31 Jul 2018

Why is this test performed?

This test is evaluated in different conditions and diseases such as nephrotic syndrome, liver diseases, kidney diseases, in a patient suspected of malnutrition, and patients severe burn. See also: Procedures for the collection of blood for hemotological investigations.

Collection of sample

For the estimation of serum albumin, patient's serum is needed. A random blood sample may be used for the test, however, fasting sample is preferred.

About 3 to 5 ml of blood is collected in a plain test tube and blood is allowed to clot to get clear serum. The blood sample is centrifuged for 5 to 10 minutes and the serum is separated for the test. The patient's serum is may be stored at 4° C which may be stable for 72 hours.

Precautions

  • Fasting blood sample is preferred.
  • Specimen with lipemia or hemolysis should be avoided.

Pathophysiology

  1. This is the richest protein in the blood.
  2. Plasma proteins are separated into three major groups:
    (a) Albumin
    (b) Globulins
    (c) Fibrinogen
  3. The most common method is electrophoresis. It forms 5 bands named as:
    (a) Albumin
    (b) α1 fraction
    (c) α2 fraction
    (d) β fraction
    (e) γ fraction
  4. Total protein is made up of 40 to 60% of albumin.
    (a) Because of its low molecular size and high concentration in blood, it is found in urine, cerebrospinal fluid (CSF), interstitial fluid, amniotic fluid, and most of the extravascular fluids.
    (b) Due to its negative charge at normal pH, it is highly water soluble.
    (c) The half-life of albumin is about 15 to 19 days.
    (d) It is extremely sensitive to liver damage.
    (e) It helps to maintain the osmotic pressure in the blood vessels, without which the fluid will leak out.
    (f) It synthesized in the liver, that is why it reflects the functions of liver and kidney.
    (g) Albumin binds calcium, bilirubin, free fatty acids, and a number of drugs.
    (h) Low level of albumin causes Edema.
    (i) In acute or chronic liver diseases, malignancy, Amyloidosis, and malnutrition decreased synthesis in the liver is seen.
    (j) The role of albumin in transporting calcium, bilirubin, bile acids, metal ions, and drugs will be the variation in its concentration.
    (k) The presence of albumin in the urine represents kidney diseases.
    (l) Dehydration causes an increase in the level of albumin (Hyperalbuminemia).
    (m) The albumin performs a role of carrier protein for calcium, bilirubin, progesterone, and drugs.
    (n) Albumin provides nutrition to the tissues and binds various molecules like vitamin, hormones, and drugs.

Terminologies

Hypoalbuminemia

It is defined as a condition in which the level of albumin in blood/serum is lower than the normal values.

Hyperalbuminemia

It is defined as a condition in which the level of albumin in blood/serum is higher than the normal values.

Normal Values

  • Normal range 3.4 to 5.5 g/dl (35 to 55 g/L)
  • Male 4.2 to 5.5 g /dl
  • Female 3.7 to 5.3 g/dl
  • Cerebrospinal fluids 15 to 45 mg/dl
  • Urine (Spot Urine) 1 to 14 mg/mL
  • 24-hour Urine 15 to 45 mg /24 hours
  • Newborn 2.8 to 4.8 g/dl
30 Jul 2018

Why is this test performed?

This hormone test is evaluated in different conditions, such as Hyperaldosteronism, Cushing's syndrome and Virilizing syndrome.

Lab tests for various adrenal abnormalities

Primary Adrenal Insufficiency (Addison's disease):

This is due to the diseases of the gland.

  • Level of sodium in serum is low.
  • Cortisol level is decreased.
  • Glucose level is decreased.
  • ACTH level is raised.
  • Potassium, calcium, and blood urea level are raised

Adrenal Hyperfunction leads to:

  • Increased level of Aldosterone causes Hyperaldosteronism.
  • Increased level of Cortisol causes Cushing's syndrome.
  • Increased level of Androgens causes Virilizing syndrome.

Primary Hyperadrenalism:

  • Level of Cortisol is raised.
  • ACTH level decreases.

Secondary Hypoadrenalism (secondary or tertiary Adrenal insufficiency):

This is due to external factors which lead to under activity of the glands.

  • ACTH level is low.
  • Cortisol level is decreased.

Adult adrenogenital syndrome:

  • There is an elevated level of:
    1. Urine 17-ketosteroids
    2. DHEA
    3. ACTH
  • There is a decreased level of:
    1. Cortisol

Congenital Adrenal Hyperplasia:

  • Decreased level of:
    1. Cortisol
    2. Aldosterone
  • There is an elevated level of:
    1. ACTH
    2. Androgens level

Primary Hyperaldosteronism (Conn's syndrome):

  • There is a decreased level of:
    1. Renin
    2. Potassium
    3. No response to aldosterone suppression test
  • There is an elevated level of:
    1. Serum sodium
    2. Aldosterone urine and blood

Cushing's syndrome:

  • There is an elevated level of Glucose, Sodium, and Cortisol.
  • There is no diurnal variation of ACTH and it is absent.
  • There is a decreased Potassium level.

Collection of sample

For the estimation of Adrenal Gland Hormones, patient's serum is needed. The 24-hour urine sample is also collected along with blood sample.

For the estimation of Cortisol level, patient's serum is required. 24-hour urine sample is also collected in a plastic container containing boric acid. The serum is stable for 2 days if kept at 2° to 8° C.

For catecholamines (Epinephrine and Norepinephrine), plasma in EDTA or heparin is needed. The sample is transported along with an ice-pack, centrifuged immediately at 4° C, and plasma is separated. Plasma is freeze until the test is run. 24-hour urine sample may also be collected in a plastic container containing 6 ml of 20% HCl and refrigerate during collection.

Estrogen can be estimated in serum. The blood sample is collected in a plain test tube, centrifuged immediately, serum is separated and refrigerated until the test is performed. 24-hour urine sample is also collected in a plastic container containing boric acid.

Aldosterone test can be done from the plasma (EDTA, citrate or heparin). Patient's blood serum may also be used for the test. Patient must be upright for 2 hours before the sample is taken. 24-hour urine sample is also collected in a plastic container containing boric acid.

Precautions before performing the Adrenal gland tests

  • Fasting blood sample is required.
  • Avoid herbal medicines and any medication which interfere with the test.
  • Avoid nuclear scan before this test.
  • Avoid exercise or physical activity.
  • Reduce the stress before performing this test.
  • Aldosterone AM sample is higher than PM.
  • Cortisol highest level is 8 AM and >50% less at 8 PM.

Normal Values

  • Plasma Epinephrine <50 pg/mL
  • Norepinephrine 110 to 410 pg/mL
  • Cortisol serum 5 to 20 µg/dL
  • Urine cortisol (free) 20 to 90 µg/ day
  • Aldosterone (recumbent) 50 to 150 ng/L
  • Aldosterone (upright) 150 to 300 ng/L

Estrogen

  • Male 20 to 80 pg/mL
  • Female Luteal phase 160 to 400 pg/mL
  • Follicular phase 60 to 200 pg/mL
  • Postmenopausal <130 pg/mL
18 Jul 2018

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