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,
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
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
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
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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