Table 1.
Measurements:
Serum IGF1, cortisol (09:00 am), prolactin, FSH/LH, oestradiol (females)/testosterone (males), TSH, and FT4 |
Check for hormone hypersecretion:
• If IGF1 is elevated, further evaluation for GH excess • Screening for glucocorticoid excess (overnight dexamethasone suppression test, 24-hour urinary free cortisol, midnight salivary cortisol) may be considered, regardless of clinical suspicion |
Check for hypopituitarism:
• In case of suspected GH deficiency, GH stimulation testing is recommended. Biochemical testing for GHD can be avoided in patients with clear-cut features of GHD and 3 other documented pituitary hormone deficits. Insulin tolerance test/GHRH + arginine/glucagon tests may be performed. • Adrenal insufficiency (AI) is indicated by a basal cortisol level < 3 μg/dL and a cortisol level > 15 μg/dL likely excludes an (AI) diagnosis. One of the following dynamic tests (ACTH stimulation test/ITT/low dose ACTH stimulation test) may be performed to check for central adrenal insufficiency. Peak cortisol levels less than 18.1 μg/dL (500 nmol/L) at 30 or 60 minutes indicates adrenal insufficiency. |
Additional appropriate screening and follow-up investigations are needed in patients with personal or family history of multiple endocrine neoplasia. |