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Hashimura H, Hu J, Kobayashi H, Gwini SM, Shen J, Chee NYN, Doery JCG, Chong W, Fuller PJ, Abe M, Li Q, Yang J. Saline suppression to distinguish the primary aldosteronism subtype: a diagnostic study. Eur J Endocrinol 2023; 188:6979713. [PMID: 36651157 DOI: 10.1093/ejendo/lvac003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/02/2022] [Accepted: 11/17/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The saline suppression test (SST) serves to confirm the diagnosis of primary aldosteronism (PA), while adrenal vein sampling (AVS) is used to subtype PA as unilateral or bilateral. Criteria that can accurately identify those with bilateral PA based on SST results could reduce the need for AVS. We previously demonstrated that a combination of plasma aldosterone concentration (PAC) < 300 pmol L-1 and a reduction in aldosterone-to-renin ratio (ARR) following recumbent SST had high specificity for predicting bilateral PA in an Australian cohort of 92 patients with PA who have undergone AVS. We sought to validate our predictive criteria in larger, independent cohorts of patients with PA. DESIGN An international, multi-centre cohort study. METHODS Data from 55 patients at Monash Health, Victoria, Australia, 106 patients from the First Affiliated Hospital of Chongqing Medical University, China, and 105 patients from Nihon University Itabashi Hospital, Japan were analysed. RESULTS A combination of PAC <300 pmol L-1 and a reduction in ARR following recumbent SST predicted bilateral PA with specificities of 88.2%, 97.0%, and 100.0% in Australian, Chinese, and Japanese cohorts, respectively. This criterion could allow 22%-38% of patients with PA to bypass AVS and proceed directly to medical treatment. CONCLUSION In patients undergoing the recumbent SST, a post-saline PAC <300 pmol L-1 together with a reduction in ARR can predict bilateral PA with high specificity and may allow targeted treatment to be commenced without AVS in up to a third of patients.
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Affiliation(s)
- Hikaru Hashimura
- Department of Endocrinology, Monash Health, Clayton, VIC 3168, Australia
| | - Jinbo Hu
- Department of Endocrinology, The Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Hiroki Kobayashi
- Department of Internal Medicine, Division of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine, Tokyo 102-8275, Japan
| | - Stella May Gwini
- School of Public Health and Preventative Medicine, Monash University, Clayton, VIC 3168, Australia
- Department of Biostatistics, Barwon Health, University Hospital Geelong - Barwon Health, Geelong, VIC 3220, Australia
| | - Jimmy Shen
- Department of Endocrinology, Monash Health, Clayton, VIC 3168, Australia
- Centre of Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia
| | - Nicholas Y N Chee
- Department of Endocrinology, Monash Health, Clayton, VIC 3168, Australia
| | - James C G Doery
- Department of Medicine, Monash University, Clayton, VIC 3168, Australia
- Department of Pathology, Monash Health, Clayton, VIC 3168, Australia
| | - Winston Chong
- Department of Imaging, Monash Health, Clayton, VIC 3168, Australia
| | - Peter J Fuller
- Department of Endocrinology, Monash Health, Clayton, VIC 3168, Australia
- Centre of Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia
| | - Masanori Abe
- Department of Internal Medicine, Division of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine, Tokyo 102-8275, Japan
| | - Qifu Li
- Department of Endocrinology, The Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jun Yang
- Department of Endocrinology, Monash Health, Clayton, VIC 3168, Australia
- Centre of Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia
- School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia
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Ng E, Gwini SM, Libianto R, Choy KW, Lu ZX, Shen J, Doery JCG, Fuller PJ, Yang J. Aldosterone, Renin, and Aldosterone-to-Renin Ratio Variability in Screening for Primary Aldosteronism. J Clin Endocrinol Metab 2022; 108:33-41. [PMID: 36179243 DOI: 10.1210/clinem/dgac568] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/23/2022] [Indexed: 02/03/2023]
Abstract
CONTEXT The plasma aldosterone concentration (PAC), renin, and aldosterone-to-renin ratio (ARR) are used to screen for primary aldosteronism (PA). Substantial intra-individual variability of PAC and ARR using plasma renin activity in the context of usual antihypertensive therapy has been described, but there is no data on ARR variability calculated using direct renin concentration (DRC). OBJECTIVE To describe the intra-individual variability of PAC, DRC, and ARR in the absence of interfering medications in patients with and without PA. DESIGN Retrospective cohort study. PATIENTS Hypertensive patients referred for investigation of PA, with at least 2 ARR measurements while off interfering medications. SETTING Endocrine hypertension service of a tertiary center, from May 2017 to July 2021. MAIN OUTCOME MEASURES PAC, DRC, and ARR variability was calculated as coefficient of variation (CV) and percent difference (PD). RESULTS Analysis of 223 patients (55% female, median age 52 years), including 162 with confirmed PA, demonstrated high variability with a sample CV of 22-25% in the PAC and sample CV of 41% to 42% in the DRC and ARR in both the PA and non-PA groups. The degree of variability was substantially higher than the assays' analytical CV. Sixty-two patients (38%) with PA had at least one ARR below 70 pmol/L:mU/L (2.4 ng/dL:mU/L), a cut-off for first-line screening of PA. CONCLUSIONS Significant intra-individual variability in PAC, DRC, and hence ARR occurs in a large proportion of patients being investigated for PA. These findings support the need for at least 2 ARR before PA is excluded or further investigated.
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Affiliation(s)
- Elisabeth Ng
- Department of Endocrinology, Monash Health, Clayton, Victoria, 3168, Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Stella May Gwini
- University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Renata Libianto
- Department of Endocrinology, Monash Health, Clayton, Victoria, 3168, Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Kay Weng Choy
- Department of Pathology, Northern Health, Epping, Victoria, Australia
| | - Zhong X Lu
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Monash Health Pathology, Monash Health, Clayton, Victoria, Australia
| | - Jimmy Shen
- Department of Endocrinology, Monash Health, Clayton, Victoria, 3168, Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - James C G Doery
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Monash Health Pathology, Monash Health, Clayton, Victoria, Australia
| | - Peter J Fuller
- Department of Endocrinology, Monash Health, Clayton, Victoria, 3168, Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Jun Yang
- Department of Endocrinology, Monash Health, Clayton, Victoria, 3168, Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
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Yang J, Libianto R, Lau KK, Doery JCG, Wan KL, Chee NYN, Shen J, Fuller PJ, Chong W. Impact of Intraprocedural Sedation on Adrenal Vein Sampling without Corticotropin Stimulation. Radiology 2022; 304:716-718. [PMID: 35608441 DOI: 10.1148/radiol.212627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
See also the editorial by Georgiades in this issue.
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Affiliation(s)
- Jun Yang
- From the Department of Endocrinology (J.Y., R.L., N.Y.N.C., J.S., P.J.F.), Monash Imaging (K.K.L., W.C.), and Monash Pathology (J.C.G.D., K.L.W.), Monash Health, Clayton, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, 27-31 Wright St, Clayton, VIC 3168, Australia (J.Y., R.L., J.S., P.J.F.); and School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia (J.Y., K.K.L., J.C.G.D.)
| | - Renata Libianto
- From the Department of Endocrinology (J.Y., R.L., N.Y.N.C., J.S., P.J.F.), Monash Imaging (K.K.L., W.C.), and Monash Pathology (J.C.G.D., K.L.W.), Monash Health, Clayton, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, 27-31 Wright St, Clayton, VIC 3168, Australia (J.Y., R.L., J.S., P.J.F.); and School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia (J.Y., K.K.L., J.C.G.D.)
| | - Kenneth K Lau
- From the Department of Endocrinology (J.Y., R.L., N.Y.N.C., J.S., P.J.F.), Monash Imaging (K.K.L., W.C.), and Monash Pathology (J.C.G.D., K.L.W.), Monash Health, Clayton, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, 27-31 Wright St, Clayton, VIC 3168, Australia (J.Y., R.L., J.S., P.J.F.); and School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia (J.Y., K.K.L., J.C.G.D.)
| | - James C G Doery
- From the Department of Endocrinology (J.Y., R.L., N.Y.N.C., J.S., P.J.F.), Monash Imaging (K.K.L., W.C.), and Monash Pathology (J.C.G.D., K.L.W.), Monash Health, Clayton, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, 27-31 Wright St, Clayton, VIC 3168, Australia (J.Y., R.L., J.S., P.J.F.); and School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia (J.Y., K.K.L., J.C.G.D.)
| | - Ken L Wan
- From the Department of Endocrinology (J.Y., R.L., N.Y.N.C., J.S., P.J.F.), Monash Imaging (K.K.L., W.C.), and Monash Pathology (J.C.G.D., K.L.W.), Monash Health, Clayton, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, 27-31 Wright St, Clayton, VIC 3168, Australia (J.Y., R.L., J.S., P.J.F.); and School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia (J.Y., K.K.L., J.C.G.D.)
| | - Nicholas Y N Chee
- From the Department of Endocrinology (J.Y., R.L., N.Y.N.C., J.S., P.J.F.), Monash Imaging (K.K.L., W.C.), and Monash Pathology (J.C.G.D., K.L.W.), Monash Health, Clayton, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, 27-31 Wright St, Clayton, VIC 3168, Australia (J.Y., R.L., J.S., P.J.F.); and School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia (J.Y., K.K.L., J.C.G.D.)
| | - Jimmy Shen
- From the Department of Endocrinology (J.Y., R.L., N.Y.N.C., J.S., P.J.F.), Monash Imaging (K.K.L., W.C.), and Monash Pathology (J.C.G.D., K.L.W.), Monash Health, Clayton, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, 27-31 Wright St, Clayton, VIC 3168, Australia (J.Y., R.L., J.S., P.J.F.); and School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia (J.Y., K.K.L., J.C.G.D.)
| | - Peter J Fuller
- From the Department of Endocrinology (J.Y., R.L., N.Y.N.C., J.S., P.J.F.), Monash Imaging (K.K.L., W.C.), and Monash Pathology (J.C.G.D., K.L.W.), Monash Health, Clayton, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, 27-31 Wright St, Clayton, VIC 3168, Australia (J.Y., R.L., J.S., P.J.F.); and School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia (J.Y., K.K.L., J.C.G.D.)
| | - Winston Chong
- From the Department of Endocrinology (J.Y., R.L., N.Y.N.C., J.S., P.J.F.), Monash Imaging (K.K.L., W.C.), and Monash Pathology (J.C.G.D., K.L.W.), Monash Health, Clayton, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, 27-31 Wright St, Clayton, VIC 3168, Australia (J.Y., R.L., J.S., P.J.F.); and School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia (J.Y., K.K.L., J.C.G.D.)
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Tan W, Zhang L, Jarujamrus P, C G Doery J, Shen W. Improvement Strategies on Colorimetric Performance and Practical Applications of Paper-based Analytical Devices. Microchem J 2022. [DOI: 10.1016/j.microc.2022.107562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Choy KW, Sezgin G, Wijeratne N, Calleja J, Liwayan R, Rathnayake G, McFarlane R, McNeil A, Doery JCG, Lu Z, Markus C, Loh TP. Assessment of analytical bias in ferritin assays and impact on functional reference limits. Pathology 2021; 54:302-307. [PMID: 34538480 DOI: 10.1016/j.pathol.2021.06.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/02/2021] [Accepted: 06/08/2021] [Indexed: 11/18/2022]
Abstract
Serum ferritin is currently the recommended laboratory test to investigate iron deficiency. There have been efforts to standardise serum ferritin assays with implementation of traceability to the World Health Organization reference standard. We evaluate the analytical bias among five widely used commercial ferritin assays in Australia. The relationship between serum ferritin and erythrocyte parameters was recently explored to derive functional reference limits. Residual patient serum specimens were analysed by five participating laboratories that utilised a different ferritin assay, Abbott, Beckman Coulter, Roche, Siemens, and Ortho. Using data mining approach, functional reference limits for Siemens, Abbott, and Ortho serum ferritin methods were derived and compared. At clinically relevant ferritin decision points, compared to the Beckman method, the Roche assay showed higher results ranging from 6 μg/L (31%) at the lowest decision point to 575 μg/L (57%) at the highest decision point. In contrast, the Ortho method underestimated ferritin results at lower decision points of 20 and 30 μg/L, with estimated ferritin results of 16 μg/L (-19%) and 27 μg/L (-12%), respectively. The Abbott and Siemens assays showed a positive bias which was introduced at differing decision points. The comparison of the Siemens and Ortho methods presents similar inflection points between the two assays in the establishment of functional reference limits for serum ferritin. There remain significant biases among some of the commonly used commercial ferritin assays in Australia. More studies are needed to assess if functional reference limits are a way to overcome method commutability issues.
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Affiliation(s)
- Kay Weng Choy
- Northern Pathology Victoria, Northern Health, Epping, Vic, Australia.
| | - Gorkem Sezgin
- Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Nilika Wijeratne
- Dorevitch Pathology, Heidelberg, Vic, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Vic, Australia
| | - John Calleja
- Melbourne Pathology, Collingwood, Vic, Australia
| | - Rachelle Liwayan
- Northern Pathology Victoria, Northern Health, Epping, Vic, Australia
| | - Geetha Rathnayake
- Territory Pathology, Royal Darwin Hospital, Darwin, NT, Australia; University and Northern Territory Medical Program, Royal Darwin Hospital Campus, Darwin, NT, Australia
| | - Robert McFarlane
- Territory Pathology, Royal Darwin Hospital, Darwin, NT, Australia
| | - Alan McNeil
- Dorevitch Pathology, Heidelberg, Vic, Australia
| | | | - Zhong Lu
- Monash Pathology, Monash Health, Clayton, Vic, Australia
| | - Corey Markus
- Flinders University College of Medicine and Public Health, Adelaide, SA, Australia
| | - Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, Singapore
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6
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Chee NYN, Abdul-Wahab A, Libianto R, Gwini SM, Doery JCG, Choy KW, Chong W, Lau KK, Lam Q, MacIsaac RJ, Chiang C, Shen J, Young MJ, Fuller PJ, Yang J. Utility of adrenocorticotropic hormone in adrenal vein sampling despite the occurrence of discordant lateralization. Clin Endocrinol (Oxf) 2020; 93:394-403. [PMID: 32403203 DOI: 10.1111/cen.14220] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/25/2020] [Accepted: 04/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adrenal vein sampling (AVS) is crucial for accurate lateralization of aldosterone excess but it is technically challenging due to the difficulty of adrenal vein cannulation. The use of adrenocorticotropic hormone (ACTH) to improve cannulation success is controversial and can lead to discordant lateralization outcomes. OBJECTIVE To evaluate the utility of ACTH in two centres with different levels of AVS expertise and formulate a strategy for interpreting discordant results. DESIGN A retrospective cross-sectional analysis of AVS results and postoperative patient outcomes. SETTING Two large tertiary hospitals with harmonized AVS protocols where adrenal venous samples are collected both before and after ACTH stimulation. MEASUREMENTS Cannulation success (measured by selectivity index, SI), lateralization (measured by lateralization index, LI) and postoperative biochemical cure. RESULTS Number of AVS procedures judged to have successful bilateral adrenal vein cannulation increased from 53% pre- to 73% post-ACTH. The increase in cannulation success was significantly higher in centre where AVS was performed by multiple radiologists with a lower basal success rate. In both centres, the proportion of cases deemed to display lateralization significantly decreased with the use of ACTH (70% pre- to 52% post-ACTH). Based on postoperative outcomes of patients with discordant results who underwent unilateral adrenalectomy, the combination of LI >3 pre-ACTH and LI >2 post-ACTH was predictive of a biochemical cure. CONCLUSION Adrenocorticotropic hormone can increase the rate of cannulation success during AVS at the expense of reduced lateralization. The criteria for lateralization should be carefully determined based on local data when ACTH is used.
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Affiliation(s)
- Nicholas Y N Chee
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
| | - Azni Abdul-Wahab
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
| | - Renata Libianto
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Stella May Gwini
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - James C G Doery
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Kay Weng Choy
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
| | - Winston Chong
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Kenneth K Lau
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Que Lam
- Department of Pathology, Austin Health, Heidelberg, Victoria, Australia
| | - Richard J MacIsaac
- Department of Endocrinology & Diabetes, St Vincent's Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Cherie Chiang
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Jimmy Shen
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Morag J Young
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Peter J Fuller
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Jun Yang
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
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Baskin LB, Naugler CT, Tan RZ, Markus C, Choy KW, Doery JCG, Loh TP. On the Use of Accuracy in Optimized Delta Check Rules for Detecting Misidentified Specimens in Children. Am J Clin Pathol 2020; 154:572-574. [PMID: 32591795 DOI: 10.1093/ajcp/aqaa063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Leland B Baskin
- University of Calgary Cumming School of Medicine Calgary, Canada
| | | | | | - Corey Markus
- Women's and Children's Hospital, South Australia, Australia
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Solanki P, Gwini SM, Doery JCG, Choy KW, Shen J, Young MJ, Fuller PJ, Yang J. Age- and sex-specific reference ranges are needed for the aldosterone/renin ratio. Clin Endocrinol (Oxf) 2020; 93:221-228. [PMID: 32306417 DOI: 10.1111/cen.14199] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/01/2020] [Accepted: 04/15/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Current Endocrine Society Clinical Practice Guidelines use a specific aldosterone/renin ratio (ARR) threshold to screen for primary aldosteronism (a treatable disease causing up to 15% of hypertension in primary care) in all patients. We sought to characterize demographic variations in the ARR, hypothesizing a need for age- and sex-specific reference ranges to improve the accuracy of the test. DESIGN Retrospective cross-sectional analysis of ARR measurements at a single tertiary hospital from December 2016 to June 2018. PATIENTS A total of 442 patients with clinically indicated ARR were included, after excluding those who were on spironolactone or the oral contraceptive pill, were pregnant or had an existing adrenal condition. MEASUREMENTS Aldosterone, renin and the ARR. RESULTS Among those aged 20-39 years (n = 74), females had significantly higher median aldosterone (369 vs 244 pmol/L, P = .028), lower median renin (17.0 vs 27.6 mIU/L, P = .034) and higher median ARR (20.7 vs 10.3 (pmol/L)/(mIU/L), P = .001) than males, despite having lower systolic (135 vs 145 mmHg, P = .021) and diastolic (89 vs 96.5 mmHg, P = .007) blood pressure. The ≥ 60-year age group (n = 157) also had significant sex differences in the ARR. With increasing age (20-39 vs ≥ 60 years), there was a significant fall in plasma aldosterone in females (369 pmol/L vs 264 pmol/L, P = .005), with no change observed in males. CONCLUSIONS For those 20-39 years old, aldosterone and the ARR are significantly higher in females despite a lower systolic and diastolic BP, highlighting the potential for false-positive results. Our findings indicate the need for prospective studies with a control population to define age- and sex-specific ARR reference ranges.
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Affiliation(s)
- Pravik Solanki
- Department of Endocrinology, Monash Health, Clayton, Vic., Australia
- Department of Medicine, Monash University, Clayton, Vic., Australia
| | - Stella May Gwini
- Barwon Health, University Hospital Geelong, Geelong, Vic., Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - James C G Doery
- Department of Medicine, Monash University, Clayton, Vic., Australia
| | - Kay Weng Choy
- Department of Endocrinology, Monash Health, Clayton, Vic., Australia
| | - Jimmy Shen
- Department of Endocrinology, Monash Health, Clayton, Vic., Australia
- Hudson Institute of Medical Research, Clayton, Vic., Australia
| | - Morag J Young
- Hudson Institute of Medical Research, Clayton, Vic., Australia
| | - Peter J Fuller
- Department of Endocrinology, Monash Health, Clayton, Vic., Australia
- Hudson Institute of Medical Research, Clayton, Vic., Australia
| | - Jun Yang
- Department of Endocrinology, Monash Health, Clayton, Vic., Australia
- Department of Medicine, Monash University, Clayton, Vic., Australia
- Hudson Institute of Medical Research, Clayton, Vic., Australia
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Abstract
OBJECTIVES Preanalytical processes in pediatric patients are generally manual and associated with a higher risk of error. The optimized delta check rules for detecting misidentified children samples are examined. METHODS Relative difference and absolute different delta check limits were applied on original and reshuffled (to simulate sample mislabeling/mix-up) paired deidentified pediatric results of 57 laboratory tests. The sensitivity, specificity, and accuracy of a range of delta check limits were determined. The delta check limit associated with the highest accuracy was considered optimal. RESULTS In general, the delta check limits had poor to moderate accuracy (0.50-0.81) in detecting misidentified patient samples. The sensitivity (rule out misidentified sample) quickly deteriorated at increasing delta check limits. At the same time, the specificity (rule in misidentified sample) of the delta check limit was also low. The performance of the relative difference and absolute difference delta check rules was similar. CONCLUSIONS Our findings showed poor delta check performance in the pediatric population. The high false-positive flag rate may lead to wasteful resource-intensive investigations and delay in result reporting. In addition, we observed that the optimized pediatric delta check correlated strongly with within-subject biologic variation, whereas delta check accuracy correlated poorly with index of individuality.
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Affiliation(s)
- Rui Zhen Tan
- Engineering Cluster, Singapore Institute of Technology, Singapore
| | - Corey Markus
- Metabolic Laboratory, Genetics and Molecular Pathology Directorate, SA Pathology, Women’s and Children’s Hospital, South Australia, Australia
| | - Kay Weng Choy
- Monash Medical Centre, Monash Health, Clayton, Australia
| | - James C G Doery
- Monash Medical Centre, Monash Health, Clayton, Australia
- Department of Medicine, Monash University, Clayton, Australia
| | - Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, Singapore
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Tan W, Zhang L, Doery JCG, Shen W. Three-dimensional microfluidic tape-paper-based sensing device for blood total bilirubin measurement in jaundiced neonates. Lab Chip 2020; 20:394-404. [PMID: 31853529 DOI: 10.1039/c9lc00939f] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
More than 60% newborns experience hyperbilirubinemia and jaundice within the initial week after birth due to the accumulation of total bilirubin in blood. Left untreated high levels of bilirubin may result in brain impairment. Simple, fast, accurate, low-cost and timely point-of-care (POC) analysis of total bilirubin is an unmet need especially in resource-limited areas. This work introduces a novel sensing device, named a "tape-paper sensor", capable of separating plasma from whole blood and measuring total bilirubin by a colorimetric diazotization method. The tape-paper sensing method overcomes non-homogeneous color distribution caused by the "coffee stain" effect, which improves the accuracy of colorimetric evaluation on paper-based analytical devices. The level of hemolysis in the plasma extracted by the device is evaluated, confirming no interference in the detection of total bilirubin. The accuracy of the tape-paper sensing approach for neonatal blood sample measurement is verified by comparison with the hospital pathology laboratory method. The small volume of samples and reagents, minimal equipment (an office scanner), fast detection (<10 min) and low fabrication cost (∼A$ 0.6) reveal the suitability of the device for POC use and in resource-limited settings. The tape-paper sensor is a low-cost, fast, and user-friendly device for measurement of blood total bilirubin levels in neonatal jaundice diagnostics.
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Affiliation(s)
- Weirui Tan
- Department of Chemical Engineering, Monash University, Wellington Road, Clayton, VIC 3800, Australia.
| | - Liyuan Zhang
- Department of Chemical Engineering, Monash University, Wellington Road, Clayton, VIC 3800, Australia. and National Local Joint Engineering Laboratory for Advanced Textile Processing and Clean Production, Science and Technology Institute, Wuhan Textile University, Wuhan 430200, China
| | - James C G Doery
- Monash Pathology, Monash Health, Clayton Road, VIC 3168, Australia and Department of Medicine, Monash University, Wellington Road, Clayton, VIC 3800, Australia
| | - Wei Shen
- Department of Chemical Engineering, Monash University, Wellington Road, Clayton, VIC 3800, Australia.
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11
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Mirzaee S, Choy KW, Doery JCG, Zaman S, Cameron JD, Nasis A. The tertiary hospital laboratory; a novel avenue of opportunistic screening of familial hypercholesterolemia. Int J Cardiol Heart Vasc 2019; 23:100354. [PMID: 31080874 PMCID: PMC6503163 DOI: 10.1016/j.ijcha.2019.100354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/09/2019] [Accepted: 03/24/2019] [Indexed: 11/03/2022]
Abstract
Background Familial hypercholesterolemia (FH) is a common monogenic hereditary lipid disorder characterised by increased serum low-density lipoprotein cholesterol (LDL-cholesterol) concentrations and high risk of premature atherosclerotic cardiovascular disease. The prevalence of FH identified in a tertiary hospital laboratory was investigated by performing an opportunistic screen for index cases. Methods The prevalence of likely FH based on LDL-cholesterol thresholds >4.9 mmol/L as employed by the Dutch Lipid Clinic Network Criteria (DLCNC) score was evaluated retrospectively in a single tertiary hospital laboratory over a six-month period (July to December 2016). Results 4943 lipid profiles screened, 106 patients (mean age 53.2 ± 12.9 and 41% male) had LDL-cholesterol of >4.9 mmol/L after exclusion of 5 patients (0.1%) with secondary causes. Possible (n = 90) and probable/definite (n = 16) FH according to DLCNC score was seen in 1.8% and 0.4% of the overall screened population, respectively. Conclusions Point prevalence of screening for FH in patients undergoing lipid profile testing in a tertiary hospital laboratory was comparable with prevalence of FH in general population (based on 1 in 200-250). This supports the benefit of establishing an efficient "alert system" in conjunction with a trigger "reflex testing" to facilitate further formal FH scoring and exclusion of possible secondary causes of hyperlipidemia in potential index FH.
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Key Words
- AHA, American Heart Association
- APO-B, Apolipoprotein-B
- ASCVD, Atherosclerotic cardiovascular disease
- CAD, Coronary artery disease
- DLCNC, Dutch Lipid Clinic Network Criteria
- FH
- FH, Familial hypercholesterolemia
- Familial hypercholesterolemia
- HDL-C, High density lipoprotein cholesterol
- HIV, Human immunodeficiency virus
- LDL-R, Low density lipoprotein receptor
- LDL-cholesterol, Low-density lipoprotein cholesterol
- Opportunistic screening
- PCSK-9, Proprotein convertase subtilisin/kexin type-9
- Tertiary hospital laboratory
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Affiliation(s)
- Sam Mirzaee
- Monash Cardiovascular Research Centre, MonashHEART, Monash Health, Monash University, Melbourne, Australia
| | - Kay W Choy
- Monash Health Pathology, Monash Health, Monash University, Melbourne, Australia
| | - James C G Doery
- Monash Health Pathology, Monash Health, Monash University, Melbourne, Australia
| | - Sarah Zaman
- Monash Cardiovascular Research Centre, MonashHEART, Monash Health, Monash University, Melbourne, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, MonashHEART, Monash Health, Monash University, Melbourne, Australia
| | - Arthur Nasis
- Monash Cardiovascular Research Centre, MonashHEART, Monash Health, Monash University, Melbourne, Australia
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12
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Hashimura H, Shen J, Fuller PJ, Chee NYN, Doery JCG, Chong W, Choy KW, Gwini S, Yang J. Saline suppression test parameters may predict bilateral subtypes of primary aldosteronism. Clin Endocrinol (Oxf) 2018; 89:308-313. [PMID: 29873811 DOI: 10.1111/cen.13757] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/01/2018] [Accepted: 06/04/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND The saline suppression test (SST) serves to confirm the diagnosis of primary aldosteronism (PA) whilst adrenal vein sampling (AVS) is used to determine whether the aldosterone hypersecretion is unilateral or bilateral. An accurate prediction of bilateral PA based on SST results could reduce the need for AVS. AIM We sought to identify SST parameters that reliably predict bilateral PA. METHODS The results from 121 patients undergoing SSTs at Monash Health from January 2010 to January 2018 including screening blood tests, imaging, AVS and histopathology results were evaluated. Patients were subtyped into unilateral or bilateral PA based on AVS and surgical outcomes. RESULTS Of 113 patients with confirmed PA, 33 had unilateral disease whilst 42 had bilateral disease. In those with bilateral disease, plasma aldosterone concentration (PAC) was significantly lower post-SST, together with a significant fall in the aldosterone-renin ratio (ARR). The combination of PAC < 300 pmol/L and a reduction in ARR post-SST provided 96.8% specificity in predicting bilateral disease. Eighteen of 39 patients (49%) with bilateral PA could have avoided AVS using these criteria. CONCLUSION A combination of PAC < 300 pmol/L and a lower ARR post-SST could reliably predict bilateral PA. An independent cohort will be needed to validate these findings.
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Affiliation(s)
- Hikaru Hashimura
- Department of Endocrinology, Monash Health, Clayton, Vic., Australia
| | - Jimmy Shen
- Department of Endocrinology, Monash Health, Clayton, Vic., Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic., Australia
| | - Peter J Fuller
- Department of Endocrinology, Monash Health, Clayton, Vic., Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic., Australia
| | - Nicholas Y N Chee
- Department of Endocrinology, Monash Health, Clayton, Vic., Australia
| | - James C G Doery
- Department of Pathology, Monash Health, Clayton, Vic., Australia
- Department of Medicine, Monash University, Clayton, Vic., Australia
| | - Winston Chong
- Department of Imaging, Monash Health, Clayton, Vic., Australia
| | - Kay Weng Choy
- Department of Pathology, Monash Health, Clayton, Vic., Australia
| | - StellaMay Gwini
- School of Public Health and Preventative Medicine, Monash University, Clayton, Vic., Australia
- University Hospital Geelong - Barwon Health, Geelong, Vic., Australia
| | - Jun Yang
- Department of Endocrinology, Monash Health, Clayton, Vic., Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic., Australia
- School of Clinical Sciences, Monash University, Clayton, Vic, Australia
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13
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Wijeratne N, McNeil AR, Doery JCG, McLeod E, Bergman PB, Montalto J. A Teenage Girl with Unexpected Pubertal Changes. Clin Chem 2018; 64:892-896. [DOI: 10.1373/clinchem.2017.277046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 08/31/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Nilika Wijeratne
- Department of Biochemistry, Dorevitch Pathology, Heidelberg, Victoria, Australia
- Monash Pathology
- Department of Medicine, Monash University
| | - Alan R McNeil
- Department of Biochemistry, Dorevitch Pathology, Heidelberg, Victoria, Australia
| | | | | | - Philip B Bergman
- Department of Pediatric Endocrinology and Diabetes, Monash Children's, Monash Health, Clayton, Victoria, Australia
- Department of Pediatrics, Monash University
| | - Joseph Montalto
- Department of Biochemistry, Dorevitch Pathology, Heidelberg, Victoria, Australia
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14
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Wong P, Milat F, Fuller PJ, Kerr PG, Doery JCG, Oh DH, Jackson D, Gillespie MT, Bowden DK, Pasricha SR, Lau KK. Urolithiasis is prevalent and associated with reduced bone mineral density in β-thalassaemia major. Intern Med J 2018; 47:1064-1067. [PMID: 28891172 DOI: 10.1111/imj.13533] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 01/19/2023]
Abstract
Asymptomatic urolithiasis is common and of mixed composition in patients with β-thalassaemia major. Twenty-seven subjects were imaged using dual-energy computer tomography to determine the presence and composition of urolithiasis. The prevalence of urolithiasis was 59% and affected patients generally had multiple stones, often with more than one component: struvite (33%), calcium oxalate (31%) and cystine (22%). Hypercalciuria was present in 78% of subjects and calcium-containing urolithiasis was associated with reduced femoral neck Z scores.
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Affiliation(s)
- Phillip Wong
- Hudson Institute of Medical Research, Melbourne, Victoria, Australia.,Department of Endocrinology, Monash Health, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Frances Milat
- Hudson Institute of Medical Research, Melbourne, Victoria, Australia.,Department of Endocrinology, Monash Health, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter J Fuller
- Hudson Institute of Medical Research, Melbourne, Victoria, Australia.,Department of Endocrinology, Monash Health, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Biochemistry and Molecular Biology, Monash University, Melbourne, Victoria, Australia
| | - Peter G Kerr
- Department of Renal Medicine, Monash Health, Melbourne, Victoria, Australia
| | - James C G Doery
- Department of Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Pathology, Monash Health, Melbourne, Victoria, Australia
| | - Danielle H Oh
- Department of Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Dana Jackson
- Department of Radiology, Monash Health, Melbourne, Victoria, Australia
| | - Matthew T Gillespie
- Hudson Institute of Medical Research, Melbourne, Victoria, Australia.,Department of Biochemistry and Molecular Biology, Monash University, Melbourne, Victoria, Australia
| | - Donald K Bowden
- Thalassaemia Service, Monash Health, Melbourne, Victoria, Australia
| | - Sant-Rayn Pasricha
- Thalassaemia Service, Monash Health, Melbourne, Victoria, Australia.,Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Ken K Lau
- Department of Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Radiology, Monash Health, Melbourne, Victoria, Australia
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15
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Affiliation(s)
- Nilika Wijeratne
- Department of Pathology and Departments of Medicine and Dorevitch Pathology, Heidelberg, Victoria, Australia;
| | | | - Zhong Xian Lu
- Department of Pathology and Departments of Medicine and Melbourne Pathology, Collingwood, Victoria, Australia
| | - Justin Brown
- Monash Children's Hospital, Monash Health, Clayton, Victoria, Australia; Pediatrics, Monash University, Clayton, Victoria, Australia
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16
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Wong P, Polkinghorne K, Kerr PG, Doery JCG, Gillespie MT, Larmour I, Fuller PJ, Bowden DK, Milat F. Deferasirox at therapeutic doses is associated with dose-dependent hypercalciuria. Bone 2016; 85:55-8. [PMID: 26802257 DOI: 10.1016/j.bone.2016.01.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 12/26/2015] [Accepted: 01/07/2016] [Indexed: 01/19/2023]
Abstract
Deferasirox is an oral iron chelator used widely in the treatment of thalassemia major and other transfusion-dependent hemoglobinopathies. Whilst initial long-term studies established the renal safety of deferasirox, there are now increasing reports of hypercalciuria and renal tubular dysfunction. In addition, urolithiasis with rapid loss of bone density in patients with β thalassemia major has been reported. We conducted a cross-sectional cohort study enrolling 152 adult patients comprising of β thalassemia major (81.5%), sickle cell disease (8%), thalassemia intermedia (2%), HbH disease (6.5%) and E/β thalassemia (2%). Cases were matched with normal control subjects on age, gender and serum creatinine. Iron chelator use was documented and urine calcium to creatinine ratios measured. At the time of analysis, 88.8% of patients were receiving deferasirox and 11.2% were on deferoxamine. Hypercalciuria was present in 91.9% of subjects on deferasirox in a positive dose-dependent relationship. This was not seen with subjects receiving deferoxamine. At a mean dose of 30.2±8.8mg/kg/day, deferasirox was associated with an almost 4 fold increase in urine calcium to creatinine ratio (UCa/Cr). Hypercalciuria was present at therapeutic doses of deferasirox in a dose-dependent manner and warrants further investigation and vigilance for osteoporosis, urolithiasis and other markers of renal dysfunction.
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Affiliation(s)
- Phillip Wong
- Hudson Institute of Medical Research, Victoria, Australia; Department of Endocrinology, Monash Health, Victoria, Australia; Department of Medicine, Monash University, Victoria, Australia.
| | - Kevan Polkinghorne
- Department of Medicine, Monash University, Victoria, Australia; Department of Nephrology, Monash Health, Victoria, Australia
| | - Peter G Kerr
- Department of Medicine, Monash University, Victoria, Australia; Department of Nephrology, Monash Health, Victoria, Australia
| | - James C G Doery
- Department of Medicine, Monash University, Victoria, Australia; Department of Pathology, Monash Health, Victoria, Australia
| | - Matthew T Gillespie
- Hudson Institute of Medical Research, Victoria, Australia; Department of Biochemistry and Molecular Biology, Monash University, Victoria, Australia
| | - I Larmour
- Department of Pharmacy, Monash Health, Victoria, Australia
| | - Peter J Fuller
- Hudson Institute of Medical Research, Victoria, Australia; Department of Endocrinology, Monash Health, Victoria, Australia; Department of Medicine, Monash University, Victoria, Australia; Department of Biochemistry and Molecular Biology, Monash University, Victoria, Australia
| | | | - Frances Milat
- Hudson Institute of Medical Research, Victoria, Australia; Department of Endocrinology, Monash Health, Victoria, Australia; Department of Medicine, Monash University, Victoria, Australia
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17
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Wijeratne N, Tudball R, Choy KW, Fietz M, Doery JCG. What's Wrong with the Transferrin? Clin Chem 2016; 62:413-4. [PMID: 26823612 DOI: 10.1373/clinchem.2015.241083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Nilika Wijeratne
- Department of Pathology, Monash Health, Clayton, VIC, Australia; Department of Medicine, Monash University, Clayton, VIC, Australia; Dorevitch Pathology, Heidelberg, VIC, Australia;
| | - Ronald Tudball
- Department of Pathology, Monash Health, Clayton, VIC, Australia
| | - Kay Weng Choy
- Department of Pathology, Monash Health, Clayton, VIC, Australia
| | - Michael Fietz
- Department of Biochemical Genetics, National Referral Laboratory, SA Pathology, Adelaide, SA, Australia
| | - James C G Doery
- Department of Pathology, Monash Health, Clayton, VIC, Australia; Department of Medicine, Monash University, Clayton, VIC, Australia
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18
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Itman C, Bielanowicz A, Goh H, Lee Q, Fulcher AJ, Moody SC, Doery JCG, Martin J, Eyre S, Hedger MP, Loveland KL. Murine Inhibin α-Subunit Haploinsufficiency Causes Transient Abnormalities in Prepubertal Testis Development Followed by Adult Testicular Decline. Endocrinology 2015; 156:2254-68. [PMID: 25781564 DOI: 10.1210/en.2014-1555] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Activin production and signaling must be strictly regulated for normal testis development and function. Inhibins are potent activin inhibitors; mice lacking the inhibin-α gene (Inha-/- mice) cannot make inhibin and consequently have highly elevated activin and FSH serum concentrations and excessive activin signaling, resulting in somatic gonadal tumors and infertility. Dose-dependent effects of activin in testicular biology have been widely reported; hence, we hypothesized that male mice lacking one copy of the Inha gene would produce less inhibin and have an abnormal reproductive phenotype. To test this, we compared hormone concentrations, testis development, and sperm production in Inha+/+ and Inha+/- mice. Serum and testicular inhibin-α concentrations in adult Inha+/- mice were approximately 33% lower than wild type, whereas activin A, activin B, FSH, LH, and T were normal. Sixteen-day-old Inha+/- mice had a mixed phenotype, with tubules containing extensive germ cell depletion juxtaposed to tubules with advanced Sertoli and germ cell development. This abnormal phenotype resolved by day 28. By 8 weeks, Inha+/- testes were 11% larger than wild type and supported 44% greater daily sperm production. By 26 weeks of age, Inha+/- testes had distinct abnormalities. Although still fertile, Inha+/- mice had a 27% reduction in spermatogenic efficiency, a greater proportion of S-phase Sertoli cells and lower Leydig cell CYP11A1 expression. This study is the first to identify an intratesticular role for inhibin/inhibin-α subunit, demonstrating that a threshold level of this protein is required for normal testis development and to sustain adult somatic testicular cell function.
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Affiliation(s)
- Catherine Itman
- Priority Research Centres for Reproductive Science (C.I., A.B., J.M., S.E.) and Chemical Biology (C.I.), School of Environmental and Life Sciences, Faculty of Science and Information Technology, University of Newcastle, Callaghan, New South Wales 2308, Australia; Departments of Anatomy and Developmental Biology (H.G., Q.L., K.L.L.) and Biochemistry and Molecular Biology (S.C.M., K.L.L.) and Monash Micro Imaging (A.J.F.), Monash University, Clayton, Victoria 3800, Australia; and Faculty of Medicine, Nursing, and Health Sciences (J.C.G.D.), Department of Medicine, Monash Medical Centre, and Monash Institute of Medical Research-Prince Henry's Institute of Medical Research (M.P.H.), Clayton, Victoria 3168, Australia
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19
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Davies-Tuck M, Yim C, Knight M, Hodges R, Doery JCG, Wallace E. Vitamin D testing in pregnancy: Does one size fit all? Aust N Z J Obstet Gynaecol 2015; 55:149-55. [PMID: 25900732 DOI: 10.1111/ajo.12278] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 09/20/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND Vitamin D deficiency is common. What the optimum level of vitamin D in pregnancy and whether vitamin D supplementation in pregnancy confers improved health benefits remain controversial. AIM To assess vitamin D status in pregnant women in a maternity service that recommends routine antenatal screening and advises supplementation where necessary, and to assess relationships between early pregnancy vitamin D levels and changes in vitamin D across pregnancy with pregnancy outcomes. MATERIALS AND METHODS Vitamin D serum concentrations were measured in early and late pregnancy. The relationships between initial vitamin D status, maternal factors and pregnancy outcomes were estimated. Change in vitamin D over pregnancy was quantified. The relationship between change in vitamin D over pregnancy and pregnancy outcomes was also estimated. RESULTS Of 1550 women, 849 (55%) were vitamin D deficient (<50 nmol/L), 571 (37%) were insufficient (50-74 nmol/L), and 130 (8%) were replete (≥75 nmol/L) in early pregnancy. Factors associated with deficiency were increased body mass index, pregnancy in either winter or spring months, and maternal country of birth (South-East, South and East Asia, and Africa). Vitamin D deficiency or insufficiency in early pregnancy was significantly associated with developing gestation diabetes mellitus. Levels of vitamin D significantly increased over pregnancy among nonreplete women. Increasing vitamin D over pregnancy was not related to pregnancy outcomes. CONCLUSION Vitamin D 'deficiency' is common but may not be associated with most adverse pregnancy outcomes. Routine vitamin D testing of all pregnant women does not appear warranted.
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Affiliation(s)
- Miranda Davies-Tuck
- The Ritchie Centre, MIMR-PHI Institute of Medical Research, Clayton, Vic., Australia; Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Vic., Australia
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20
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Affiliation(s)
- Nilika G Wijeratne
- Department of Pathology, Monash Health, Clayton, Victoria, Australia; Department of Medicine, Monash University, Clayton, Victoria, Australia; Dorevitch Pathology, Heidelberg, Victoria, Australia;
| | - Kung-Ting Kao
- Department of Pediatric Endocrinology and Diabetes, Monash Children's, Monash Health, Clayton, Victoria, Australia
| | - Peter J Simm
- Department of Pediatric Endocrinology and Diabetes, Monash Children's, Monash Health, Clayton, Victoria, Australia; Department of Endocrinology and Diabetes, The Royal Children's Hospital, Parkville, Victoria, Australia; Centre for Hormone Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - James C G Doery
- Department of Pathology, Monash Health, Clayton, Victoria, Australia; Department of Medicine, Monash University, Clayton, Victoria, Australia
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Fedele PL, Choy KW, Doery JCG, Grigoriadis G, Shortt J, Lu ZX. Inter-laboratory discordance of beta-2 microglobulin results: impact on the validity of the international staging system for multiple myeloma. Br J Haematol 2014; 166:951-3. [DOI: 10.1111/bjh.12922] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Kay-Weng Choy
- Pathology Department; Monash Medical Centre; Clayton Vic. Australia
| | - James C. G. Doery
- Pathology Department; Monash Medical Centre; Clayton Vic. Australia
- Southern Clinical School; Faculty of Medicine; Dentistry and Health Sciences; Monash University; Clayton Vic. Australia
| | - George Grigoriadis
- Monash Haematology; Monash Medical Centre; Clayton Vic. Australia
- Southern Clinical School; Faculty of Medicine; Dentistry and Health Sciences; Monash University; Clayton Vic. Australia
| | - Jake Shortt
- Monash Haematology; Monash Medical Centre; Clayton Vic. Australia
- Southern Clinical School; Faculty of Medicine; Dentistry and Health Sciences; Monash University; Clayton Vic. Australia
| | - Zhong X. Lu
- Pathology Department; Monash Medical Centre; Clayton Vic. Australia
- Southern Clinical School; Faculty of Medicine; Dentistry and Health Sciences; Monash University; Clayton Vic. Australia
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Abstract
INTRODUCTION A standard short Synacthen test (SST) is the conventional diagnostic test for primary hypoadrenalism. Measuring simultaneous plasma cortisol and adrenocorticotrophin hormone (ACTH) and using the cortisol: ACTH ratio as a first-line test may be safer and more convenient than performing a SST. METHODS A retrospective study of 349 patients who had a SST with simultaneous baseline plasma cortisol and ACTH performed between 2005 and 2010 in two separate Australian health centres. The plasma cortisol: ACTH ratio was calculated for each patient and their final diagnosis was determined based on their SST result and a review of their clinical notes. RESULTS Eighteen patients had primary hypoadrenalism, 46 patients had secondary hypoadrenalism and 285 patients had normal adrenal function. All the patients with primary hypoadrenalism had a plasma cortisol: ACTH ratio <3, while none of the patients with normal adrenal function or secondary hypoadrenalism had a cortisol: ACTH ratio <3. Therefore, a cortisol: ACTH ratio <3 had a 100% sensitivity and specificity for the diagnosis of primary hypoadrenalism. Patients with secondary hypoadrenalism had a cortisol: ACTH ratio >3, while subjects with normal adrenal function had a cortisol: ACTH ratio >15. There was overlap in cortisol: ACTH ratios of patients with secondary hypoadrenalism and normal adrenal function. CONCLUSIONS Although the cortisol: ACTH ratio predicts primary hypoadrenalism, its value is limited to diagnosing primary hypoadrenalism as it does not distinguish secondary hypoadrenalism from normal adrenal function. Larger prospective studies that include patients with early primary hypoadrenalism are needed to confirm the reliability of plasma cortisol: ACTH ratio as a diagnostic test for primary hypoadrenalism.
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Affiliation(s)
- Mark K V Lee
- Department of Internal Medicine, Royal Perth Hospital, , Perth, Western Australia, Australia
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Milat F, Wong P, Fuller PJ, Johnstone L, Kerr PG, Doery JCG, Strauss BJ, Bowden DK. A case of hypophosphatemic osteomalacia secondary to deferasirox therapy. J Bone Miner Res 2012; 27:219-22. [PMID: 21956684 DOI: 10.1002/jbmr.522] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 07/13/2011] [Accepted: 08/25/2011] [Indexed: 01/30/2023]
Abstract
Patients with β-thalassemia major require iron-chelation therapy to avoid the complication of iron overload. Until recently, deferoxamine (DFO) was the major iron chelator used in patients requiring chronic hypertransfusion therapy, but DFO required continuous subcutaneous therapy. The availability of deferasirox (Exjade®), an orally active iron chelator, over the past 4 years represented a necessary alternative for patients requiring chelation therapy. However, there have been increasing reports of proximal renal tubular dysfunction and Fanconi syndrome associated with deferasirox in the literature. We report a case of hypophosphataemic osteomalacia secondary to deferasirox therapy.
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Affiliation(s)
- Frances Milat
- Prince Henry's Institute and Department of Endocrinology, Melbourne, Australia
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24
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Wijeratne NG, Doery JCG, Graudins A. Occult lead poisoning from Ayurvedic medicine produced, prescribed and purchased in India. Med J Aust 2011; 194:205-6. [PMID: 21401464 DOI: 10.5694/j.1326-5377.2011.tb03776.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 11/28/2010] [Indexed: 11/17/2022]
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Coakley J, Scott S, Mackay R, Greaves R, Jolly L, Massie J, Mishra A, Bransden A, Doery JCG, Chiriano A, Robins H. Sweat testing for cystic fibrosis: standards of performance in Australasia. Ann Clin Biochem 2009; 46:332-7. [DOI: 10.1258/acb.2009.009023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Accurate measurement of sweat chloride concentration is essential for the diagnosis of cystic fibrosis (CF). We surveyed all laboratories enrolled in the Royal College of Pathologists of Australasia Quality Assurance Program (QAP) for Sweat Electrolytes to determine how closely they comply with the Australian Guidelines for the performance of the sweat test for the diagnosis of CF. Methods A detailed questionnaire covering most aspects of sweat collection and analysis was sent to all participating laboratories in 2007. Results Twenty out of 38 laboratories completed the questionnaire. While adherence to accepted guidelines was noted in many areas, the following main variations were recorded: some laboratories were not doing enough sweat tests to maintain expertise; some were not collecting sweat for the recommended collection time; sweat conductivity was the only test available in some laboratories; there was a lack of agreement between the sweat chloride concentration used to indicate CF or define an equivocal result. Conclusions There is room for improvement in the performance of the sweat test in some laboratories in Australasia. The Sweat Testing Working Party of the Australasian Association of Clinical Biochemists is the appropriate body to address the problems involved in sweat testing and to bring about change.
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Affiliation(s)
- John Coakley
- Department of Biochemistry, The Children's Hospital at Westmead, Westmead
| | - Sue Scott
- RCPA Chemical Pathology Quality Assurance Programs, Adelaide, Australia
| | - Richard Mackay
- Clinical Biochemistry Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Ronda Greaves
- Department of Clinical Biochemistry, The Royal Children's Hospital, Melbourne
| | - Lisa Jolly
- RCPA Chemical Pathology Quality Assurance Programs, Adelaide, Australia
| | - John Massie
- Department of Respiratory Medicine, The Royal Children's Hospital, Melbourne
| | | | - Anna Bransden
- Department of Chemical Pathology, Royal Brisbane Hospital, Brisbane
| | - James C G Doery
- Department of Biochemistry, Monash Medical Centre and Department of Medicine, Monash University, Melbourne
| | - Angela Chiriano
- Department of Clinical Biochemistry, The Royal Children's Hospital, Melbourne
| | - Heather Robins
- Department of Biochemistry, The Canberra Hospital, ACT, Australia
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Newman JD, Doery JCG. Assessing hypogonadism in men--how helpful are current testosterone assays? Aust Fam Physician 2008; 37:670-671. [PMID: 18704220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In recent years, hormone therapy (HT) with testosterone has gained increasing prominence and popularity in aging men. It has a demonstrated ability to decrease fat mass and increase lean body mass in men with initial 'low' testosterone levels. The Australian Pharmaceutical Benefits Scheme (PBS) only allows subsidisation of male HT if two morning testosterone values are <8.0 nmol/L (or 8-15 nmol/L with elevated luteinising hormone [LH]). The scientific basis of this 'cut off' for testosterone replacement is unclear but it is close to the lower limit of normal for some laboratories. There is well documented diurnal variation (and even seasonal variation) of testosterone. However, the PBS requirements avoid such diurnal variation by requiring two morning blood samples. The underlying assumption is that all laboratories obtain similar results.
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Affiliation(s)
- Julie D Newman
- Biochemistry Unit, Southern Cross Pathology Australia, Monash Medical Centre, Department of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria.
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Newman JD, Bergman PB, Doery JCG, Balazs NDH. Factitious Increase in Thyrotropin in a Neonate Caused by a Maternally Transmitted Interfering Substance. Clin Chem 2006; 52:541-2. [PMID: 16510439 DOI: 10.1373/clinchem.2005.064832] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
Abstract The present study describes the clinical and laboratory features of 11 patients with thyrotoxic, hypokalaemic periodic paralysis, presenting to five Melbourne teaching hospitals between 1991 and 2000. All 11 patients were Asian or Polynesian men aged 18-41 years, and most had experienced previous episodes of acute, unexplained paralysis. All cases resolved without significant morbidity. Thyrotoxic, hypokalaemic periodic paralysis is a potentially life-threatening and terrifying condition, which is often under-recognized and will present with increasing frequency in the community. The diagnosis should be considered in any Asian-Australian male presenting with sudden onset paralysis.
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Affiliation(s)
- H A Tran
- ACT Pathology, The Canberra Hospital, Canberra, Australian Capital Territory,Victoria, Australia.
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