The Cleveland Clinic Manual of Dynamic Endocrine Testing, 2015

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.  

Part I: Dynamic Tests in Pituitary/Adrenal Disorders.- ACTH Stimulation Test for Adrenal Insufficiency with Total Cortisol Levels.- ACTH Stimulation Test for Adrenal Insufficiency with Free Cortisol Levels.- ACTH Stimulation Test for Late Onset (Non-classic) 21-Hydroxylase  Deficiency.- Metyrapone Stimulation Test.- Two Day Low Dose Dexamethasone Suppression Test.- Combined CRH Dexamethasone Suppression Test.- Overnight Low Dose Dexamethasone Suppression Test – 1 mg.- Overnight High Dose Dexamethasone Suppression Test – 8 mg.- Ovine Corticotropin Releasing Hormone (oCRH) Stimulation Test.- Insulin Tolerance Test (ITT).- Glucagon Stimulation Test for GHD (GST).- GHRH-Arginine GH Stimulation Test.- Growth Hormone Suppression Test (Post-Glucose Administration).- Clonidine Suppression Test for Pheochromocytoma.- Intravenous Saline Suppression Test for Evaluation of Primary Aldosteronism.- Oral Sodium Loading Test.- Captopril Challenge Test.- Water Deprivation Test for DI.- Part II: Dynamic Tests in Thyroid Disorders.- Thyroid Cancer Follow-up: Withdrawal Protocol.- Thyroid Cancer Follow-up: Thyrogen Injection with No Scan.- Thyroid Cancer Follow-up: Thyrogen Injection with Scan with/without Treatment.- Levothyroxine Absorption Test.- Part III: Dynamic Tests in Glucose Metabolism/Pancreas Disorders.- Seventy-two Hour Fast for Insulinoma.- Glucagon Stimulation to Test Beta Cell Reserve.- Mixed Meal Hypoglycemia Test.- Secretin Stimulation Test for Gastrinoma.- Part IV: Invasive Dynamic Endocrine Testing.- Inferior Petrosal Sinus Sampling.- Adrenal Venous Sampling.

Ahmet Bahadir Ergin, MD, Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland, OH, USA

Amir H. Hamrahiam, MD, Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland, OH, USA

A. Laurence Kennedy, MD, FRCP, Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland, OH, USA

Manjula K. Gupta, PhD, Department of Clinical Pathology, Cleveland Clinic Cleveland, OH, USA