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: | – | 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 | | <5 mIU/mL |
Postmenopausal | <10 mIU/mL | | <10 mIU/mL |
Females postconception | | | |
<1 wk | 5-50 mIU/mL | | 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 | | 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 | | 15,000-200,000 mIU/mL |
2-3 mo | 10,000-100,000 mIU/mL | | 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 | | | |
am | 0.4-1.92 μg/dL | | 11-53 nmol/L |
pm | 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 | | 5.0-13.0 mU/mL |
3 mo-16 y | 9.0-28.0 mU/mL | | 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 | | 2.5-10.2 IU/L |
Midcycle peak | 3.1-17.7 IU/L | | 3.1-17.7 IU/L |
Luteal phase | 1.5-9.1 IU/L | | 1.5-9.1 IU/L |
Postmenopausal | 23-116 IU/L | | 23-116 IU/L |
Boy | | | |
0-9 y | <3.0 IU/L | | <3.0 IU/L |
10-13 y | 0.3-4.0 IU/L | | 0.3-4.0 IU/L |
14-17 y | 0.4-7.4 IU/L | | 0.4-7.4 IU/L |
Girls | | | |
0-8 y | 0.5-4.5 IU/L | | 0.5-4.5 IU/L |
9-13 y | 0.4-6.5 IU/L | | 0.4-6.5 IU/L |
14-17 y | 0.8-8.5 IU/L | | 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 | | 320-3820 pmol/L |
9-13 y | 240-2890 pmol/L | | 240-2890 pmol/L |
14-17 y | 290-3140 pmol/L | | 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 | | 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 | 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 | | 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 | | 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 | | 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 | | 0.5-1.4 mg/L |
16 d-1 y | 0.7-3.6 mg/L | | 0.7-3.6 mg/L |
2 y | 0.8-3.9 mg/L | | 0.8-3.9 mg/L |
3 y | 0.9-4.3 mg/L | | 0.9-4.3 mg/L |
4 y | 1.0-4.7 mg/L | | 1.0-4.7 mg/L |
5 y | 1.1-5.2 mg/L | | 1.1-5.2 mg/L |
6 y | 1.3-5.6 mg/L | | 1.3-5.6 mg/L |
7 y | 1.4-6.1 mg/L | | 1.4-6.1 mg/L |
8 y | 1.6-6.5 mg/L | | 1.6-6.5 mg/L |
9 y | 1.8-7.1 mg/L | | 1.8-7.1 mg/L |
10 y | 2.1-7.7 mg/L | | 2.1-7.7 mg/L |
11 y | 2.4-8.4 mg/L | | 2.4-8.4 mg/L |
12 y | 2.7-8.9 mg/L | | 2.7-8.9 mg/L |
13 y | 3.1-9.5 mg/L | | 3.1-9.5 mg/L |
14 y | 3.3-10 mg/L | | 3.3-10 mg/L |
15 y | 3.5-10 mg/L | | 3.5-10 mg/L |
16 y | 3.4-9.5 mg/L | | 3.4-9.5 mg/L |
17 y | 3.2-8.7 mg/L | | 3.2-8.7 mg/L |
18 y | 3.1-7.9 mg/L | | 3.1-7.9 mg/L |
19-20 y | 2.9-7.3 mg/L | | 2.9-7.3 mg/L |
21-40 y | 3.4-7.8 mg/L | | 3.4-7.8 mg/L |
41-60 y | 3.3-6.9 mg/L | | 3.3-6.9 mg/L |
61-70 y | 3.0-6.6 mg/L | | 3.0-6.6 mg/L |
71-80 y | 2.5-5.7 mg/L | | 2.5-5.7 mg/L |
81-85 y | 2.2-4.5 mg/L | | 2.2-4.5 mg/L |
Males | | | |
Tanner I | 1.4-5.2 mg/L | | 1.4-5.2 mg/L |
Tanner II | 2.3-6.3 mg/L | | 2.3-6.3 mg/L |
Tanner III | 3.1-8.9 mg/L | | 3.1-8.9 mg/L |
Tanner IV | 3.7-8.7 mg/L | | 3.7-8.7 mg/L |
Tanner V | 2.6-8.6 mg/L | | 2.6-8.6 mg/L |
Females | | | |
Tanner I | 1.2-6.4 mg/L | | 1.2-6.4 mg/L |
Tanner II | 2.8-6.9 mg/L | | 2.8-6.9 mg/L |
Tanner III | 3.9-9.4 mg/L | | 3.9-9.4 mg/L |
Tanner IV | 3.3-8.1 mg/L | | 3.3-8.1 mg/L |
Tanner V | 2.7-9.1 mg/L | | 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 | | 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 | | 40.2-108.0 ng/mL |
10-13 y | 35.8-165.5 ng/mL | | 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 | | 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 | | 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 | | 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 | | 7-49 nmol/L |
30-39 y | 8-48 nmol/L | | 8-48 nmol/L |
40-49 y | 9-45 nmol/L | | 9-45 nmol/L |
50-59 y | 18-47 nmol/L | | 18-47 nmol/L |
60-69 y | 17-54 nmol/L | | 17-54 nmol/L |
70-79 y | 23-65 nmol/L | | 23-65 nmol/L |
80-91 y | 20-63 nmol/L | | 20-63 nmol/L |
Females | | | |
18-29 y | 6-112 nmol/L | | 6-112 nmol/L |
30-39 y | 14-102 nmol/L | | 14-102 nmol/L |
40-49 y | 11-100 nmol/L | | 11-100 nmol/L |
50-59 y | 17-78 nmol/L | | 17-78 nmol/L |
60-69 y | 17-95 nmol/L | | 17-95 nmol/L |
70-79 y | 21-90 nmol/L | | 21-90 nmol/L |
80-91 y | 26-77 nmol/L | | 26-77 nmol/L |
Children | | | |
Males and females | | | |
3-9 y | 18-136 nmol/L | | 18-136 nmol/L |
10-13 y | 17-123 nmol/L | | 17-123 nmol/L |
14-17 y | 11-71 nmol/L | | 11-71 nmol/L |
Tanner stage | | | |
Males | | | |
I | 39-155 nmol/L | | 39-155 nmol/L |
II | 33-135 nmol/L | | 33-135 nmol/L |
III | 21-72 nmol/L | | 21-72 nmol/L |
IV | 11-92 nmol/L | | 11-92 nmol/L |
V | 11-54 nmol/L | | 11-54 nmol/L |
Females | | | |
I | 38-114 nmol/L | | 38-114 nmol/L |
II | 24-90 nmol/L | | 24-90 nmol/L |
III | 22-112 nmol/L | | 22-112 nmol/L |
IV | 22-69 nmol/L | | 22-69 nmol/L |
V | 18-76 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 | | 0.40-4.50 mU/L |
Pregnant females | | | |
1st trimester | 0.3-4.5 mU/L | | 0.3-4.5 mU/L |
2nd trimester | 0.5-4.6 mU/L | | 0.5-4.6 mU/L |
3rd trimester | 0.8-5.2 mU/L | | 0.8-5.2 mU/L |
Children | | | |
Term infants | | | |
1-4 d | 3.2-35.0 mU/L | | 3.2-35.0 mU/L |
5-6 d | Not established | | 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 | | 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 |