levels decline in first several weeks of life, although they remain elevated in some infants. Free T4 is helpful in the interpretation of TSH.

Males and nonpregnant females

0.40-4.50 mU/L

Pregnant females

1st trimester

0.3-4.5 mU/L

2nd trimester

0.5-4.6 mU/L

3rd trimester

0.8-5.2 mU/L

Children

Term infants

1-4 d

3.2-35.0 mU/L

5-6 d

Not established

1-4 wk

1.7-9.1 mU/L

1-12 mo

0.80-8.20 mU/L

1-19 y

0.5-4.30 mU/L

Thyroid-stimulating hormone receptor antibody (TSH-R Ab [stim])

Serum

≤125% of basal activity

–

Assay based on cyclic AMP generation in CHO cells transfected with human TSH receptor gene.

Thyroid uptake of radioactive iodine (RAIU)

Activity over thyroid gland

Fractional uptake

Ingestion or administration of iodide will decrease thyroid uptake of RAI.

2 h

4%-12%

6 h

6%-15%

24 h

8%-30%

Thyrotropin-binding inhibitory immunoglobulin (TB-II)

Serum

Adults and children

≤16% inhibition

–

Sensitivity: 2% inhibition. May be useful in Graves disease, neonatal hypothyroidism, and postpartum thyroid dysfunction.

Graves disease

16%-100% inhibition

Thyrotropin-blocking antibody

Serum

Adults

≤10% inhibition

–

In vitro bioassay useful in diagnosis of transient hypothyroidism in infants due to maternally transferred antibodies; elevated in some forms of hypothyroidism.

Thyroxine-binding globulin (TBG)

Serum

Men

12.7-25.1 μg/mL

1.00

Quantifies TBG to differentiate TBG abnormalities from thyroid dysfunction.

Women

13.5-30.9 μg/mL

Children

3-8 y

16.1-24.2 μg/mL

9-13 y

12.5-25.8 μg/mL

14-17 y

9.8-23.7 μg/mL

Thyroxine (T4)

Serum

Children

12.87

Refrigerate serum. Fasting preferred. Elevated levels in pregnancy due to increased TBG.

1-8 y

5.9-11.5 μg/dL

75.9-148 nmol/L

9-13 y

4.7-10.4 μg/dL

60.5-133.8 nmol/L

14-17 y

5.0-9.8 μg/dL

64.3-126.1 nmol/L

Adults

4.8-10.4 μg/dL

61.8-133.8 nmol/L

Pregnancy

First trimester

6.4-15.2 μg/dL

82.4-195.6 nmol/L

Second trimester

7.4-15.2 μg/dL

95.2-195.6 nmol/L

Third trimester

7.7-14.7 μg/dL

99.1-189.2 nmol/L

Thyroxine, free (FT4)

Serum

Children (3-20 y)

1.0-2.4 ng/dL

12.87

12.87-30.9 pmol/L

Direct equilibrium dialysis and radioimmunoassay. Refrigerate serum.

Adults (21-87 y)

0.8-2.7 ng/dL

10.3-34.7 pmol/L

Pregnancy

1st trimester

0.9-2.0 ng/dL

11.6-25.7 pmol/L

2nd trimester

0.8-1.5 ng/dL

10.3-19.3 pmol/L

3rd trimester

0.8-1.7 ng/dL

10.3-23.6 pmol/L

Triiodothyronine (T3), total

Serum

<1 y

Not established

0.0154

Not established

Refrigerate serum. Immunochemiluminometric assay. Used to diagnose and monitor treatment of hyperthyroidism.

1-9 y

127-221 ng/dL

1.96-3.4 nmol/L

10-13 y

123-211 ng/dL

1.89-3.25 nmol/L

14-18 y

97-186 ng/dL

1.49-2.86 nmol/L

Adult

60-181 ng/dL

0.92-2.79 nmol/L

Pregnancy

1st trimester

81-190 ng/dL

1.25-2.93 nmol/L

2nd and 3rd trimester

100-260 ng/dL

1.54-4.00 nmol/L

Free T3 (FT3)

Serum

Adults

230-420 pg/dL

15.4

3.5-6.47 pmol/L Not established 5.19-7.79 pmol/L 5.16-7.79 pmol/L 4.42-7.01 pmol/L

Nondialysis; ICMA on refrigerated serum.

Children

<1 y

Not established

1-9 y

337-506 pg/dL

10-13 y

335-480 pg/dL

14-18 y

287-455 pg/dL

FT3

Serum

Nonpregnant adults

210-440 pg/dL

15.4

3.23-6.78 pmol/L

Tracer dialysis, RIA on refrigerated serum.

Pregnant women

200-380 pg/dL

3.08-5.85 pmol/L

Children

<1 y

Not established

1-9 y

282-518 pg/dL

4.34-7.98 pmol/L

10-13 y

286-556 pg/dL

4.40-8.56 pmol/L

14-17 y

242-501 pg/dL

3.73-7.72 pmol/L

Reverse T3 (RT3)

Serum

0.11-0.32 ng/mL

0.0154

0.169-0.49 nmol/L

Radioimmunoassay to establish the cause of abnormal thyroid function tests as due to nonthyroidal illness.

Vanillylmandelic acid (VMA)

24-h urine

Adults

≤6.0 mg/d

5.88

≤13.5 nmol/d

10 mL aliquot of urine, HPLC detection; 24-h urine is collected with 25 mL of 6N HCl added. Patients should avoid alcohol, coffee, tea, tobacco, nicotine, bananas, citrus fruit, and heavy exercise prior to the collection.

Children

3-8 y

≤2.3 mg/d

≤20 nmol/d

9-12 y

≤3.4 mg/d

≤22.9 nmol/d

13-17 y

≤3.9 mg/d

≤35.3 nmol/d

Random or spot urine

Children

0.573

Birth-6 mo

5.5-26 mg/g Cr

3.2-14.9 mmol VMA/mol Cr

7-11 mo

6.1-20 mg/g Cr

3.5-11.5 mmol VMA/mol Cr

1-2 y

2.5-21 mg/g Cr

1.4-12.0 mmol VMA/mol Cr

3-8 y

1.7-6.5 mg/g Cr

0.97-3.7 mmol VMA/mol Cr

9-12 y

1.4-5.1 mg/g Cr

0.80-2.9 mmol VMA/mol Cr

13-17 y

1.5-3.6 mg/g Cr

0.86-2.1 mmol VMA/mol Cr

Adults

1.1-4.1 mg/g Cr

0.63-2.3 mmol VMA/mol Cr

Vasoactive intestinal peptide

Serum

<50 pg/mL

0.30

<15 pmol/L

Frozen EDTA plasma.

Vitamin D (25-hydroxy)

Serum

20-100 ng/mL

2.50

50-250 nmol/L

Measures both D2 and D3. Freeze serum in plastic tube at −20°C. Liquid chromatography tandem mass spectrometry (LC/MS/MS)

Vitamin D (1,25 dihydroxy)

Serum

Adults

15-60 pg/mL

2.50

32.5-167 pmol/L

Extraction, chromatography, radioreceptor assay. Freeze serum in plastic tube at −20°C.

Children 3-7 y

27-71 pg/mL

22.5-135 pmol/L

aAdapted from the Clinical Laboratories Manual of the University of California Hospital and Clinics, San Francisco, California, July 4, 2010; and, with permission, from Quest Diagnostics Nichols Institute normal values for endocrine tests. The Quest Diagnosis Manual. Endocrinology Test Selection and Interpretation. 4th ed. Fisher D, ed. 2007. The factors used in converting conventional units to SI units were derived in part from the CRC Handbook of Chemistry and Physics and conversion tables from other online resources. It is important to emphasize that normal ranges vary among different laboratories, and the clinician must know the normal range for the test of interest in the laboratory performing the test.

bSemen analysis is discussed in Chapter 12.

BCE, bone collagen equivalent.

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Appendix: Normal Hormone Reference Ranges

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Appendix: Normal Hormone Reference Ranges

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