ASSESMENT OF ENDOCRINE FUNCTIONS M. Šnajderová Pediatrická klinika, 2. LF UK a FN Motol, Praha Photos of patients and other documents which are subject to copyright were removed

Methods of investigation in endocrinology History Physical examination Diagnostic plan Methods of investigation (laboratory, CT, MR, isotope …) Therapy Follow up

ANTIDIURETIC FUNCTION Patient with polyuria : Central DI x nephrogenic DI Urine osmolality (below 200 mosm/kg), low specific gravity 1.005 or less Combined Water Restriction-Vasopressin Administration Test- careful supervision (avoid excessive dehydration)

SOMATOTROPIC FUNCTION 1 Growth and pubertal development: body height, proportions …body weight… Tanner stages GH Secretion- basal GH, GH profile (20´intervals over 12-24 hours), excretion of GH in urine Provocative Stimulation Tests – numerous tests, pharmacological stimulation

SOMATOTROPIC FUNCTION 2 IGF-I : Plasma concentrations of IGF-I reflect GH secretion and action (age, puberty, nutrition) IGFBP3

Hypo and hyperadrenocorticism Feeding problems in early life, fatigue, skin, obesity, growth in childhood, blood pressure, glycaemia … acute/chronic

THYROID GLAND 1 History Inspection, palpation, blood pressure, FH.. Thyroid function : Blood hormone levels under basal conditions: FT3, FT4, TSH – RIA (and/or enzyme immunoassay systems)

THYROID GLAND 2 Evaluation of hypothalamic-pituitary-thyroid axis (TRH stimulation test) Thyroid antibodies (A-TG, A-TPO, TRAb) ?!? Normal values – interpretation (inter-lab variability, relation to age)

TRH test Evaluation of pituitary and thyroid function TRH i.v. bolus Blood samples to asses TSH levels : 0, 40, 60´ 0´: FT3, FT4 and 3, 4 hours after TRH

Gonads Production of hormones – endocrine function Gamets and germinal function

GONADAL FUNCTION 1 Basal levels : T – good marker of testicular function E2 – poor indicator of ovarian function (age) Inhibin – increases during puberty AMH hCG test : M: capacity of Leydig cells to secrete T (bilateral cryptorchidism, suspicion of anorchia before puberty, hypogonadism, hypogenitalism, intersex)

GONADAL FUNCTION 2 GnRH Stimulation Test – GnRH i.v. , serum: LH and FSH, cannot distinguish between hypothalamic and pituitary lesion Clomiphene-Stimulating Test – Stimulation of varian function – of no use before puberty – induction of ovulation in adults Prolactin – Hyperprolactinemia, hypothyroidism, some drugs…

INSULIN AND GLUCOSE TOLERANCE 1 Fasting insulin – Fasting test- age and risk of hypoglycaemia, 12-24 hr Glucose Tolerance Test – oGTT, i.v. GTT – WHO criteria (glycaemia, C-peptide, IRI, insulin secretion – first and second phase of insulin release)

INSULIN AND GLUCOSE TOLERANCE 2 Intravenous Glucagon Test – In patients with DM1 – evaluating the residual B cell function. Research setting for the evaluating of DM remission.

Discussion and conclusions