MessageDear Derek,
Rafaq Azad from Bradford suggested Julia Jones.
I have been in touch with Julia who has a CBG assay and runs it periodically ( approx twice a year depending on how many samples she has ), and we will send a serum to her ( Julia Jones, Senior Clinical Biochemist, Clinical Oncology dept, Charing Cross. )
We are also sending salivary a.m. cortisol to Southampton.
Thanks for your interest.
Best wishes,
Keith.
Keith Wakelin
Consultant Chemical Pathologist,
Dorset County Hospital,
Dorchester,
Dorset.
----- Original Message -----
From: DEREK MACDONALD
To: Keith Wakelin
Sent: Friday, January 11, 2008 12:29 PM
Subject: FW: Corticosteroid binging globulin
Keith,
Don't suppose you had any positive replies did you?
I have attached a thread of a conversation I had last year
Derek Macdonald
Inverness
------------------------------------------------------------------------------
From: DEREK MACDONALD
Sent: 30 July 2007 11:45
To: RODERICK HARVEY
Subject: FW: Corticosteroid binging globulin
Rod
Forward from Mike Wallace,
Derek
------------------------------------------------------------------------------
From: Mike Wallace [mailto:[log in to unmask]]
Sent: 30 July 2007 11:11
To: DEREK MACDONALD
Subject: RE: Corticosteroid binging globulin
Dear Derek,
Am really embarrassed about the delay your email got lost amongst a few hundred waiting for me on my return form holiday !
In relation to salivary cortisol we do not have reference data in relation to synacthen test.
We do, however, have reference values for morning and evening salivary cortisol.
It might be of interest to find out whether the morning salivary cortisol falls within these limits.
With best wishes
Mike
Dr A M Wallace,
Consultant Clinical Scientist,
Department of Clinical Biochemistry,
Macewen Building,
Glasgow Royal Infirmary,
Glasgow G4 0SF
Tel: +44 141 211 4490 (Internal 24490)
Fax: +44 141 552 3324
-----Original Message-----
From: DEREK MACDONALD [mailto:[log in to unmask]]
Sent: 30 July 2007 10:42
To: Mike Wallace
Subject: FW: Corticosteroid binging globulin
Copy as discussed
Derek
------------------------------------------------------------------------------
From: RODERICK HARVEY
Sent: 27 July 2007 15:36
To: DEREK MACDONALD
Subject: RE: Corticosteroid binging globulin
Derek
Have you had any reply yet from Mike Wallace?
Dr Roderick Harvey
Consultant Physician
Clinical Director, Medical Directorate
Raigmore Hospital
Inverness IV2 3UJ
+44(0)1463 705640 (direct), 705557 (secretary)
e-mail [log in to unmask]
------------------------------------------------------------------------------
From: DEREK MACDONALD
Sent: 05 June 2007 10:29
To: [log in to unmask]
Cc: RODERICK HARVEY
Subject: FW: Corticosteroid binging globulin
Hello Mike,
I was wondering if you could help with this patient, tried phoning today, Tuesday, but you are away till Friday.
Specifically do you think salivary cortisols might help to solve our diagnostic dilemma?
If so do you recommend a random sample or repeat of the SST?
What container do we collect the saliva sample in, how much sample and what do we do to process it?
Many thanks for your help
Derek Macdonald (Inverness)
------------------------------------------------------------------------------
From: Perry Les [mailto:[log in to unmask]]
Sent: 04 June 2007 17:10
To: DEREK MACDONALD
Subject: RE: Corticosteroid binging globulin
Hi Derek,
Thank you for your enquiry.
At present I am not running th CBG assay. We have run this in the past usually in conjunction with some research samples.
In terms of your patient - I would ask why did the clinican want to do the short syancthen test?
I note that you have only done the 0 & 30 min sample - presumably a 60 min sample was not done? The reason why I ask this is that if the patient has been on glucocorticosteroid treatment in the recent past we often see the serum cortisol higher on the 60 min sample than the 30 min sample indicating some degree of pituitary down regulation - explaining why the ACTH is not higher.
In this instance you could repeat the short synacthen test. I would so serum cortisol at 60min as well as basal and +30min. Also do the basal ACTH.
Salivary cortisol would help. I think the lab in Glasgow - with Mike Wallace and Anne Pollock do have normal reference ranges and so would be able to interpret the saliva cortisol levels during the SST.
If I can be of any further help let me know
regards
Les Perry
Principal Clinical Scientist
-----Original Message-----
From: DEREK MACDONALD [mailto:[log in to unmask]]
Sent: 04 June 2007 15:46
To: Perry Les
Subject: Corticosteroid binging globulin
Dear Les,
Anne Pollock suggested I contact you to see if you were able to do this assay.
Male dob 27.06.21
Synachten Test
0 minute cortisol 246 nmol/l
30 minute cortisol 452 nmol/l
Basal ACTH 7 u/l (Ref: < 20)
One of our Endocrinologists wonders if patient has normal free cortisol levels as a result of low CBG levels.
My question is:
Do you offer a CBG or a serum free cortisol assay?
If so should we repeat synachten test or will a random sample do for CBG?
What is the cost and turnaround time?
Do you think it will help in this patient?
Would salivary cortisol help?
Sorry to bother you,
Hope you can help
Derek Macdonald (Biochemist)
Biochemistry Department
Raigmore Hospital
Inverness IV2 4AE Tel 01463704210
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