Others

Normal level :

• 1 to 16 years = 51 to 217 pg/mL
• Adult = 50 to 300 pg/mL

Increased PTH Level Is Seen In:

1. Primary hyperparathyroidism.
2. Pseudohypoparathyroidism ( Secondary hyperparathyroidism ).
3. Vit. D deficiency ( hereditary ) and rickets.
4. Zollinger Ellison syndrome.
5. Non-PTH producing tumors give rise to the paraneoplastic syndrome, 
6. Chronic renal failure.
7. Hypocalcemia.
8. Malabsorption.

Decreased PTH Level Is Seen In:

1. Grave’s disease ( Hypoparathyroidism ).
2. Non-Parathyroid hypercalcemia.
3. Surgical, secondary hypoparathyroidism.
4. Sarcoidosis.
5. Metastatic bone tumors.
6. Vit.D intoxication.
7. Milk-alkali syndrome.
8. DiGeorge syndrome.

Adrenocorticotropic hormone(ACTH)

1. This is a polypeptide hormone produced by the corticotropic cells of the anterior pituitary gland.
   1. ACTH is a tropic hormone, it binds to the cells of the adrenal cortex and influences their activities.
   2. ACTH in plasma is highest between 6 to 8 AM and lowest in the evening between 6 to 11 PM.ACTH action on adrenal cortex

2. ACTH may be raised as primary or ectopic production.
3. Ectopic production from:
   1. Small cell carcinoma of the lung ( >200 ng/L).
   2. Pancreatic carcinoma.
   3. Breast.
   4. Stomach.
   5. Colon.
4. Benign conditions are:
   1. Chronic obstructive pulmonary disease.
   2. Mental depression.
   3. Obesity.
   4. Hypertension.
   5. Diabetes.
   6. Stress.
5. ACTH in normal person does not exceed 50 pg/mL at its peak and the basal level is near 5 pg/mL.
6. Raised ACTH level is seen in:
   1. In primary adrenal deficiency.
   2. In patients with Cushing’s syndrome.
   3. In patients with ectopic tumors e.g.
      1. Basophilic neoplasm of the anterior pituitary.
      2. Ectopic carcinoma of the lung.
7. Normal
   1. AM level = <80 pg/mL (<18 pmol/L).
   2. PM level = <50 pg/mL (<11 pmol/L).

Human Chorionic gonadotropin hormone (HCG)

1. This is also called Chorionic gonadotropin.
2. This is a glycoprotein secreted by the syncytiotrophoblastic cells of the placenta.
   1. This consists of two subunits:
      1. α- HCG.
      2. β-HCG.
3. Elevated HCG level is seen in:
   1. Trophoblastic disease (level is usually >one million IU/L).
   2. Germ cell tumor and non-seminomatous tumors of the testis (there is a moderate increase).
   3. Reported in melanoma and carcinoma of the breast, GIT tumors, lung, and ovary.
4. The presence of HCG in seminoma indicates another component as choriocarcinoma.
5. Also raised in benign conditions like:
   1. Cirrhosis.
   2. Duodenal ulcer.
   3. Inflammatory bowel diseases.
   4. Pregnancy.
6. Normal HCG
   1. Male and nonpregnant females = <5 mIU/mL.

Calcitonin

1. This is a polypeptide with 32 amino acids.
   1. This is produced by the C cells of the thyroid.
   2. The serum half-life is 12 minutes.
   3. In a normal person is <0.1 µg /L.
2. This is produced in response to increased serum calcium levels.
3. Calcitonin is useful for the monitoring of disease after treatment.
4. It inhibits the release of calcium from the bone, lowers the serum calcium.
5. Calcitonin is useful to diagnose :
   1. Medullary carcinoma of the thyroid.
   2. Carcinoid tumor.
   3. Lung cancers.
   4. Breast cancer.
   5. Kidney tumor.
   6. Liver tumor.
6. Calcitonin level also raised in nonmalignant conditions like:
   1. Pulmonary disease.
   2. Pancreatitis.
   3. Hyperparathyroidism.
   4. Paget’s disease of bone.
   5. Pregnancy.
   6. Pernicious anemia.
7. Normal (Source 2)
   1. Basal (plasma)
      1. Male = ≤19 pg/mL  (≤19 ng/L)
      2. Female = ≤14 pg/mL  (≤14 ng/L)
   2. Calcium infusion  (2.4 mg/kg)
      1. Male = ≤190 pg/mL  (≤190 ng/L)
      2. Femal =   ≤130 pg/mL  (≤130 ng/L)
   3. Pentagastrin injection (0.5 µg/kg)
      1. Male = ≤110 pg/mL  (≤110 ng/L)
      2. Female = ≤30 pg/mL   (≤30 ng/L)

Normal level:

Women before puberty = 0 to 4 mIU/L

• Menstruating women
  1. Follicular  = 5 to 20 IU/L.
  2. Ovulatory phase = 30 to 50 IU/L.
  3. Luteal phase = 1.09 to 9.2 IU/L.
• Women post menopause = 19.5 to 100.6. IU/L.
• Men before puberty = 0 to 5 mIU/L
  1. Men during puberty = 1.42 to 15.4. IU/L
  2. Men  adult = 1.5 to 12.5 IU/L.
• Children:
  1. Male = 0.3 to 4.6 IU/L.
  2. Female = 0.68 to 6.7 IU/L.

High FSH:

1. Loss of ovarian function before age 40 (ovarian failure).
2. Polycystic ovary syndrome (PCOS).
3. Menopause has occurred.
4. Pituitary adenoma.
5. Precocious puberty.
6. Ovarian dysgenesis ( Turner syndrome ).

High  FSH values in a man:

1. Klinefelter syndrome ( Testicular dysgenesis ).
2. Testicles are absent or not functioning properly.
3. Testicles have been damaged by alcohol dependence or treatments like X-rays or chemotherapy.
4. High values in children may mean that puberty is about to start.
5. Complete testicular feminization syndrome.

Decreased FSH :

1. Pituitary failure.
2. Hypothalamic failure.
3. Stress.
4. Anorexia nervosa.
5. Malnutrition.

Low Values Of FSH Indicate:

1. A woman not producing eggs (prevents ovulation) leads to infertility.
2. A man is not producing sperm.
3. The hypothalamus or pituitary gland is not functioning properly.
4. A tumor is present that interferes with the brain’s ability to control FSH production.
5. Stress.
6. Starvation or being very underweight.

Normal Level:

Increased values of  (LH) :

1. A gonadal failure like:
   1. Menopause.
   2. Ovarian dysgenesis. (Turner syndrome).
   3. Testicular dysgenesis (Klinefelter syndrome).
2. Precocious puberty.
3. Pituitary adenoma.
4. Raised level of both  LH and FSH is seen in:
   1. Gonadal failure.
   2. Polycystic ovary.
   3. During menopause.

Decreased values of LH:

1. Pituitary failure. Both LH/ FSH are low.
2. Hypothalamic failure will also lead to low LH and FSH levels.
3. Stress.
4. Anorexia nervosa.
5. Malnutrition.
6. In secondary gonadal failure, the LH and FSH level is low.

Normal level:

Total Testosterone

• Men = 3 to 10 ng/mL
• Women = <1 ng/mL
• Prepubertal boys and girls = 0.05 to 0.2 ng/mL

Free testosterone

• Men = 50 to 210 pg/mL.
• Women = 1.0 to 8.5 pg/mL.
• Children:
  • Boy = 0.1 to 3.2 pg/mL.
  • Children Girl = 0.1 to 0.9 pg/mL.
• Puberty:
  • Boy = 1.4 to 156 pg/mL.
  • Puberty Girls = 1.0 to 5.2 pg/ml.

Total Testosterone

• Men = 270 to 1070 ng/dL.
• Women = 15 to 70 ng/dL.
• Postmenopausal women = 8 to 35 ng/dL.
• Pregnant women = 3 to 4 ng/dL

Increased Values Of Total Testosterone :

1. Male
   1. hyperthyroidism.
   2. Adrenal tumors.
   3. Adrenal Hyperplasia.
   4. Hypothalamic tumor, Pinealoma.
   5. Viral encephalitis.
   6. Testicular or extragonadal tumors where Leydig cells produce testosterone.
   7. Testosterone resistance syndrome.
2. Female
   1. Adrenal neoplasm.
   2. Hilar cell tumor.
   3. Idiopathic Hirsutism.
   4. Trophoblastic disease during pregnancy
   5. Ovarian tumors
   6. Polycystic ovary.

Decreased Total Testosterone Value  In Male:

1. Klinefelter syndrome.
2. Pituitary failure leading to hypogonadism.
3. Hypopituitarism may be primary or secondary.
4. Orchiectomy.
5. Delayed puberty.
6. Down syndrome (trisomy 21).
7. Cirrhosis.
8. Cryptorchidism due to undescended testes.

Increased Free Testosterone in Female:

1. Hirsutism.
2. Virilization.
3. polycystic ovaries.

Decreased Free Testosterone Is Seen In Male:

1. Hypogonadism.
2. old age.

 Normal level;

• Adult male = 0 to 20 ng/mL
• Adult female = 0 to 25 ng/mL
• Pregnant female = 20 to 400 ng/mL

1.Increased prolactin level is seen in :

1. Breast stimulation.
2. Pregnancy.
3. Nursing.
4. Stress.
5. Exercise.

2.Pituitary tumors form acidophilic cells that produce prolactin.

3.The moderate level increase is seen in :

6. Secondary amenorrhea.
7. Galactorrhea.
8. primary hypothyroidism.
9. Polycystic ovary syndrome.