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Low Dose Dexamethasone Suppression Test Protocol: A Comprehensive Guide
Introduction:
Are you facing the challenge of understanding the Low Dose Dexamethasone Suppression Test (LDDST) protocol? This detailed guide delves into the intricacies of this crucial diagnostic test used primarily to evaluate cortisol production, specifically in cases of suspected Cushing's syndrome. We'll unpack the protocol step-by-step, explaining the procedure, interpretation of results, and potential limitations. By the end, you'll have a clear understanding of the LDDST, empowering you to navigate discussions with healthcare professionals more confidently. This comprehensive guide is designed for medical professionals, students, and individuals seeking to understand this important diagnostic tool.
What is the Low Dose Dexamethasone Suppression Test?
The Low Dose Dexamethasone Suppression Test (LDDST) is a biochemical test used to assess the functionality of the hypothalamic-pituitary-adrenal (HPA) axis. This axis is responsible for regulating the production and release of cortisol, a crucial steroid hormone impacting various bodily functions, including metabolism, stress response, and immune function. The test involves administering a low dose of dexamethasone, a synthetic glucocorticoid, and measuring the subsequent cortisol levels in the blood. Dexamethasone suppresses cortisol production in individuals with normal HPA axis function. However, in individuals with Cushing's syndrome (a condition characterized by excessive cortisol production), the cortisol levels remain elevated, even after dexamethasone administration.
Protocol Details: A Step-by-Step Guide
The precise protocol might vary slightly depending on the laboratory and physician, but the core principles remain consistent:
1. Preparation: Patients usually need to fast for a specific period (typically 8-12 hours) before the test. Certain medications may interfere with test results and should be discussed with the doctor beforehand.
2. Baseline Cortisol Measurement: A baseline blood sample is collected to measure the initial cortisol level before dexamethasone administration.
3. Dexamethasone Administration: A low dose of dexamethasone (typically 0.5 mg) is administered orally at 11 PM. This timing is crucial as cortisol levels naturally fluctuate throughout the day, peaking in the early morning.
4. Post-Dexamethasone Cortisol Measurement: A blood sample is drawn the following morning, typically between 8 AM and 9 AM, to measure the cortisol level after dexamethasone suppression.
5. Result Interpretation: The results are interpreted by comparing the post-dexamethasone cortisol level to the baseline level and established reference ranges. A significant suppression of cortisol levels indicates normal HPA axis function. Failure to suppress cortisol suggests a potential problem with the HPA axis, potentially indicating Cushing's syndrome. However, it's crucial to note that LDDST isn't diagnostic on its own; further investigations are usually required to confirm the diagnosis.
Interpreting the Results: What Do They Mean?
Suppressed Cortisol: A significant reduction in cortisol levels after dexamethasone administration suggests normal HPA axis function. This usually rules out Cushing's syndrome.
Unsuppressed Cortisol: Elevated cortisol levels after dexamethasone administration raise suspicion for Cushing's syndrome. However, other conditions can cause this, necessitating further investigation. The degree of suppression (or lack thereof) is important.
Limitations of the LDDST: The LDDST isn't foolproof. False-negative results can occur, particularly in patients with subtle forms of Cushing's syndrome or those with certain conditions affecting cortisol metabolism. Conversely, false-positive results can happen due to factors like stress, certain medications, or other underlying medical issues.
Further Investigations After an Unsuppressed LDDST:
If the LDDST results indicate an inability to suppress cortisol, further testing is usually necessary to confirm the diagnosis of Cushing's syndrome. These tests may include:
24-hour urinary free cortisol: Measures the total amount of cortisol excreted in urine over a 24-hour period.
Late-night salivary cortisol: Measures cortisol levels in saliva at bedtime, reflecting the overall cortisol levels during the day.
High-dose dexamethasone suppression test (HDDST): A more stringent test using a higher dose of dexamethasone.
Imaging studies: Such as MRI or CT scans, to identify potential adrenal or pituitary tumors.
Possible Causes of Unsuppressed Cortisol Beyond Cushing's Syndrome:
It's crucial to remember that an unsuppressed LDDST doesn't automatically equate to Cushing's syndrome. Other conditions can lead to similar results, including:
Obesity: Excess body fat can interfere with cortisol metabolism.
Severe stress: Stress hormones can elevate cortisol levels, masking underlying issues.
Certain medications: Some medications can interfere with cortisol production and regulation.
Alcohol use: Excessive alcohol consumption can disrupt the HPA axis.
Conclusion:
The Low Dose Dexamethasone Suppression Test is a valuable tool in the diagnostic workup of suspected Cushing's syndrome. However, it's essential to interpret the results carefully, considering the patient's clinical presentation and other potential contributing factors. The LDDST, while helpful, is typically just one piece of a larger diagnostic puzzle. A comprehensive approach involving clinical evaluation and additional tests is necessary to reach an accurate diagnosis and appropriate management strategy.
Article Outline:
Title: Understanding the Low Dose Dexamethasone Suppression Test Protocol
Introduction: Briefly explain the LDDST and its purpose.
Chapter 1: The HPA Axis and Cortisol Regulation: Detail the role of the HPA axis in cortisol production and regulation.
Chapter 2: The LDDST Protocol: A Step-by-Step Guide: Describe the test preparation, administration, and timing of blood samples.
Chapter 3: Interpreting LDDST Results: Explain how to interpret suppressed and unsuppressed cortisol levels, emphasizing the importance of context and further investigation.
Chapter 4: Further Investigations and Differential Diagnoses: Discuss additional tests and conditions that can mimic Cushing's syndrome.
Conclusion: Summarize the importance of the LDDST within the broader context of Cushing's syndrome diagnosis.
(The article above expands on each point in the outline.)
FAQs:
1. How long does the LDDST take? The test itself involves a few blood draws over a short period. However, the entire process may take a day or two to complete, including result interpretation.
2. Are there any risks associated with the LDDST? The risks are minimal, primarily related to the blood draws themselves (minor bruising, bleeding).
3. What if my cortisol levels are borderline? Borderline results often require further testing to clarify the diagnosis.
4. Can I eat before the LDDST? Usually, fasting is required for a specific period before the test. This will be explained by your doctor or lab personnel.
5. What medications can interfere with the LDDST? Several medications can interfere; discuss all medications with your doctor beforehand.
6. Is the LDDST painful? The only discomfort is likely from the blood draws.
7. How accurate is the LDDST? The LDDST isn't perfectly accurate; false-positive and false-negative results can occur.
8. How quickly will I get my results? Result turnaround time varies depending on the laboratory.
9. What should I do if my LDDST results are abnormal? Discuss the results with your doctor; further testing will likely be required.
Related Articles:
1. Cushing's Syndrome: Symptoms, Diagnosis, and Treatment: An overview of Cushing's syndrome, covering its symptoms, causes, and treatment options.
2. Understanding the Hypothalamic-Pituitary-Adrenal (HPA) Axis: A detailed explanation of the HPA axis and its function in regulating cortisol production.
3. High-Dose Dexamethasone Suppression Test (HDDST): Protocol and Interpretation: A guide to the HDDST, a more stringent test for Cushing's syndrome.
4. 24-Hour Urinary Free Cortisol Test: A Comprehensive Guide: Information on the 24-hour urinary free cortisol test, another key test for Cushing's syndrome.
5. Late-Night Salivary Cortisol Test: A Non-Invasive Approach: An explanation of the late-night salivary cortisol test and its advantages.
6. Adrenal Tumors: Types, Symptoms, and Treatment Options: A discussion of adrenal tumors and their relationship to cortisol overproduction.
7. Pituitary Tumors: Causes, Symptoms, and Treatment Approaches: An overview of pituitary tumors and their potential impact on hormone production.
8. Differential Diagnosis of Hypercortisolism: Exploring various conditions that can cause elevated cortisol levels.
9. Managing Cushing's Syndrome: A Holistic Approach: A guide to managing Cushing's syndrome, focusing on medical and lifestyle strategies.
| low dose dexamethasone suppression test protocol: The Hypothalamus-Pituitary-Adrenal Axis , 2008-09-12 The hypothalamic-pituitary-adrenal axis controls reactions to stress and regulates various body processes such as digestion, the immune system, mood and sexuality, and energy usage. This volume focuses on the role it plays in the immune system and provides substantive experimental and clinical data to support current understanding in the field, and potential applications of this knowledge in the treatment of disease. - Evidence presented in this book suggests that the nervous, endocrine, and immune systems form the Neuroendoimmune Supersystem, which integrates all the biological functions of higher organisms both in health and disease for their entire life cycle - Contributors include both the scientists who initiated the work on the HPA axis and on the autonomic nervous system, and those who joined the field later |
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| low dose dexamethasone suppression test protocol: Endocrine Hypertension Karel Pacak, Graeme Eisenhofer, 2002 Several genetic, biochemical and radiologic discoveries have impacted the management of endocrine hypertension, while surgical procedures have revolutionized treatment of patients with endocrine hypertension. This text contains the proceedings of a 2001 workshop on the topic. |
| low dose dexamethasone suppression test protocol: The Cleveland Clinic Manual of Dynamic Endocrine Testing Ahmet Bahadir Ergin, A. Laurence Kennedy, Manjula K. Gupta, Amir H. Hamrahian, 2015-03-27 Developed via a peer review process that included 25 experienced endocrinologists and utilizing the best current evidence, The Cleveland Clinic has created a practical set of protocols for over 25 commonly used dynamic endocrine tests. The cornerstone of clinical endocrinology, these evidence-based protocols play an important role in clinical decision-making and are important element of billing and compliance with high quality standards. Included here are various tests for pituitary and adrenal disorders, thyroid disorders, and glucose metabolism and pancreatic disorders, presented systematically with indications, preparation, materials needed, precautions, procedure, interpretation, and caveats. Filling the gap left by a lack of national guidelines, The Cleveland Clinic Manual of Dynamic Endocrine Testing is an up-to-date practical guide for endocrinologists, nurses, and their staff, inside or outside of the US, who need to perform and interpret dynamic endocrine testing in their everyday practice, as well as medical students, residents and fellows who have interest in endocrinology. |
| low dose dexamethasone suppression test protocol: Androgens in Gynecological Practice Leo Plouffe (Jr.), Botros R. M. B. Rizk, 2015-06-25 A practical approach to the field of androgen excess or deprivation in women's health. The content includes multiple viewpoints on the most common disorders in this class, such as polycystic ovary disease, hirsutism and menopausal issues. Each chapter provides a combination of long-lasting clinical principles in the diagnosis and management of these patients along with a state-of-the-art review. This text takes an innovative approach to uncommon conditions (such as congenital adrenal hyperplasia, transgender conditions). In addition to presenting clinical insights, and a review of the basic science underpinning these conditions, it focuses on key concepts that can be derived from these rare conditions to the entire field. This book is an essential addition to the library for any busy clinician who is looking for a practical reference guide but also for the sub-specialist who is looking for new and thought-provoking insights in this complex scientific area. |
| low dose dexamethasone suppression test protocol: Adrenal Disorders Andrew N. Margioris, George P. Chrousos, 2001-04-20 In Adrenal Disorders, a panel of distinguished physicians and researchers select the most relevant new findings and integrate them into the existing body of clinical knowledge on adrenal pathologies. The book includes important reviews of disturbances in cortisol homeostasis, and new concepts regarding adrenal tumors and hereditary adrenal diseases. Also discussed are mineralocorticoids and the syndromes of mineralocortoid excess and aldosterone synthase deficiency. Authoritative and insightful, Adrenal Disorders provides physicians and scientists with a comprehensive, state-of-the-art practical guide to the devastating diseases of the adrenals that are so often difficult to diagnose and treat. |
| low dose dexamethasone suppression test protocol: Polycystic Ovary Syndrome Andrea Dunaif, R. Jeffrey Chang, Stephen Franks, Richard S. Legro, 2008-01-12 This volume includes the latest diagnostic criteria for PCOS and comprises the most up-to-date information about the genetic features and pathogenesis of PCOS. It critically reviews the methodological approaches and the evidence for various PCOS susceptibility genes. The book also discusses additional familial phenotypes of PCOS and their potential genetic basis. All four editors of this title are extremely prominent in the field of PCOS. |
| low dose dexamethasone suppression test protocol: The Bart's Endocrine Protocols Peter J. Trainer, G. M. Besser, 1995 A practical guide for the physician to use on ward rounds. This text advises which endocrine tests to request and the order in which to carry them out for a range of clinical problems. Data sheets, investigation protocol sheets and tables of normal ranges are included. |
| low dose dexamethasone suppression test protocol: Oxford Handbook of Endocrinology and Diabetes Helen Turner, John Wass, 2009-03-26 This handbook in endocrinology and diabetes discusses clinical investigation and management in a convenient way, including both the protocols and explicit clinical information necessary for the management of individual patients. |
| low dose dexamethasone suppression test protocol: Diseases of the Abdomen and Pelvis 2018-2021 Juerg Hodler, Rahel A. Kubik-Huch, Gustav K. von Schulthess, 2018-03-20 This open access book deals with imaging of the abdomen and pelvis, an area that has seen considerable advances over the past several years, driven by clinical as well as technological developments. The respective chapters, written by internationally respected experts in their fields, focus on imaging diagnosis and interventional therapies in abdominal and pelvic disease; they cover all relevant imaging modalities, including magnetic resonance imaging, computed tomography, and positron emission tomography. As such, the book offers a comprehensive review of the state of the art in imaging of the abdomen and pelvis. It will be of interest to general radiologists, radiology residents, interventional radiologists, and clinicians from other specialties who want to update their knowledge in this area. |
| low dose dexamethasone suppression test protocol: The Cat Susan E. Little, 2011-10-14 Comprehensive in scope and exclusively devoted to feline medical care, Dr. Susan Little's The Cat: Clinical Medicine and Management is an essential resource for anyone who provides complete, state-of-the-art care to cats. In one convenient volume, you'll find authoritative, clinically-focused information enhanced by full-color illustrations, tables, boxes, algorithms, key points, and much more — all in a format designed for quick access. Dr. Little and her expert contributors address the unique concerns and challenges facing the feline practitioner, including the latest advances in feline medical diagnosis and management and their clinical applications to everyday practice. User-friendly and complete, The Cat is also available as an e-book, giving you easy access to the complete, fully-searchable contents online. - Covers the latest advances in feline medicine from a systemic and adjunctive care perspective. It's the most comprehensive feline medical reference available with a strong clinical focus. - Helps you meet the increasing demand for state-of-the-art medical care by cat owners — including advanced diagnostic services and treatments designed to extend and improve quality of life for feline companions. - Features a full-color design with hundreds of schematic drawings, tables, boxes, key points, algorithms, and photographs for quick and easy access to information. - Addresses key topics unique to feline medicine and not currently covered in other books, including: insights and clinical advances attributable to the mapping of the feline genome; medical conditions associated with behavioral problems; managing the feline patient with co-existing and chronic disease; special medical problems and care considerations for the geriatric cat; environmental enrichment for the indoor cat; feline zoonotic agents and implications for human health; and shelter medicine and overpopulation solutions. - Provides in-depth information on indoor cats and senior cats, including timely guidance on meeting owners' expectations for longer, healthier lives for their cats. - Addresses the challenges of pet overpopulation, particularly the impact of millions of feral cats on public health and the environment. - Presents information written in the manner of expanded conference proceedings, delivering the latest insights and most current approaches to management of feline medical disorders. - Includes contributions from approximately 60 contributors, drawing on the valuable expertise of those most knowledgeable in the field of feline medical care. - Bears the full endorsement of the Winn Feline Foundation, a non-profit organization that supports studies about cat health and funds feline research projects worldwide, and is internationally regarded as a major contributor to the health and wellbeing of all cats. - The complete contents also are available online through Veterinary Consult. |
| low dose dexamethasone suppression test protocol: Childhood Acute Lymphoblastic Leukemia Ajay Vora, 2017-04-21 This book provides a comprehensive and up-to-date review of all aspects of childhood Acute Lymphoblastic Leukemia, from basic biology to supportive care. It offers new insights into the genetic pre-disposition to the condition and discusses how response to early therapy and its basic biology are utilized to develop new prognostic stratification systems and target therapy. Readers will learn about current treatment and outcomes, such as immunotherapy and targeted therapy approaches. Supportive care and management of the condition in resource poor countries are also discussed in detail. This is an indispensable guide for research and laboratory scientists, pediatric hematologists as well as specialist nurses involved in the care of childhood leukemia. |
| low dose dexamethasone suppression test protocol: Laboratory Tests and Diagnostic Procedures Cynthia C. Chernecky, Barbara J. Berger, 2012-12-01 Find complete answers to questions such as which laboratory tests to order or what the results might mean. Laboratory Tests and Diagnostic Procedures, 6th Edition covers more tests than any other reference of its kind, with over 900 lab tests and diagnostic procedures in all. In Part I, you'll find an alphabetical list of hundreds of diseases, conditions, and symptoms, including the tests and procedures most commonly used to confirm or rule out a suspected diagnosis. In Part II, you’ll find descriptions of virtually every laboratory and diagnostic test available. This edition is updated with the latest research and over 20 NEW test entries. Written by educator Cynthia Chernecky and clinical nurse specialist Barbara Berger, this lab reference covers today’s lab tests with concise, easy-to-use information. More than 900 laboratory tests and diagnostic procedures are included — more than any other reference! Over 600 diseases, conditions, and symptoms are listed, along with the tests used to confirm them. Alphabetical organization and A-to-Z thumb tabs make it easy to find the information you’re looking for. Alternative test names and acronyms are cross-referenced to simplify lookup. Instructions for client and family teaching help you offer guidance concerning test preparation and follow-up care. Age and gender-specific norms are provided, giving you complete lifespan coverage. Risks and Contraindications are highlighted to help you safeguard your patients and provide effective care. Panic Level Symptoms and Treatment are provided for dangerously increased and decreased levels. Minimum volumes for blood samples are included, useful when a client’s blood preservation is essential, as well as information on whether blood specimens can be drawn during hemodialysis. Tests for toxic substances are included, making this a lab, diagnostic, and toxicology book all in one. Abbreviations, measurement prefixes, and symbols are listed on the front and back covers for convenience. Information on herbal supplements indicates when a client’s use of natural remedies might affect test results. Over 20 NEW test entries present the latest tests and procedures, with a strong focus on affordable, clinically relevant genetic tests. UPDATED content includes the latest research relating to accuracy of tests, diagnostic value of results, and associated cost-benefit ratios. |
| low dose dexamethasone suppression test protocol: Duncan and Prasse's Veterinary Laboratory Medicine Kenneth S. Latimer, 2011-11-16 Now in full color throughout, Duncan and Prasse’s Veterinary Laboratory Medicine: Clinical Pathology, Fifth Edition offers a comprehensive overview of hematology, hemostasis, clinical chemistry, urinalysis, cytology, and reference intervals in a highly accessible outline format. With information on all major domestic species, the text is designed for the reader to quickly find answers to clinical questions. Taking a problem-solving approach to the interpretation of laboratory data, this book includes clinical cases to illustrate the concepts of laboratory data interpretation, with tables and key words to aid readers in locating and applying information. The fifth edition has been fully revised to reflect the latest knowledge, diagnostic methods, and practices in veterinary laboratory medicine. A companion website provides the images in PowerPoint and references linked to PubMed at www.wiley.com/go/latimer. Duncan and Prasse’s Veterinary Laboratory Medicine is an excellent quick reference for practicing veterinarians, veterinary students, clinical interns and residents, and pathology residents. |
| low dose dexamethasone suppression test protocol: Endocrine Hypertension Christian A Koch, George P Chrousos, 2012-08-30 The prevalence of hypertension is almost three times as high as that of diabetes mellitus type 2, with both conditions being major risk factors for stroke, ischemic heart disease, cardiac arrhythmias, and heart failure. The exact prevalence of hypertension related to hormonal derangements (endocrine hypertension) is not known but estimated to affect less than 15% of hypertensive patients. Recent scientific discoveries have increased the understanding of the pathophysiologic mechanisms of hypertension. In Endocrine Hypertension, a renowned panel of experts provides a comprehensive, state-of-the-art overview of this disorder, discussing when to assign an endocrine cause in one of many conditions that may present with hypertension. The first part of Endocrine Hypertension is dedicated to adrenal causes. The second part of the volume concerns potential nonadrenal causes of hypertension, such as growth hormone excess or deficiency, primary hyperparathyroidism, vitamin D deficiency, testosterone deficiency, insulin resistance, obesity-associated hypertension, and the role of central mineralocorticoid receptors and cardiovascular disease. An important contribution to the literature, Endocrine Hypertension is an indispensable reference not only for endocrinologists, diabetologists, and adrenal investigators, but also for translational scientists and clinicians from cardiology, internal medicine, pediatrics, family medicine, geriatrics, urology, and reproductive medicine / gynecology. |
| low dose dexamethasone suppression test protocol: IAP Textbook on Pediatric Endocrinology Khadilkar Vaman, 2019-02-06 Section 1: Basics in Pediatric Endocrinology Section 2: Clinical Pointers to Endocrine Disorders in Pediatric Practice Section 3: Growth and Growth Disorders Section 4: Disorders of Puberty Section 5: Thyroid Gland and its Disorders Section 6: The Adrenal Gland and its Disorders Section 7: Disorders of Sexual Development Section 8: Disorders of Water, Electrolytes and Acid Base Section 9: Disorders of Calcium, Phosphorus and Bone Metabolism Section 10: Disorders of Parathyroid Hormone Section 11: Polyglandular Syndromes Section 12: Hypoglycemia Section 13: Diabetes Mellitus Section 14: Lipid Disorders in Children Section 15: Obesity in Children Section 16: Low Birth Weight and Endocrine Dysfunction in Postnatal Life Section 17: Miscellaneous Section 18: Biochemistry of Endocrinology Section 19: Practical Protocols for Dynamic Testing in Children Section 20: Radiology in Pediatric Endocrinology Section 21: Drugs in Pediatric Endocrinology Index |
| low dose dexamethasone suppression test protocol: Veterinary Laboratory Medicine Morag G. Kerr, 2008-04-15 Veterinary Laboratory Medicine covers all aspects of basic clinical biochemistry and haematology, and includes test-by-test interpretation of laboratory results. Information is provided on sampling techniques, the selection and use of an external laboratory, as well as near-patient testing and the practice laboratory. Also included are step-by-step instructions for most commonly used point-of-care tests, a guide to the evaluation of instruments for in-practice use, and a detailed explanation of the principles of impedance counting and photometric analysis. The book will be ideal for practitioners who require a guide to laboratory work, and for veterinary students studying laboratory medicine and clinical pathology. The second edition has been fully updated to reflect advances in diagnostic techniques, and includes new chapters on diagnostic endocrinology and feline virus testing as well as a much expanded chapter on diagnostic profiling and pattern recognition. |
| low dose dexamethasone suppression test protocol: Canine and Feline Endocrinology - E-Book Edward C. Feldman, Richard W. Nelson, Claudia Reusch, J. Catharine Scott-Moncrieff, 2014-11-14 - NEW! Updated content includes the latest information on: thyroid disease; current imaging studies; atypical Addison's disease; atypical Cushing's disease; idiopathic hypercalcemia in cats; insulin therapy in dogs and cats; diagnostics and treatments; and radiotherapy. - NEW! Integration of sound nutrition practices into the treatment of endocrine disorders ensures that you have the knowledge you need to efficiently treat these disorders. - NEW! Expanded coverage provides more information on geriatric dogs and cats and the latest findings regarding the treatment of diabetes (two factors which are often interrelated). |
| low dose dexamethasone suppression test protocol: CDC Yellow Book 2018: Health Information for International Travel Centers for Disease Control and Prevention CDC, 2017-04-17 THE ESSENTIAL WORK IN TRAVEL MEDICINE -- NOW COMPLETELY UPDATED FOR 2018 As unprecedented numbers of travelers cross international borders each day, the need for up-to-date, practical information about the health challenges posed by travel has never been greater. For both international travelers and the health professionals who care for them, the CDC Yellow Book 2018: Health Information for International Travel is the definitive guide to staying safe and healthy anywhere in the world. The fully revised and updated 2018 edition codifies the U.S. government's most current health guidelines and information for international travelers, including pretravel vaccine recommendations, destination-specific health advice, and easy-to-reference maps, tables, and charts. The 2018 Yellow Book also addresses the needs of specific types of travelers, with dedicated sections on: · Precautions for pregnant travelers, immunocompromised travelers, and travelers with disabilities · Special considerations for newly arrived adoptees, immigrants, and refugees · Practical tips for last-minute or resource-limited travelers · Advice for air crews, humanitarian workers, missionaries, and others who provide care and support overseas Authored by a team of the world's most esteemed travel medicine experts, the Yellow Book is an essential resource for travelers -- and the clinicians overseeing their care -- at home and abroad. |
| low dose dexamethasone suppression test protocol: Pituitary Disorders of Childhood Brenda Kohn, 2019-03-27 This unique book presents an up-to-date discussion of clinical disorders of the pituitary gland in children with specific emphasis on state-of-the-art diagnostic and treatment modalities, highlighting the newest scientific advances in genomics and molecular biology that clinician-scientists caring for children need to know. Chapters focus on the current knowledge base in genomics, pathophysiology, diagnosis, and medical and surgical management, organized into thematic sections. Part I discusses embryologic and genetic disorders, including genomics and congenital disorders of the pituitary. Part II presents acquired pituitary disorders, such as prolactinomas, Cushing's Disease, and both hormone secreting and non-secreting pituitary tumors. Subsequent sections cover posterior pituitary disorders, such as diabetes insipidus, functional hormone deficiencies of the hypothalamic-pituitary axis, including delayed puberty and pubertal disorders and growth hormone disorders, neuro-opthalmic disease, CNS radiation, childhood cancer treatment and traumatic brain injury. Authoritative and comprehensive, Pituitary Disorders of Childhood will serve as a precise guide for clinical endocrinologists and will guide future investigation into translational and clinical research on the pediatric pituitary. |
| low dose dexamethasone suppression test protocol: Cushing's Syndrome Marcello D. Bronstein, 2010-10-01 Cushing ́s syndrome is a relatively rare clinical disorder that is associated with many co-morbidities such as systemic hypertension, diabetes, osteoporosis, impaired immune function and growth impairment in children, all of which severely reduce quality of life and life expectancy. Cushing’s Syndrome: Pathophysiology, Diagnosis and Treatment reviews the difficulties in distinguishing Cushing’s syndrome from these and other common conditions, such as central obesity, menstrual irregularity and depression. It also provides state-of-the-art information on various strategies to establish the diagnosis of Cushing’s syndrome and the differential diagnosis among its diverse etiologies, as well as therapeutic approaches. Additionally, a range of conditions that represent challenges for the diagnosis and treatment--such as renal failure, pediatric age, cyclic hypercortisolism, and pregnancy--are covered in detail. A valuable resource not only for endocrinologists but also internal medicine physicians, gynecologists, pediatricians, , pituitary surgeons and urologists, Cushing’s Syndrome: Pathophysiology, Diagnosis and Treatment provides insights by experts that will help all physicians dealing with Cushing ́s syndrome to expand their knowledge about the condition and provide targeted, comprehensive care. |
| low dose dexamethasone suppression test protocol: The Cat - E-Book Susan E. Little, 2024-03-05 Comprehensive in scope and exclusively devoted to feline medical care, Dr. Susan Little's The Cat: Clinical Medicine and Management, 2nd Edition, is an essential resource for providing complete, state-of-the-art care to cats. Authoritative, clinically focused information is enhanced by full-color images, tables, boxes, algorithms, key points, and more — all in an easy-to-understand, quick-reference format. Dr. Little and her expert contributors address the unique concerns and challenges facing any practitioner providing care for cats, including the latest advances in feline medical diagnosis and management and the clinical applications to everyday practice. An eBook version, included with print purchase, provides access to all the text, figures, and references, with the ability to search, customize content, make notes and highlights, and have content read aloud. The eBook also offers convenient video lessons and client handouts. - Covers the latest advances in feline medicine from a systemic and adjunctive care perspective, making it the most comprehensive feline medical reference available with a strong clinical focus. - Addresses key topics unique to feline medicine and not currently covered in other books, including: insights and clinical advances attributable to the mapping of the feline genome; medical conditions associated with behavioral problems; managing the feline patient with co-existing and chronic diseases; special medical problems and care considerations for the geriatric cat; environmental enrichment for the indoor cat; feline zoonotic agents and implications for human health; and humane solutions for shelter medicine and overpopulation challenges. - Helps meet the increasing demand for state-of-the-art medical care by cat owners, including advanced diagnostic services and treatments designed to extend and improve quality of life for feline companions. - Features a full-color design with hundreds of schematic drawings, tables, boxes, key points, algorithms, and photographs for quick and easy access to information. - Provides in-depth information on indoor cats and senior cats, including timely guidance on meeting owners' expectations for longer, healthier lives for their cats. - Addresses the challenges of cat overpopulation, particularly humane approaches to improve quality of life for millions of feral and community cats and minimize their impact on public health and endangered species of animals. - Presents information written in the manner of expanded conference proceedings, delivering the latest insights and most current approaches to management of feline medical disorders. - Includes contributions from approximately 80 contributors, including many from outside the US, to provide a global perspective and valuable expertise from those most knowledgeable in the field of feline medical care. |
| low dose dexamethasone suppression test protocol: Clinical Endocrinology of Companion Animals Jacquie Rand, Ellen Behrend, Danielle Gunn-Moore, Michelle Campbell-Ward, 2013-01-22 Clinical Endocrinology of Companion Animals offers fast access to clinically relevant information on managing the patient with endocrine disease. Written by leading experts in veterinary endocrinology, each chapter takes the same structure to aid in the rapid retrieval of information, offering information on pathogenesis, signalment, clinical signs, diagnosis, differential diagnosis, treatment, prognosis, and prevention for a broad list of endocrine disorders. Chapters begin with brief summaries for quick reference, then delve into greater detail. With complete coverage of the most common endocrine diseases, the book includes chapters on conditions in dogs, cats, horses, ferrets, reptiles, and other species. Clinical Endocrinology of Companion Animals is a highly practical resource for any veterinarian treating these common diseases. |
| low dose dexamethasone suppression test protocol: Clinical Medicine of the Dog and Cat, Second Edition Michael Schaer, 2009-10-23 While covering all the major areas of internal medicine of the dog and cat, this book emphasizes the more common disorders. The book is organized by body system, and each chapter is structured in a consistent way, providing the definition of each disorder, its causes, clinical features, differential diagnoses, diagnosis, and management options. The practical, focused text is richly illustrated throughout by 1,505 clinical color photographs, imaging, diagrams and tables. |
| low dose dexamethasone suppression test protocol: Tietz Textbook of Clinical Chemistry and Molecular Diagnostics - E-Book Nader Rifai, 2017-01-16 The Tietz Textbook of Clinical Chemistry and Molecular Diagnostics, 6th Edition provides the most current and authoritative guidance on selecting, performing, and evaluating the results of new and established laboratory tests. This classic clinical chemistry reference offers encyclopedic coverage detailing everything you need to know, including: analytical criteria for the medical usefulness of laboratory tests, variables that affect tests and results, laboratory medicine, applications of statistical methods, and most importantly clinical utility and interpretation of laboratory tests. It is THE definitive reference in clinical chemistry and molecular diagnostics, now fully searchable and with quarterly content updates, podcasts, clinical cases, animations, and extended content online through Expert Consult. - Analytical criteria focus on the medical usefulness of laboratory procedures. - Reference ranges show new approaches for establishing these ranges — and provide the latest information on this topic. - Lab management and costs gives students and chemists the practical information they need to assess costs, allowing them to do their job more efficiently and effectively. - Statistical methods coverage provides you with information critical to the practice of clinical chemistry. - Internationally recognized chapter authors are considered among the best in their field. - Two-color design highlights important features, illustrations, and content to help you find information easier and faster. - NEW! Internationally recognized chapter authors are considered among the best in their field. - NEW! Expert Consult features fully searchable text, quarterly content updates, clinical case studies, animations, podcasts, atlases, biochemical calculations, multiple-choice questions, links to Medline, an image collection, and audio interviews. You will now enjoy an online version making utility of this book even greater. - UPDATED! Expanded Molecular Diagnostics section with 12 chapters that focus on emerging issues and techniques in the rapidly evolving and important field of molecular diagnostics and genetics ensures this text is on the cutting edge and of the most value. - NEW! Comprehensive list of Reference Intervals for children and adults with graphic displays developed using contemporary instrumentation. - NEW! Standard and international units of measure make this text appropriate for any user — anywhere in the world. - NEW! 22 new chapters that focus on applications of mass spectrometry, hematology, transfusion medicine, microbiology, biobanking, biomarker utility in the pharmaceutical industry and more! - NEW! Expert senior editors, Nader Rifai, Carl Wittwer and Rita Horvath, bring fresh perspectives and help ensure the most current information is presented. - UPDATED! Thoroughly revised and peer-reviewed chapters provide you with the most current information possible. |
| low dose dexamethasone suppression test protocol: Pocket Book of Hospital Care for Children World Health Organization, 2013 The Pocket Book is for use by doctors nurses and other health workers who are responsible for the care of young children at the first level referral hospitals. This second edition is based on evidence from several WHO updated and published clinical guidelines. It is for use in both inpatient and outpatient care in small hospitals with basic laboratory facilities and essential medicines. In some settings these guidelines can be used in any facilities where sick children are admitted for inpatient care. The Pocket Book is one of a series of documents and tools that support the Integrated Managem. |
| low dose dexamethasone suppression test protocol: Canadian Immunization Guide Canada. Comité consultatif national de l'immunisation, Canada. National Advisory Committee on Immunization, 2006 The seventh edition of the Canadian Immunization Guide was developed by the National Advisory Committee on Immunization (NACI), with the support ofthe Immunization and Respiratory Infections Division, Public Health Agency of Canada, to provide updated information and recommendations on the use of vaccines in Canada. The Public Health Agency of Canada conducted a survey in 2004, which confi rmed that the Canadian Immunization Guide is a very useful and reliable resource of information on immunization. |
| low dose dexamethasone suppression test protocol: Tietz Fundamentals of Clinical Chemistry and Molecular Diagnostics - E-Book Nader Rifai, 2018-10-31 Get the foundational knowledge you need to successfully work in a real-world, clinical lab with Tietz Fundamentals of Clinical Chemistry and Molecular Diagnostics, 8th Edition. From highly respected clinical chemistry expert Nader Rifai, this condensed, easier-to-understand version of the acclaimed Tietz Textbook of Clinical Chemistry and Molecular Diagnostics uses a laboratory perspective to guide you through selecting and performing diagnostic lab tests and accurately evaluating the results. Coverage includes laboratory principles, analytical techniques, instrumentation, analytes, pathophysiology, and more. This eighth edition features new clinical cases from The Coakley Collection, new questions from The Deacon's Challenge of Biochemical Calculations Collection, plus new content throughout the text to ensure you stay ahead of all the latest techniques, instrumentation, and technologies. - Condensed version of the clinical chemistry bible offers the same authoritative and well-presented content in a much more focused and streamlined manner. - Coverage of analytical techniques and instrumentation includes optical techniques, electrochemistry, electrophoresis, chromatography, mass spectrometry, enzymology, immunochemical techniques, microchips, automation, and point of care testing. - Updated chapters on molecular diagnostics cover the principles of molecular biology, nucleic acid techniques and applications, and genomes and nucleic acid alterations, reflecting the changes in this rapidly evolving field. - Learning objectives, key words, and review questions are included in each chapter to support learning. - More than 500 illustrations plus easy-to-read tables help readers better understand and remember key concepts. - NEW! Clinical Cases from The Coakley Collection use real-life scenarios to demonstrate how concepts from the text will come in to play in real life practice. - NEW! Questions from The Deacon's Challenge of Biochemical Calculations Collection help reinforce concepts and help readers' critical thinking skills. - NEW! Updated content throughout the text keeps readers up to date on the latest techniques, instrumentation, and technologies. - NEW! New lead author Nader Rifai lends his expertise as the Director of Clinical Chemistry at Children's Hospital in Boston, the Editor-in-Chief of the journal Clinical Chemistry, and a Professor of Pathology at Harvard University. |
| low dose dexamethasone suppression test protocol: Tietz Fundamentals of Clinical Chemistry and Molecular Diagnostics 8 E; South Asia Edition;e-Book Nader Rifai, 2019-07-16 Get the foundational knowledge you need to successfully work in a real-world, clinical lab with Tietz Fundamentals of Clinical Chemistry and Molecular Diagnostics, 8th Edition. From highly respected clinical chemistry expert Nader Rifai, this condensed, easier-to-understand version of the acclaimed Tietz Textbook of Clinical Chemistry and Molecular Diagnostics uses a laboratory perspective to guide you through selecting and performing diagnostic lab tests and accurately evaluating the results. Coverage includes laboratory principles, analytical techniques, instrumentation, analytes, pathophysiology, and more. This eighth edition features new clinical cases from The Coakley Collection, new questions from The Deacon's Challenge of Biochemical Calculations Collection, plus new content throughout the text to ensure you stay ahead of all the latest techniques, instrumentation, and technologies. Condensed version of the clinical chemistry bible offers the same authoritative and well-presented content in a much more focused and streamlined manner. Coverage of analytical techniques and instrumentation includes optical techniques, electrochemistry, electrophoresis, chromatography, mass spectrometry, enzymology, immunochemical techniques, microchips, automation, and point of care testing. Updated chapters on molecular diagnostics cover the principles of molecular biology, nucleic acid techniques and applications, and genomes and nucleic acid alterations, reflecting the changes in this rapidly evolving field. Learning objectives, key words, and review questions are included in each chapter to support learning. More than 500 illustrations plus easy-to-read tables help readers better understand and remember key concepts |
| low dose dexamethasone suppression test protocol: Tietz Textbook of Clinical Chemistry and Molecular Diagnostics - E-Book Carl A. Burtis, Edward R. Ashwood, David E. Bruns, 2011-12-16 As the definitive reference for clinical chemistry, Tietz Textbook of Clinical Chemistry and Molecular Diagnostics, 5th Edition offers the most current and authoritative guidance on selecting, performing, and evaluating results of new and established laboratory tests. Up-to-date encyclopedic coverage details everything you need to know, including: analytical criteria for the medical usefulness of laboratory procedures; new approaches for establishing reference ranges; variables that affect tests and results; the impact of modern analytical tools on lab management and costs; and applications of statistical methods. In addition to updated content throughout, this two-color edition also features a new chapter on hemostasis and the latest advances in molecular diagnostics. Section on Molecular Diagnostics and Genetics contains nine expanded chapters that focus on emerging issues and techniques, written by experts in field, including Y.M. Dennis Lo, Rossa W.K. Chiu, Carl Wittwer, Noriko Kusukawa, Cindy Vnencak-Jones, Thomas Williams, Victor Weedn, Malek Kamoun, Howard Baum, Angela Caliendo, Aaron Bossler, Gwendolyn McMillin, and Kojo S.J. Elenitoba-Johnson. Highly-respected author team includes three editors who are well known in the clinical chemistry world. Reference values in the appendix give you one location for comparing and evaluating test results. NEW! Two-color design throughout highlights important features, illustrations, and content for a quick reference. NEW! Chapter on hemostasis provides you with all the information you need to accurately conduct this type of clinical testing. NEW! Six associate editors lend even more expertise and insight to the reference. NEW! Reorganized chapters ensure that only the most current information is included. |
| low dose dexamethasone suppression test protocol: MRI of the Pituitary Gland Jean-François Bonneville, Fabrice Bonneville, Françoise Cattin, Sonia Nagi, 2016-04-26 This clinically oriented book will familiarize the reader with all aspects of the diagnosis of tumors and other disorders of the pituitary gland by means of magnetic resonance imaging (MRI). The coverage includes acromegaly, Cushing’s disease, Rathke cleft cysts, prolactinomas, incidentalomas, nonsecreting adenomas, other lesions of the sellar area, hypophysitis, and central diabetes insipidus. Normal radiologic anatomy and the numerous normal variants are described, and guidance is also provided on difficulties, artifacts, and other pitfalls. The book combines concise text and high-quality images with a question and answer format geared toward the needs of the practitioner. MRI is today considered the cornerstone in the diagnosis of diseases of the hypophyseal-hypothalamic region but the relatively small size of the pituitary gland, its deep location, the many normal anatomic variants, and the often tiny size of lesions can hinder precise evaluation of the anatomic structures and particularly the pituitary gland itself. Radiologists and endocrinologists will find MRI of the Pituitary Gland to be full of helpful information on this essential examination, and the book will also be of interest to internists and neurosurgeons. |
| low dose dexamethasone suppression test protocol: Adrenal Imaging Michael A. Blake, Giles Boland, 2009-02-28 Imaging of the adrenal gland has made tremendous progress in the last decade as new technologies continue to evolve. Adrenal Imaging highlights the pertinent clinical and pathological information that underpins the accurate interpretation and use of adrenal imaging. Written by a prestigious group of international contributors, individual chapters in Adrenal Imaging serve as a relevant and up-to-date reference of adrenal imaging findings, algorithms and techniques in CT, MR nuclear medicine, intervention and trauma. Summary sections at the end of each chapter illuminate key teaching points to enhance retention. |
| low dose dexamethasone suppression test protocol: Canine and Feline Endocrinology and Reproduction Edward C. Feldman, Richard William Nelson, 2004-01-01 This book provides complete, current information on pathophysiology, diagnosis, and treatment of endocrine, metabolic, and reproductive diseases in dogs and cats. It also discusses the importance of testing procedures in endocrine and reproductive diseases, as well as cost-effective and expedient diagnostic protocols. A complete review of reproduction is presented with the endocrine material, making this text the most inclusive resource overall on the topic.Expansive sections on Canine Male and Female Reproduction.The book is divided into nine sections for an organized and accessible approach to information.Discussions of testing procedures in endocrine and reproductive diseases.Explains cost-effective and expedient diagnostic protocols.Logical, step-by-step guidelines aid in accurate decision-making and diagnosis. A new chapter in the Adrenal Gland section (Section 3) addresses feline hyperadrenocorticism.The chapter on diabetes mellitus in the canine and feline has been divided into two chapters in order to explore the specific aspects of the disease in each species.All material has been extensively revised and brought up to date for this edition.Additional tables and algorithms throughout the book summarize and clarify information. |
| low dose dexamethasone suppression test protocol: Fundamentals of Veterinary Clinical Pathology Steven L. Stockham, Michael A. Scott, 2013-05-31 This book provides in-depth information about common clinical laboratory assays that are used to evaluate domestic mammals, including what assays measure, sample or assay conditions that affect results, and what results indicate about the physiologic or pathologic state of a patient. Whenever possible, diseases and conditions are grouped by common mechanisms or processes to promote a conceptual understanding of laboratory data that can be generally applied across many species. New to the second edition are additional disorders, diagnostic tests, illustrations, images, references, and pathophysiologic explanations. This text has proven valuable to students and veterinarians wanting a fundamental understanding of veterinary clinical pathology. |
| low dose dexamethasone suppression test protocol: Glucocorticoid Action Tomoshige Kino, Evangelia Charmandari, George P. Chrousos, 2004 Glucocorticoids regulate multiple metabolic and developmental processes and play a vital role in the maintenance of basal and stress-related homeostasis. For the last 50 years, pharmacologic doses of glucocorticoids have been used in the treatment of inflammatory, autoimmune, and lymphoproliferative diseases and in the prevention of allograft rejection, while substitution doses have been employed in the management of adrenocortical insufficiency. aspects of glucocorticoid action, in particular, (i) the impact of maternal and early life stress on stress-related gene regulation in the offspring; (ii) the importance of glucocorticoids and their receptors; (iii) further understanding of the mechanisms of GR action, including its effect on chromatin modulation, its interaction with coactivators and corepressors, and the genetic dissection of GR function in mice; (iv) The interaction of hGR with other transcription factors, such as NF-kappa-B, p53, transforming growth factor beta (TGF-beta) and the chicken ovalbumin upstream promoter transcription factor II (COUP-TFII); recycling, ubiquitination and degradation of the receptor, actions of the GR-beta isoform, a novel synthetic nonsteroidal target gene-specific agonist, the importance of target tissue activity of 11-beta-hydroxysteroid dehydrogenase type 1 in glucocorticoid action in health and disease, the interaction of the receptor with the nutrient carnitine, the anthrax products protective antigen (PA) and lethal factor (LF), and the human immunodeficiency virus type-1 (HIV-1)-encoded molecules Vpr and Tat; (vi) an update on the effects of glucocorticoids on the immune system; and (vii) the clinical implications of glucocorticoid action, including glucocorticoid resistance/hypersensitivity, familial and sporadic glucocorticoid resistance, and the effects of stress and depression. |
| low dose dexamethasone suppression test protocol: Brook's Clinical Pediatric Endocrinology Charles G. D. Brook, Peter Clayton, Rosalind Brown, 2008-04-15 This new edition of the benchmark text on clinical pediatric endocrinology still remains at the forefront of world clinical opinion. Furthermore, the style, which has been the hallmark of the book for the last 20 years, has been maintained for this Fifth Edition. New features of this Fifth Edition include: Special new chapters cover the fetal origins of adult disease and the endocrine consequences and management of critical illness Now opens with a basic science section summarizing the mechanisms of hormone action, genomics, proteomics and the application of molecular biology to clinical practice Two new co-editors have been introduced – Peter Clayton and Rosalind Brown Every chapter has been updated |
| low dose dexamethasone suppression test protocol: Pharmacometrics Ene I. Ette, Paul J. Williams, 2013-03-14 Pharmacometrics is the science of interpreting and describing pharmacology in a quantitative fashion. The pharmaceutical industry is integrating pharmacometrics into its drug development program, but there is a lack of and need for experienced pharmacometricians since fewer and fewer academic programs exist to train them. Pharmacometrics: The Science of Quantitative Pharmacology lays out the science of pharmacometrics and its application to drug development, evaluation, and patient pharmacotherapy, providing a comprehensive set of tools for the training and development of pharmacometricians. Edited and written by key leaders in the field, this flagship text on pharmacometrics: Integrates theory and practice to let the reader apply principles and concepts. Provides a comprehensive set of tools for training and developing expertise in the pharmacometric field. Is unique in including computer code information with the examples. This volume is an invaluable resource for all pharmacometricians, statisticians, teachers, graduate and undergraduate students in academia, industry, and regulatory agencies. |
| low dose dexamethasone suppression test protocol: Blackwell's Five-Minute Veterinary Consult Larry P. Tilley, Francis W. K. Smith, Jr., 2011-09-09 Be ready to confidently face common and not-so-common canine and feline disorders with Blackwell's Five-Minute Veterinary Consult: Canine and Feline, Fifth Edition. The most trusted and well-known quick reference available to veterinarians, the updated Fifth Edition continues to provide swift, authoritative answers to every question concerning canine and feline health. More than 300 top specialists provide complete coverage of 838 specific disorders, with dozens of new topics and existing topics thoroughly revised to include the latest research. Arranged alphabetically from A-Z for efficient searching, each topic covers clinical signs, diagnosis, treatment, and follow-up. The customizable Client Handouts, which have been fully updated and redesigned with an attractive color design, are now available online, along with an image and video bank. Whether you're a student or a practicing veterinarian, this bestselling reference book will cut down on time spent navigating through other resources, allowing you to study, diagnose and treat more quickly. |
| low dose dexamethasone suppression test protocol: Veterinary Hematology and Clinical Chemistry Mary Anna Thrall, 2004 This reference on veterinary haematology and clinical chemistry is designed to be both comprehensive and practical. From basic principles and laboratory techniques to diagnostic evaluation, readers will find equally concise and clear coverage of both haematology and clinical chemistry for many domestic and exotic species. It also features numerous four-colour and black-and-white illustrations, coverage of avian and exotic haematology and an extensive use of case studies. |
| low dose dexamethasone suppression test protocol: Mosby's Diagnostic and Laboratory Test Reference - E-Book Kathleen Deska Pagana, Timothy J. Pagana, Theresa Noel Pagana, 2018-09-19 Get the latest research and easy access to today’s most important diagnostic and lab tests! Known for its accuracy, currency, and clear, easy-to-use format, Mosby’s Diagnostic & Laboratory Test Reference 14th Edition features concise test entries that are arranged alphabetically and reflect the latest in diagnostic and lab testing and research. This new edition adds 15 tests with vital information such as alternate or abbreviated test names, test explanation, normal and abnormal findings, possible critical values, and guidelines to patient care before, during, and after the test. Plus, all related tests are cross-referenced throughout the book to simplify lookup. A compact size, durable cover, and A-to-Z thumb tabs make this market-leading book ideal for everyday use in the classroom and on the job! Alphabetically organized tests offer quick reference with A-to-Z thumb tabs, so you will never have to search for a test by having to first determine its correct category or body system. Normal findings for adult, elderly, and pediatric patients are included where applicable. Abnormal findings are highlighted with directional arrows to show increased or decreased test results. Convenient appendix lists tests by body system and test type, making it easy to quickly locate related studies. A durable cover with rounded edges helps prevent the book from being damaged and makes it easier to handle. Each test entry begins on a new page, making tests easy to find. Possible critical values are highlighted to show situations requiring immediate intervention. Icon for patient teaching-related care indicates information that should be shared with patients and their families. User’s Guide to Test Preparation and Performance provides an overview and guidelines for each type of laboratory test and diagnostic procedure, so you can minimize worry about having to repeat a test due to an error. Abbreviations for tests are listed in the back of the book, and symbols and units of measurement are listed in an appendix. Cross-referencing of related tests makes them easy to find. NEW! Test entries include the latest diagnostic tests and laboratory procedures, featuring 10 new monographs and 15 additional tests. NEW! Content reflects the latest research on the diagnostic values of results, accuracy of testing, and patient care and education for each test. NEW! Common Reference Ranges section added to the Inside Front Cover material. |
