CLINICAL BIOCHEMISTRY DEPARTMENT

 
ASSESSMENT OF PITUITARY FUNCTION

Please read instructions before commencing test

PATIENT DETAILS

Name:

  

Hosp. No:

  

Ward:

  

Consultant:

  

Date:

  

Signed:

  


DOSAGE DETAILS
Dose		 Time Given
(Please indicate if not given)

Insulin

    

Repeat Insulin*

    

TRH

    

LH-RH

    


SAMPLE DETAILS

     

Actual Time

 Repeat Dose*

Actual Time

 Tests performed

1.

Basal

    

Glu, Cort, GH, (TSH, LH/FSH, Prolactin).

2.

20 min

 

  

Glu, Cort, GH, (TSH, LH/FSH).

3.

45 min

 

  

Glucose only.

4.

60 min

 

  

Glu, Cort, GH, (TSH, LH/FSH).

5.

90 min

 

  

Glucose, Cortisol, GH.

6.

120 min

 

  

Glucose, Cortisol, GH.

*Only complete if repeat dose of insulin is required at 60 minutes.

NOTES

a)

Collect 6ml clotted blood in SST tube (yellow top) + fluoride (grey top) at each time specified above.

Paediatric specimens: If difficult to bleed, collect as much blood as possible into 6ml SST tubes (yellow top) only (no fluoride tube).

b)

Label all specimen containers with sequence number, record actual time taken above. When test is complete, send form and all the specimens to Clinical Biochemistry as soon as possible (keep at 4°C until delivered).

c)

Please note the times of any clinical symptoms of hypoglycaemia.