Clinical Chemistry
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Clinical Chemistry 45: 1323-1330, 1999;
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(Clinical Chemistry. 1999;45:1323-1330.)
© 1999 American Association for Clinical Chemistry, Inc.

Articles

Maximizing Efficacy of Endocrine Tests: Importance of Decision-focused Testing Strategies and Appropriate Patient Preparation

George G. Klee

Department of Laboratory Medicine and Pathology, Mayo Clinic and Mayo Foundation, 200 First Street S.W., Rochester, MN 55905. Fax 507-284-4542; e-mail klee.george{at}mayo.edu

The efficacy of endocrine tests depends on the choice of tests, the preparation of the patients, the integrity of the specimens, the quality of the measurements, and the validity of the reference data. Close dialogue among the clinicians, the laboratory, and the patients is a key factor for optimal patient care. The characteristics of urine and plasma samples and the advantages and limitations of paired test measurements are presented. The importance of test sequence strategies, provocative or inhibitory procedures, and elimination of drug interferences is illustrated with four cases involving Cushing syndrome, pheochromocytoma, primary aldosteronism, and hypercalcemia. For each of these scenarios, key clinical issues are highlighted, along with discussions of the best test strategies, including which medications are likely to interfere. The importance of targeting laboratory tests to answer well-focused clinical decisions is emphasized. The roles of some time-honored provocative procedures are questioned in light of more sensitive and specific analytic methods. The importance of decision-focused analytical tolerance limits is emphasized by demonstrating the impact of analytic bias on downstream medical resource utilization. User-friendly support systems to facilitate the implementation of test strategies and postanalytic tracking of patient outcomes are presented as essential requirements for quality medical practice.© 1999 American Association for Clinical Chemistry




The following articles in journals at HighWire Press have cited this article:


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G. Mengozzi, D. Rossato, C. Bertello, C. Garrone, A. Milan, R. Pagni, F. Veglio, and P. Mulatero
Rapid Cortisol Assay during Adrenal Vein Sampling in Patients with Primary Aldosteronism
Clin. Chem., November 1, 2007; 53(11): 1968 - 1971.
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Copyright © 1999 by the American Association for Clinical Chemistry.