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Membership & Community

RECENT Artery Conversations

Bromcresol Purple Albumin Reference Interval

I was wondering if anyone out there is using bromcresol purple to measure albumin and if so what reference interval they are using. I have been looking in the literature and all I can find is BCG ranges. Can you help?

Should the breathalyzer be under the purview of the lab?

I recently received a point of care request for a breathalyzer for use in our drug abuse clinic. When I reviewed the package insert for the requested breathalyzer, I realized that we would not be able to evaluate the performance of this instrument, nor find or be able to run quality control materials for it. I'm leaning towards this not being a lab test or falling under the purview of the lab. What do you think, should this fall under the purview of the lab? Have you encountered this situation or used the breathalyzer as a point of care test at your institution?

Suspected Cushing’s in a patient on exogenous glucocorticoids

How would you investigate suspected Cushing's in a patient who is on exogenous glucocorticoids? In 2003 ACTH producing pituitary adenoma was diagnosed in a patient. This required several attempts of transphenoidal surgeries, radiotherapy and mitotane before she develop hypopituitarism. She has even presented with adrenal crisis in 2013 when her ACTH was <10 ng/L (RR 10-50)and serum cortisol was 45 nmol/L, Sodium 115 mmol/L (135-145). Now the patient is on hydrocortisone 16mg (8mg mane, 4 mg mid-day, 4 mg afternoon). The patient is concerned she might have developed Cushing's and at times she becomes non-compliant. She is 28 weeks into her pregnancy. She does not have overt cushioned features according to the endocrinologist. There is 8 kg weight gain over the last 2 years. She is now 41 years. Clinical questions How to diagnose a recurrence? Could this be related to exogenous glucocorticoids? Is she over-treated? How to investigate?