Lege Artis Medicinae

[Evaluating endocrine laboratory findings]

KOVÁCS L. Gábor1, TOLDY Erzsébet1, LŐCSEI Zoltán2

FEBRUARY 01, 2000

Lege Artis Medicinae - 2000;10(02)

[The clinical value of hormonal laboratory findings is determined by many more factors than of the conventional (non-endocrine) parameters. The increased complexity is partly due to the physiological and pathophysiological properties of hormonal biomolecules as well as to the characteristic differences in the analytical methods. Correct interpretation of the endocrine results requires the consideration of potential preanalytical errors and the collection and handling of samples done more carefully. Because of the low physiological concentrations of hormones, only microanalytical methods can be used. Endocrine parameters in clinical laboratories are usually measured with immunoassay methods these days. Due to the assay characteristics of these methods (e.g. cross-reactivity of the antibodies, specificity, technology-dependent differences in sensitivity), numerical values appearing on the laboratory reports – particularly if not accompanied with additional information - may be incorrectly interpreted by the clinicians. Therefore, plausibility control should be an integral part of the post-analytical tasks of a laboratory. The authors evaluate these specialties based on their own analytical and clinical experience as well as on literature data. It is concluded that correct endocrine laboratory report should contain not only data on reference values, but also the confidentiality limits of the given endocrine test. Subnormal values, provided they are of clinical relevance, should be evaluated together with the variation coefficient and the functional sensitivity, measured specifically in this lower range. The frequently asked question, whether a difference in endocrine results is due to biological factors determined by a disease, or to analytical problems, is particularly important when using dynamic tests. ]


  1. Központi Laboratórium Vas megyei Markusovszky Kórház, Orvostudományi Egyetemi Oktatókórház, Szombathely
  2. I. Sz. Belgyógyászati Osztály, Vas megyei Markusovszky Kórház, Orvostudományi Egyetemi Oktatókórház, Szombathely



Further articles in this publication

Lege Artis Medicinae

[Perinatal postasphyxial brain damage and its obstetric prevention]

PAPP Zoltán

[The author provides an overview of the definition and aethiopathogenesis of fetal hypoxia and asphyxia, including possible forms of post asphyxial damages of mature fetuses as well as the incidence and neurological consequences of cerebralpalsy. Among from the screening methods of fetal hypoxia the special importance of colour-Doppler and pulse-Doppler technique (flowmetry), cardiotocography (CTG), non-stress test, biophysical profile examinations, amnioscopy and fetal pulsoxymetry are emphasized. In the prevention of fetal asphyxia the significance of preconceptional and prenatal care, the importance of maternal diseases, pathological conditions of the fetus and the umbilical cord, as well as the influence of factors during labour and delivery are also emphasized. The practice of the authors is supported by the recommendation of British obstetricians, when making a fetal scalp pH examination in case of pathological CTG findings, or performing a prophylactic cesarean section if the pH examination is not available. Since the number of postasphyxial damage in mature newborn infants is still high in Hungary, it is concluded, that an increase is required in the rate of cesarean sections when fetal asphyxia is present. ]

Lege Artis Medicinae

[Practical questions of perinatal thyroidology]

ILYÉS István

[Characteristic features of maternal, fetal and neonatal thyroid functions are discussed. The role of maternal thyroid hormone transfer in fetal development is emphasised with the interpretation of the association between maternal and fetal thyroid functions. Thyroid disorders and dysfunctions during neonatal period are summarised and the influence of maternal thyroid disease to neonatal thyroid function is demonstrated. The role of iodine deficiency and importance of optimal iodine intake during pregnancy are also emphasised. Congenital hypothyroidism and thyroid dysfunctions of premature infants are shortly presented. The importance of prenatal care, screening for congenital hypothyroidism and thyroid function checks in premature infants are also pointed out. ]

Lege Artis Medicinae

[Scientific Browser]

Lege Artis Medicinae

[A case of juvenile haemochromatosis presenting adrenocortical insufficinecy ]

VÁRKONYI Andrea, KOLLAI Géza, ROMCSIK László, MÜZES Györgyi, TULASSAY Zsolt, TORDAI Attila, ANDRIKOVICS Hajnalka, PETER Kaltwasser Joachim, SEIDL Christian

[Juvenile haemochromatosis is a rare autosomally inherited disorder of iron metabolism causing severe iron overload in young adults. The organs mostly affected are liver, spleen, pancreas, heart and the skin similarly to the genetically also determined adult form. CASE REPORT - Contrary to most juvenile haemochromatosis cases characterised by secondary hypogonadotropic hypogonadism, this patient presented with adrenocortical insufficiency. Involvement of the heart was present on diagnosis while liver showed normal architecture without increased iron content. Genetic analysis revealed that the patient did not carry the C282Y mutation, while the H63D mutation was present in heterozygous form. With hormone supply and regular vena sections the patient is free of complaints. CONCLUSION – This case demonstrates that severe iron overload can occur early in adult life without the presence of HFE gene mutations suggesting a putative gene defect responsible for juvenile haemochromatosis. ]

Lege Artis Medicinae

[Standardizing the results of Diabcare Hungary; A method for comparison and quality Improvement]

TABÁK Gy. Ádám, TAMÁS Gyula, KERÉNYI Zsuzsa

[INTRODUCTION – DiabCare, the monitoring system of the WHO/IDF-Euro was developed for continuous quality improvement of diabetes care based on a structured and standardized diabetes dataset. PATIENTS AND METHODS - Data from 5 DiabCare Hungary centers with different patient populations were adjusted for demographic parameters and compared to the 2403 records of the national dataset collected between 1995–97. RESULTS - More than half of the investigated patients were >56 years old (centers analyzed in detail: 20–83%), one third of them had an age 36-55 years (17-52%), 45% were male (27-63%). The prevalence of type 1 DM was 29% (0–80%). Almost one third of the patients had a diabetes duration >15 years (14-58%). Eyes were examined in 79% (28-98%), retinopathy was found in 29% (28–81%, minimal change after standardization). Risk factor identification was above 80% in all centers (except in center 3: 16-94%). Rate of patients with risk factors: HbAlc >8%: 43%; triglycerides >2mmol/l: 33% (in center 5 lower, 17%; after standardization 37%), blood pressure (>160/95 Hgmm), smoking and alcohol consumption together 15%. Albuminuria was examined in 55% (25–89%), with microalbuminuria present in 24% (0-38%). The frequency of self-monitoring and of severe hypoglycemia (49 and 5%) paralleled the relative weight of type1 DM patients during standardization. CONCLUSION - It is concluded that centralized evaluation and anonymous comparison of crude and adjusted data might be helpful in assessing and improving the quality of diabetes care. ]

All articles in the issue

Related contents

Clinical Neuroscience

Cases of inborn errors of metabolism diagnosed in children with autism

CAKAR Emel Nafiye, YILMAZBAS Pınar

Autism spectrum disorder is a neurodevelopmental disorder with a heterogeneous presentation, the etiology of which is not clearly elucidated. In recent years, comorbidity has become more evident with the increase in the frequency of autism and diagnostic possibilities of inborn errors of metabolism. One hundred and seventy-nine patients with diagnosis of autism spectrum disorder who presented to the Pediatric Metabolism outpatient clinic between 01/September/2018-29/February/2020 constituted the study population. The personal information, routine and specific metabolic tests of the patients were analyzed retrospectively. Out of the 3261 patients who presented to our outpatient clinic, 179 (5.48%) were diagnosed with autism spectrum disorder and were included in the study. As a result of specific metabolic examinations performed, 6 (3.3%) patients were diagnosed with inborn errors of metabolism. Two of our patients were diagnosed with classical phenylketonuria, two with classical homocystinuria, one with mucopolysaccharidosis type 3D (Sanfilippo syndrome) and one with 3-methylchrotonyl Co-A carboxylase deficiency. Inborn errors of metabolism may rarely present with autism spectrum disorder symptoms. Careful evaluation of the history, physical examination and additional findings in patients diagnosed with autism spectrum disorder will guide the clinician in the decision-making process and chose the appropriate specific metabolic investigation. An underlying inborn errors of metabolism may be a treatable cause of autism.

Clinical Neuroscience

Electrophysiological investigation for autonomic dysfunction in patients with myasthenia gravis: A prospective study


Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular transmission. Autonomic dysfunction is not a commonly known association with MG. We conducted this study to evaluate autonomic functions in MG & subgroups and to investigate the effects of acetylcholinesterase inhibitors. This study comprised 30 autoimmune MG patients and 30 healthy volunteers. Autonomic tests including sympathetic skin response (SSR) and R-R interval variation analysis (RRIV) was carried out. The tests were performed two times for patients who were under acetylcholinesterase inhibitors during the current assessment. The RRIV rise during hyperventilation was better (p=0.006) and Valsalva ratio (p=0.039) was lower in control group. The SSR amplitudes were lower thereafter drug intake (p=0.030). As much as time went by after drug administration prolonged SSR latencies were obtained (p=0.043).Valsalva ratio was lower in the AchR antibody negative group (p=0.033). The findings showed that both ocular/generalized MG patients have a subclinical parasympathetic abnormality prominent in the AchR antibody negative group and pyridostigmine has a peripheral sympathetic cholinergic noncumulative effect.

Clinical Neuroscience

Comparison of direct costs of percutaneous full-endoscopic interlaminar lumbar discectomy and microdiscectomy: Results from Turkey

ÜNSAL Ünlü Ülkün, ŞENTÜRK Salim

Microdiscectomy (MD) is a stan­dard technique for the surgical treatment of lumbar disc herniation (LDH). Uniportal percutaneous full-endoscopic in­terlaminar lumbar discectomy (PELD) is another surgical op­tion that has become popular owing to reports of shorter hos­pitalization and earlier functional recovery. There are very few articles analyzing the total costs of these two techniques. The purpose of this study was to compare total hospital costs among microdiscectomy (MD) and uniportal percutaneous full-endoscopic interlaminar lumbar discectomy (PELD). Forty patients aged between 22-70 years who underwent PELD or MD with different anesthesia techniques were divided into four groups: (i) PELD-local anesthesia (PELD-Local) (n=10), (ii) PELD-general anesthesia (PELD-General) (n=10), (iii) MD-spinal anesthesia (MD-Spinal) (n=10), (iv) MD-general anesthesia (MD-General) (n=10). Health care costs were defined as the sum of direct costs. Data were then analyzed based on anesthetic modality to produce a direct cost evaluation. Direct costs were compared statistically between MD and PELD groups. The sum of total costs was $1,249.50 in the PELD-Local group, $1,741.50 in the PELD-General group, $2,015.60 in the MD-Spinal group, and $2,348.70 in the MD-General group. The sum of total costs was higher in the MD-Spinal and MD-General groups than in the PELD-Local and PELD-General groups. The costs of surgical operation, surgical equipment, anesthesia (anesthetist’s costs), hospital stay, anesthetic drugs and materials, laboratory wor­kup, nur­sing care, and postoperative me­dication diffe­red significantly among the two main groups (PELD-MD) (p<0.01). This study demonstrated that PELD is less costly than MD.

Clinical Neuroscience

Atypical presentation of late-onset Sandhoff disease: a case report

SALAMON András , SZPISJAK László , ZÁDORI Dénes, LÉNÁRT István, MARÓTI Zoltán, KALMÁR Tibor , BRIERLEY M. H. Charlotte, DEEGAN B. Patrick , KLIVÉNYI Péter

Sandhoff disease is a rare type of hereditary (autosomal recessive) GM2-gangliosidosis, which is caused by mutation of the HEXB gene. Disruption of the β subunit of the hexosaminidase (Hex) enzyme affects the function of both the Hex-A and Hex-B isoforms. The severity and the age of onset of the disease (infantile or classic; juvenile; adult) depends on the residual activity of the enzyme. The late-onset form is characterized by diverse symptomatology, comprising motor neuron disease, ataxia, tremor, dystonia, psychiatric symptoms and neuropathy. A 36-year-old female patient has been presenting progressive, symmetrical lower limb weakness for 9 years. Detailed neurological examination revealed mild symmetrical weakness in the hip flexors without the involvement of other muscle groups. The patellar reflex was decreased on both sides. Laboratory tests showed no relevant alteration and routine electroencephalography and brain MRI were normal. Nerve conduction studies and electromyography revealed alterations corresponding to sensory neuropathy. Muscle biopsy demonstrated signs of mild neurogenic lesion. Her younger brother (32-year-old) was observed with similar symptoms. Detailed genetic study detected a known pathogenic missense mutation and a 15,088 base pair long known pathogenic deletion in the HEXB gene (NM_000521.4:c.1417G>A; NM_000521:c.-376-5836_669+1473del; double heterozygous state). Segregation analysis and hexosaminidase enzyme assay of the family further confirmed the diagnosis of late-onset Sandhoff disease. The purpose of this case report is to draw attention to the significance of late-onset Sandhoff disease amongst disorders presenting with proximal predominant symmetric lower limb muscle weakness in adulthood.

Journal of Nursing Theory and Practice

[Results of a national survey in the field of primary care]

HIRDI Henriett Éva, KÁLMÁNNÉ Simon Mária, BALOGH Zoltán

[To identify recent national trends in the employment and earnings of nursing personnel in primary healthcare and determine whether salaries and wage growth are associated with changes in the employment. The cross-sectional survey was conducted between 17 May 2021 and 17 June 2021 among nurses working in general, child and family practices, and dental practices selected using a random, sampling method (N=2007). The data gathering took place using a web-based, anonymous, self-completion questionnaire. The authors analysed the gathered data with Microsoft Excel 2007 and SPSS 22.0 software, employing descriptive statistical methods. Participants are highly experienced, with 80% reporting more than 16 years of experience. 7.9% of nurses are educated at or above the baccalaureate level. The majority (89.5%) work full-time as employees of their organizations (95.4%). The GP’s territorial care obligation disparities in nurses salaries documented here should spark healthcare policymakers to conduct pay equity assessments of employees’ salaries to identify and ameliorate pay inequality. The study findings also indicate that tailoring salaries to qualification for the individual nurses may aid in recruiting and retaining nurses in practice. ]