1. ASSESMENT OF ENDOCRINE FUNCTIONS
M. Šnajderová
Pediatrická klinika, 2. LF UK a FN Motol, Praha
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to copyright were removed

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

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

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

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

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

7. 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)

8. 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)

9. 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

10. Gonads Production of hormones – endocrine function
Gamets and germinal function

11. 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)

12. 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…

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

14. 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.

15. Discussion and conclusions