腦垂體檢查

Three combined pituitary function test

-          NPO since MN and keep recumbent position until test finish

-          Set 3-way catheter in forearm vein (Heparin locked)

-          Check plasma Sugar, hGH, Cortisol, TSH, prolactin, LH, FSH at 8:00AM

-          RI 0.15u/kg, TRH 1 Amp, LH-RH 1 Amp (100ug), iv injection at the same time after blood drawing

-          Check plasma Sugar at 15, 30, 60 minutes or presence of hypoglycemia s/s

-          Check hGH at 60, 90 minutes

-          Check (ACTH), cortisol at 30, 60, 90 minutes

-          Check TSH at 15, 30, 60 minutes

-          Check prolactin(=PRL) at 30, 60, 90 minutes

-          Check LH, FSH at 30, 60, 120 minutes

-          Test 結束後, 馬上進食

-          備 50% G/W 3 Amp, solu-cortef 1 vial 以備不時之需

→做測試時需有醫師在場。

acromegaly

OGTT	-NPO since前一天10PM -7:50AM check plasma hGH (0 min) -7.5 Amp 的50% G/W(=75g) 稀釋成300 cc, 請病人10 minutes內喝完 -Check plasma hGH at 30, 60 minutes)
Glucagon test	-NPO since 12MN -Check hGH at 0 minute -Glucagon 3 mg(=3Amp) (1mg/Amp) sc injection -Check hGH at 30, 60, 90, 120, 150, 180 minutes

 

GH deficiency

GH 缺乏 (growth retard)

-NPO since MN -Check hGH at 0 minute -Glucagon 0.03 mg/Kg (max 1mg) IM -Check hGH at 30, 60, 90, 120, 150, 180 minutes

  

Insulin Tolerance Test	growth hormone deficiency	-NPO since MN -Check GH, cortisol and sugar at 0 minute -RI ____u (0.1 u/kg) iv push, keep N/S 1BT patent line. 備50% G/W 4 AMP -打完RI後, check sugar at 15, 30, 45, 60, 90, 120 minutes -Check GH, cortisol at 30, 45, 60, 90 minutes -若有hypoglycemia symptoms 出現, check sugar, GH, ACTH and cortisol, 並立刻終止test
	growth retard.	-NPO since MN -Check hGH, cortisol and sugar at 0 minute -RI (0.05-0.1 u/kg) iv push -打完RI後, check sugar at 15, 30, 45, 60, 90, 120 minutes -Check hGH, at 15, 30, 60, 75, 90, 120 minutes -若有hypoglycemia symptoms 出現, check sugar, hGH and cortisol, 並立刻終止test -Prepare IV line for 50% D5W.
Clonidine (Catapress) test	growth hormone insufficiency	-at 8AM check baseline BP and GH -8AM Catapress______(0.075mg/tab)(0.15/m2 or 4ug/Kg -check BP and GH q30mins ,at 8:30 ,9:00, 9:30, 10:00AM (*Precaution:hypotension may be induced, watchout orthostatic hypotension )and fall
Levodopa test	growth hormone insufficiency	-Madopar (      mg)_______      -at 0,60,90, check BP and GH      (Be aware of nausea ,vomiting ,dystonic movement ,postural hypotension )      *Madopar dose:       1.<15kg :125mg  (=Madopar 125mg 1#)       2.10-35kg:250mg (=Madopar 250mg 1#)       3.>35kg:500mg  (=Madopar 250mg 2#)

  

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尿崩症:

23.  Water deprevation test – for DI

-          NPO since 6:00 AM and check body weight

-          Empty bladder at 8:00AM and discard

-          Empty bladder again at 9:00 Am and check urine osmolarity.

1. If urine osmo > 800 mOsm/kg, 則停止 test

2. If not, continue test, collect hourly urine amount and osmolarity under fluid restriction

-          Check blood osmolarity at time of 9:00, 12:00, 15:00 and 16:30

-          Stop the test if the urine osmolarity does not increase more than 30 mOsm/kg between 2 consecutive collections

-          DDAVP 1μg (1/4 Amp) intravenous (or SC or IM皆可) injection, then collect plasma and urine osmolarity at the end of an hour

-          注意事項:

1. Weigh initially and hourly, stop test if weight fall 3% of baseline

2. Monitor BP hourly, stop test if hypotension, mental change and profound weakness occurred

3. Vasopressin in contraindicated in patients with H/T, CAD or peripheral vascular disease.