Services A to Z

Glasgow Royal Infirmary (GRI)

The laboratory is located in the MacEwen Building on Alexandra Parade (adjacent to A and E). It provides routine service Monday to Friday between 9.00am and 5.00pm and on Saturday between 9.00am and 12.00pm. An emergency service operates at all times.

Gartnavel General Hospital (GGH)

The main laboratory is at GGH (in the Laboratory Block of the GGH Complex). This laboratory provides routine and emergency services Monday to Friday between 9.00am and 5.00pm. Between 5.00pm and 7.30pm samples can be sent via the pneumatic tube system, these will be diverted to the porter’s room and sent regularly to GRI for analysis. This service stops at 7.30pm, all samples collected after this time should be sent via taxi to the laboratories at GRI. This taxi should be organised locally at ward level. Any samples sent in the pneumatic tube system after 7.30pm may remain un-analysed until the next day.

New Stobhill Hospital

A small satellite laboratory is located on Level 1 and operates Monday to Friday between 9.00am and 5.00pm.

Enquiries (9.00am until 5.00pm)

There is a central reporting office located at GRI which covers the three North Glasgow laboratory sites.

Duty Biochemist/General Enquiries 0141 242 9500 (x.29500)

Enquiries (Out of Hours)

Contact the on-call biochemist via switchboard 0141 211 4000

Emergency Laboratories (24/7)

Glasgow Royal Infirmary call 0141 211 4487 (x.24487)

Thank you for continuing to send samples to the Biochemistry Department at Glasgow Royal Infirmary. In April 2025 we had a UKAS inspection to assess compliance to ISO15189. This assessment highlighted known deficiencies in the processing of external quality assessment (EQA) samples. While all analytes remained registered with an EQA provider, factors out with our control led to gaps in result reporting and review. In response to these gaps UKAS are suspending our accreditation for a subset of analytes until July 2025. A comprehensive list of affected analytes is listed within the letter to users.

As a department we are working hard to retrospectively review any outstanding EQA and fully expect accreditation for all effected assays to be reinstated in July. Service users will not experience any changes to the routine operations of the department during this period.

During periods of Trakcare downtime, Biochemistry requests must be made on paper request forms. The paper request form should also be used for add on requests. Request forms can be ordered through PECOS, however a pdf copy of the Biochemistry is available for download and printing.

North Glasgow Biochemistry Ward User Survey 2023

Audit of Myeloma Screen requesting in Primary Care 2023

Audit of PTH requesting in Primary Care 2021

• Clyde Laboratory Handbook
• Quality Manual
• Centrifuge Requirements in Non-Laboratory areas

• Newsletter 1 – August 2014
• Newsletter 2 – November 2014
• Newsletter 3 – April 2015
• Newsletter 4 – September 2015
• Newsletter 5 – March 2016
• Newsletter 6 – August 2016
• Newsletter 7 – February 2017
• Newsletter 8 – October 2017
• Newsletter 9 – December 2017
• Newsletter 10 – April 2018
• Newsletter 11 – October 2018
• Newsletter Supplemental – QFIT
• Newsletter 12 – February 2019
• Newsletter 13 – July 2019
• Newsletter 14 – December 2019
• Newsletter 15 – February 2020
• Newsletter 16 – July 2020
• Newsletter 17 – December 2020
• Newsletter 18 – October 2021
• Newsletter 19 – March 2022
• Newsletter 20 – September 2022
• Newsletter 21 – December 2022
• Newsletter 22 – April 2023
• Newsletter 23 – August 2023
• Newsletter 24 – September 2023
• Newsletter 25 – April 2024
• Newsletter 26 – November 2024

• Primary Care 2017 (2022 coming soon)
• Secondary Care 2021

• Patient identification for patients without CHI (Dec 2018)
• The importance of putting samples in the correct bag for transport to laboratories (Dec 2018)
• Transport bags poster (Dec 2018)
• Transport bags poster (Bute and Dunoon) (Dec 2018)
• Please do not send requests for tests done by other disciplines on Biochemistry / Haematology request forms (Jan 2020)
• QFit for practices not using ICE electronic ordering (Jan 2020)
• Changes to the urine catecholamine and 5HIAA service (GRI memo, Mar 2020)
• Introduction of Active B12 assay (May 2024)
• IFU email add on service (Nov 2024)

• Use of paper request forms when Trakcare not available (Nov 2018)
• Sending samples requested on Trakcare to the laboratory (Nov 2018)
• Cryoglobulin service at Vale of Leven (Nov 2018)
• Barcodes for Point of Care Testing (Nov 2018)
• Urine pregnancy test false positive results (Jul 2019)
• Biochemistry samples apparently being put in Microbiology bags (Aug 2019)
• New P3NP assay (Oct 2019)
• GEM 5000 gas analysers (Nov 19)
• Biochemistry samples apparently being put in Microbiology or Virology bags (Apr 2020)
• IFU email add on service (Nov 2024)
• Request slip for biochemistry add ons – Out of hours only (Oct 2024)

• New National Guidance on GP requesting for certain laboratory tests
• During periods of TrakCare downtime, Biochemistry requests need to be made on a paper request form. These can be ordered through PECOS and a pdf copy is available for download and printing
• All Blood Gas analysers (GEM 5000) are now located solely within  clinical areas within the main hospital campus, positioned according to current clinical need. A list of all locations is available at each blood gas analyser. We do not have the facility to carry out Blood Gas analysis within the laboratory

Telephone

The Main laboratory contact  number is 0141 354 9060 (89060 for use within the hospital). An auto-attendant system is in operation to route your call more effectively. Please listen carefully to the new message which will direct you as follow:

1. All results and add on tests, press 1 
2. Information on all sample requirements, press 2 
3. For advice on Blood Gas or Blood Glucose analysers, press 3 
4. For interpretation of results, clinical advice and emergency requests, press 4 

Email

In addition to the telephone options there are two email accounts which will be answered Monday to Friday 9.00am – 5.00pm,  which are available for specific, non-urgent requests, processed at the QEUH:

• SouthGlasgow.BiochemistryAddOn@ggc.scot.nhs.uk
  • for NON-urgent add on tests for Biochemistry samples sent to the South Glasgow Biochemistry laboratory only.
  • You must include the following information in your email : CHI Number/DOB, surname, Date and Time of original sample, original location of sample, Test/Analysis to be added on.
• ggc.qeuhbiochemistsggc@nhs.scot – this is an email for Non-Urgent Clinical Advice
  • Please include your query as well as the full patient details
• SouthGlasgow.BiochemistryPOCT@ggc.scot.nhs.uk 
  • for NON- urgent enquiries about point of care Blood Gas and Blood Glucose systems based in the QEUH, RHC, New Victoria, Mearnskirk and Leverndale Hospital

Our address

Department of Biochemistry,
Level 1, Laboratory Medicine and Facilities Management  Building,
Queen Elizabeth University Hospital,
1345 Govan Road,
Glasgow
G51 4TF

The main service hours are 9am to 5pm Monday to Friday, 9.00am to 12.30pm Saturday, Sunday and  Public holidays (9am to 5pm Monday to Friday only for satellite Blood Sciences Lab at New Victoria ACH). Outwith these hours a reduced analytical service is provided. 

For requests outwith the working day, a limited repertoire of urgent analyses can be undertaken as an emergency. 

The BMS on duty can be contacted on Page 17684 (QEUH). 

A consultant is always available for advice. 

Outside working hours he/she may be contacted via the hospital switchboard.

In our Laboratory Handbook you will find comprehensive information regarding the use of the Biochemistry service, including information on  test repertoire, specimen requirements, urgent requests and details of specialist assays available. Special advice on tests/investigations can also be found within our Metabolic  Handbook. GP users across GG&C can find additional guidance in the General Practice Handbook.

We provide comprehensive reference ranges for our tests. These are available when accessing results via Trakcare and Clinical portal/SCI store and are also printed on Biochemistry Report forms. Information on reference ranges is also provided within our Laboratory Handbook. Interpretative comments are also provided on reports, where appropriate. For more detailed reference range data and for further interpretation of results, please contact the  Department. Reference ranges will be regularly reviewed and amended as required.

• South Glasgow Biochemistry Laboratory Handbook
• South Glasgow Biochemistry Metabolic Handbook

• Information on the services provided by the Toxicology Service at the QEUH
• Additional guidance on Tumour markers (guidance for the non specialist on the appropriate use of commonly requested tumour markers) is now available in the form of a ‘tumour marker bookmark‘. This has been recently released by the Scottish Clinical Biochemistry  Network (SCBN), with the backing of the Royal College of Pathologists and the Realistic Medicine Program.
• Information for patients on the personal information we request within the laboratory, how we obtain and store it, and how we protect it can be found on the NHS GGC Data Protection and Privacy page

Alpha-fetoprotein (AFP) is a 591 amino acid glycoprotein produced by the liver and yolk sac of a developing baby during pregnancy. Plasma concentrations begin decreasing at the end of the first trimester of pregnancy and fall rapidly after birth, with normal adult concentrations achieved by the age of 8 to 12 months. AFP is increased in neonates, during pregnancy and in some patients with benign liver disease. AFP is usually measured to assist with diagnosis of primary hepatocellular carcinoma or non seminomatous germ cell tumour (NSGCT) and to monitor treatment or detect recurrent disease in patients with these tumours. N.B. Send AFP for maternal screening to Medical Genetics, QEUH.

Sample Requirements and Reference Ranges

• Sample Type: Serum
• Container: SST
• Precautions: None
• Minimum Volume: 2 mL
• Reference Range: ≤6 kU/L
• Turnaround Time: 1 day
• Method: Abbott Architect/Alinity
• Quality Assurance: UK NEQAS

CA125 (carbohydrate antigen 125) is a glycoprotein MW >200 kDa. It is present in tissues derived from the foetal coelomic epithelium. In adults it occurs on the pleura and peritoneum, the gastrointestinal tract and female reproductive tract, including the endometrium. CA125 may be increased in women at the time of menstruation, in endometriosis, benign ovarian disease and renal or liver disease, and may be very high in early pregnancy. It is also elevated in patients with ascites, a pleural effusion or CCF.  Measurement is usually restricted to monitoring the treatment of ovarian carcinoma. 

Sample Requirements and Reference Ranges

• Sample Type: Serum
• Container: SST
• Precautions: None
• Minimum Volume: 2 mL
• Reference Range: ≤35 kU/L
• Turnaround Time: 1 day
• Method: Abbott Architect/Alinity
• Quality Assurance: UK NEQAS

Calcitonin is a 32 amino acid peptide synthesised, stored and secreted by the C-cells of the thyroid. Measurement of calcitonin is useful in the diagnosis and monitoring of medullary thyroid carcinoma (MTC), a rare tumour, accounting for only 10% of all thyroid carcinomas. MTC can occur as a sporadic tumour or inherited as part of multiple endocrine neoplasia type 2 (MEN 2). C-cell hyperplasia can increase calcitonin concentration and response to calcium infusion can be used to distinguish hyperplasia from MTC. NB. Calcitonin is only useful as a screening test in patients where there is a known family history of MTC.

Sample Requirements and Reference Ranges

• Sample Type: Plasma
• Container: Lithium heparin
• Precautions: Separate and freeze plasma within 4 hours of sample collection. Transport frozen.
• Minimum Volume: 1 mL
• Reference Range: <9 ng/L
• Turnaround Time: 14 days
• Method: Siemens Immulite
• Quality Assurance: UK NEQAS

Carcinoembryonic antigen (CEA) is a highly glycosylated cell surface glycoprotein involved in intercellular adhesion. Its size varies in different organs from 90 to 200 kDa, due to variable glycosylation. CEA may be elevated in smokers and a number of benign liver, renal, lung or gastrointestinal tract conditions. Therefore CEA is not a useful screening or diagnostic test. Its main role is to monitor response to therapy and detect recurrent gastrointestinal malignancy.

Sample Requirements and Reference Ranges

• Sample Type: Serum
• Container: SST
• Precautions: None
• Minimum Volume: 2mL
• Reference Range: ≤5 μg/L
• Turnaround Time: 1 day
• Method: Abbott Architect/Alinity
• Quality Assurance: UK NEQAS

Chromogranin A is an acidic 439 amino acid glycoprotein (48 kDa) originating from the chromaffin granules of most neuroendocrine cell types. In health, chromogranin A is released as a pro-hormone together with other peptide hormones in response to stimulation. Larger quantities of chromogranin A are produced by neuroendocrine derived tumours thus allowing it to be used as a tumour marker. Chromogranin A is the most commonly raised neuroendocrine tumour (NET) marker.

This guidance details which tumour markers to request during the diagnosis and monitoring of NETs.

Sample Requirements and Reference Ranges

• Sample Type: Serum
• Container: SST/Plain Serum
• Precautions: Spin and separate within 8 hours. Store serum for up to four days refrigerated. Store frozen if longer term storage is required. Samples from referral laboratories can be posted at room temperature using 1^st class post.
• Minimum Volume: 1 mL
• Reference Range: <95 µg/L
• Turnaround Time: 28 days
• Method: CisBio ELISA
• Quality Assurance: UK NEQAS

Gastrin-secreting cells (G-cells) produce, store and release gastrin within the pyloric and upper duodenal mucosa. Gastrin stimulates gastric acid secretion by parietal cells and circulates in 2 active forms: gastrin-34 (G-34) and gastrin-17 (G-17).   Determination of circulating gastrin concentrations can aid in the diagnosis of gastrinoma. Greater than 50% are malignant and approximately 25% occur as part of multiple endocrine neoplasia type 1 (MEN 1). The presence of gastrinoma and hypergastrinaemia resulting in severe refractory peptic ulcer disease is known as Zollinger-Ellison syndrome. Increased circulating gastrin concentrations can also occur as a result of reduced or absent gastric acid secretion e.g. H pylori infection, chronic atrophic gastritis +/- pernicious anaemia or long-term use of proton pump inhibitors (PPIs). This is due to the lack of inhibitory feedback of acid on the G-cells. Therefore elevated gastrin levels should be interpreted in relation to gastric acid secretion.

Sample Requirements and Reference Ranges

• Sample Type: Plasma
• Container: Heparinised plasma (EDTA unsuitable)
• Precautions: Sample should be collected after an overnight fast. Separate and freeze plasma within 4 hours of sample collection. Transport frozen. Proton pump inhibitors should be discontinued for a week, and H2 blockers for 48 hours, prior to sampling. Icterus and lipaemia moderately reduce results.
• Minimum Volume: 1 mL
• Reference Range: <115 µg/L (fasting)
• Turnaround Time: 28 days
• Method: Siemens Immulite. This assay measures both the G-17 isoform and, to a lesser extent, the G-34 isoform.
• Quality Assurance: UK NEQAS

Human chorionic gonadotrophin (HCG) is a glycoprotein hormone produced by trophoblastic tissue. This is found in the placenta in normal pregnancy, in choriocarcinoma and in trophoblastic elements in germ cell tumours. HCG consists of two subunits (alpha and beta). When HCG is used as a tumour marker it is important that both free beta subunit and intact HCG are measured. HCG is used to diagnose, monitor or detect recurrent disease in germ cell tumours. 

Sample Requirements and Reference Ranges

• Sample Type: Serum
• Container: SST
• Precautions: None
• Minimum Volume: 2 mL
• Reference Range: As tumour marker ≤5 U/L
• Turnaround Time: 1 day
• Method: Abbott Architect/Alinity
• Quality Assurance: UK NEQAS

Metastatic carcinoid tumours arising from enterochromaffin cells produce excessive amounts of serotonin. The main metabolite of serotonin, 5-hydroxyindole acetic acid (5-HIAA) is excreted in urine and its measurement can be used to diagnose and monitor carcinoid tumours.

Sample Requirements and Reference Ranges

• Sample Type: 24 hr urine (acidified)
• Container: 24 hr urine container with 50 mL hydrochloric acid
• Precautions: Elevated by dietary walnuts, bananas, tomatoes, avocado, kiwi fruit,  pineapple, plantain, plums, pecan nuts. Avoid for 3-4 days prior to  starting urine collection. Patient information sheet for urine collection

• Minimum Volume: 10 mL
• Reference Range: ≤ 42 μmol/24 h
• Turnaround Time: 14 days
• Method: Liquid chromatography-tandem mass spectrometry
• Quality Assurance: UK NEQAS

The plasma free metadrenalines profile:

• Metadrenaline
• Normetadrenaline
• 3-methoxytyramine

Plasma free metadrenalines are used for the diagnosis of catecholamine producing tumours including phaeochromocytoma or paraganglioma (PPGL). Patients with PPGL may present with episodes of hypertension with palpitations, severe headaches and sweating. Patients may be asymptomatic but have an incidentally discovered adrenal mass.

Sample Requirements and Reference Ranges

• Sample Type: Plasma
• Container: EDTA
• Precautions: Plasma must be separated from red blood cells within 2 hours of collection. Certain medications may cause false elevations of plasma metadrenalines. If clinically feasible, it is optimal to discontinue these medications at least 1 week before sample collection.
• Minimum Volume: 500 µL
• Reference Range:
  • Metadrenaline < 510 pmol/L
  • Normetadrenaline < 1180 pmol/L
  • 3-methoxytyramine < 180 pmol/L
• Turnaround Time: 14 days
• Method: Liquid chromatography-tandem mass spectrometry
• Quality Assurance: UKNEQAS

The urine free metadrenaline profile:

• Metadrenaline
• Normetadrenaline
• 3-methoxytyramine

Urine free metadrenalines are used for the diagnosis of catecholamine producing tumours including phaeochromocytoma or paraganglioma (PPGL). Patients with PPGL may present with episodes of hypertension with palpitations, severe headaches and sweating. Patients may be asymptomatic but have an incidentally discovered adrenal mass.

Sample Requirements and Reference Ranges

• Sample Type: 24hr urine
• Container: Plain urine container (no preservative)
• Precautions: Certain medications may cause false elevations of urine metadrenalines. If clinically feasible, it is optimal to discontinue these medications at least 1 week before sample collection. Patient information sheet for urine collection

• Minimum Volume: 10 mL
• Reference Range:
  • Metadrenaline < 350 nmol/24 h
  • Normetadrenaline < 650 nmol/24 h
  • 3-methoxytyramine < 400 nmol/24 h
• Turnaround Time: 14 days
• Method: Liquid chromatography-tandem mass spectrometry
• Quality Assurance: RCPA

Prostate specific antigen (PSA), a protease, is a normal constituent of seminal fluid. It is produced by the secretory cells of the acini and ducts of the prostate and other cells expressing the nuclear androgen receptor.  PSA is measured to aid the diagnosis and for monitoring of prostate cancer.   PSA may be spuriously elevated in a number of situations: catheterisation; acute retention of urine; urinary infection; ejaculation or vigorous exercise; DRE; prostate biopsy. Where these may have contributed to an elevated PSA result, suggest repeat in 6 weeks.

Sample Requirements and Reference Ranges

• Sample Type: Serum
• Container: SST
• Precautions: None
• Minimum Volume: 2 mL
• Reference Range:
  •  Age (yrs)          PSA (μg/L)
  • <60                      ≤ 3.0
  • 60 – 69                 ≤ 4.0
  • ≥70                      ≤ 5.0
• Turnaround Time: 1 day
• Method: Abbott Architect/Alinity
• Quality Assurance: UK NEQAS

Thyroglobulin (Tg), a protein produced by normal or malignant thyroid tissue, is used to monitor treatment of differentiated thyroid cancer and to detect recurrence. Tg measured a few months after total thyroidectomy for thyroid carcinoma provides valuable prognostic information. Please note that recent thyroid biopsy or surgery will cause an increase in Tg. 15-20% of thyroid cancer patients have thyroglobulin antibodies (TgAb). If present, TgAb can interfere with Tg measurements causing an artefactually low result. TgAb status may alter during treatment and TgAb should therefore always be measured on all Tg samples. Persistent or increasing concentrations of TgAb following thyroidectomy may indicate residual or recurrent tumour. Tg measurement is also of use in establishing the presence or absence of thyroid tissue in neonates with congenital hypothyroidism.

Sample Requirements and Reference Ranges

• Sample Type: Serum
• Container: Plain/SST
• Precautions: None
• Minimum Volume: 2 mL
• Reference Range: Not applicable
• Turnaround Time: 7 days
• Method: Beckman Access
• Quality Assurance: UK NEQAS

NHSGGC Specialist Endocrine Laboratory

• General enquiries: 0141 242 9500, option 2

Contact Telephones

• Karen Smith, Consultant Clinical Scientist: 0141 201 6434
• Dr Maurizio Panarelli, Consultant Clinical Biochemist: 0141 242 9573
• Donna Chantler, Principal Clinical Scientist: 0141 242 9525
• Alison Fairservice, Principal Clinical Scientist: 0141 242 9520
• Amy Frank, Principal Clinical Scientist (USP): 0141 242 9534
• Susan Johnston, Principal Clinical Scientist: 0141 242 9537

Address

Department of Clinical Biochemistry
Macewen Building
Glasgow Royal Infirmary
Glasgow
G4 0SF

Thank you for continuing to send samples to the Biochemistry Department at Glasgow Royal Infirmary. In April 2025 we had a UKAS inspection to assess compliance to ISO15189. This assessment highlighted known deficiencies in the processing of external quality assessment (EQA) samples. While all analytes remained registered with an EQA provider, factors out with our control led to gaps in result reporting and review. In response to these gaps UKAS are suspending our accreditation for a subset of analytes until July 2025. A comprehensive list of affected analytes is listed within the letter to users.

As a department we are working hard to retrospectively review any outstanding EQA and fully expect accreditation for all effected assays to be reinstated in July. Service users will not experience any changes to the routine operations of the department during this period.

Aldosterone is produced in the zona glomerulosa of the adrenal glands in response to renin and angiotensin intermediates. Measurement of aldosterone is most useful in the investigation of hypertension when measured concurrently with renin so that an aldosterone/renin ratio may be calculated.

Beta blockers, diuretics, ACE inhibitors, angiotensin II receptor blockers, calcium channel blockers, a restricted salt diet and posture can affect interpretation of aldosterone results.

Sample Requirements and Reference Ranges

• Sample Type: Plasma
• Container: EDTA
• Precautions: Posture and relevant drug therapies (see above) may affect interpretation of results.
• Minimum Volume: 500 µL (140 µL for neonates)
• Reference Range:
  • <1 month: 140 – 4900 pmol/L
  • 1-12 months: 140 – 2500 pmol/L
  • 1 year – <2 years: 140 – 1500 pmol/L
  • 2 year – <5 years: 75 – 970 pmol/L
  • 5 years & above: 75 – 630 pmol/L

• Turnaround Time: 14 days
• Method: Liquid chromatography-tandem mass spectrometry
• Quality Assurance: UK NEQAS

17-hydroxyprogesterone (17OHP) is one of the intermediary steroid metabolites in the cortisol biosynthetic pathway. The most common genetic defect in cortisol production is deficiency of the 21-hydroxlase enzyme, which leads to congenital adrenal hyperplasia (CAH). 17OHP concentrations are raised in this form of CAH (approximately 90% of CAH cases) and is a useful marker to monitor response to therapy. Measuring 17OHP in blood spot samples is less invasive than venepuncture and allows multiple samples to be taken over a 24hr period.

Blood spot 17OHP is not a diagnostic test and is only useful in monitoring treatment.

Sample Requirements and Reference Ranges

• Sample Type: Whole blood spotted onto pre-prepared card (available on request)
• Container: N/A
• Precautions: None
• Minimum Volume: Ensure that blood soaks through to the back of the card
• Reference Range: N/A
• Turnaround Time: 56 days
• Method: Liquid chromatography-tandem mass spectrometry
• Quality Assurance: RfB

Dehydroepiandrosterone sulphate (DHEAS) is the sulphated ester of the 19-carbon androgen DHEA, produced by the adrenal gland. DHEAS is the most abundant circulating androgen and shows no diurnal rhythm. DHEAS acts as a precursor to other androgens, such as androstenedione and testosterone.

Measurement of DHEAS may be of benefit for the investigation of excess androgen. DHEAS is relatively specific for the adrenal glands, whereas other androgens, such as testosterone and androstenedione are also produced by the gonads.

Measurement of DHEAS is unhelpful in adult males.

Sample Requirements and Reference Ranges

• Sample Type: Serum or Plasma
• Container: SST or Lithium Heparin
• Precautions: None
• Minimum Volume: 500 μL (140 μL for neonates)
• Reference Range:
  • Pre-pubertal: <2.0 μmol/L
  • Adult female <50 yr: ≤9.6 μmol/L
  • Adult female  ≥50 yr: ≤3.1 μmol/L

• Turnaround Time: 14 days
• Method: Liquid chromatography-tandem mass spectrometry
• Quality Assurance: UK NEQAS

Cortisol is an essential glucocorticoid steroid produced by the adrenal cortex. Cortisol circulates bound to cortisol binding protein (CBG) with only 15% being the unbound biologically active form. The saliva concentration generally reflects the free cortisol concentration in serum and may be useful in the investigation of cyclical Cushing’s syndrome due to the non-invasive nature of sample collection.

Sample Requirements and Reference Ranges

• Sample Type: Saliva (passive drool)
• Container: 5 mL plain (can be supplied by laboratory)
• Precautions: If multiple samples collected over several weeks, store frozen and send by 1st class post.
• Minimum Volume: 2.5 mL
• Reference Range:
  • am: <20 nmol/L
  • pm: <5 nmol/L

• Turnaround Time: 35 days
• Method: Liquid chromatography-tandem mass spectrometry
• Quality Assurance: UKNEQAS

The serum androgen profile simultaneously measures:

• testosterone
• androstenedione
• 17-hydroxyprogesterone (17OHP)
• 11-deoxycortisol (11DOC)
• 21-deoxycortisol (21DOC)

11DOC and 21DOC are not routinely reported. If an abnormality is detected in either, a comment will be made on the report.

The androgen profile is recommended for investigation of hirsutism, polycystic ovarian syndrome (PCOS) and infertility in females, and for the diagnosis and monitoring of congenital adrenal hyperplasia (CAH) in both males and females. Please state clinical details and menstrual cycle information on the request form. 

Androgens pre- and 60-min post synacthen may be of benefit for the investigation of late onset CAH if elevated androgens have been observed in a follicular phase sample.

In neonates, 17OHP can be measured from the day of birth for the investigation of CAH, however levels may continue to rise immediately after birth, with further adrenal stimulation. An elevated 21DOC would confirm 21-hydroxylase deficiency CAH.

Sample Requirements and Reference Ranges

• Sample Type: Serum
• Container: SST. Please send primary sample if possible. Some interference has been observed with certain aliquoter tubes, such as the Impeco tube.
• Precautions: None
• Minimum Volume: 500 μL (140 μL for neonates)
• Reference Range:
  • Adult Females:
    • Testosterone <1.5 nmol/L
    • 17-Hydroxyprogesterone <6.0 nmo/L
    • Androstenedione (18 – 40yrs) <5.5 nmol/L
    • Androstenedione (>40yrs) <3.0 nmol/L
  • Adult Males:
    • Testosterone 7.0 – 30 nmol/L
    • 17-Hydroxyprogesterone <6.0 nmol/L
    • Androstenedione <5.5 nmol/L
  • Paediatric ranges under evaluation

• Turnaround Time: 7 days (Please contact the lab to notify of any urgent neonatal  sample)
• Method: Liquid chromatography-tandem mass spectrometry
• Quality Assurance: UK NEQAS

Testosterone

Testosterone is a 19-carbon androgen, produced by both the adrenal glands and gonads. Production is controlled by LH or HCG. Serum testosterone is often measured in female patients to investigate suspected polycystic ovary syndrome (PCOS) or idiopathic hirsutism. However, some women will have a more serious pathology, such as adrenal/ovarian tumours, Cushing’s syndrome or late onset congenital adrenal hyperplasia (CAH).

In females, testosterone, androstenedione and 17-hydroxyprogesterone (17OHP) are lowest in the follicular phase. In males, testosterone is highest early in the morning and declines through the day.

Androstenedione

Androstenedione is a 19-carbon androgen, produced by both the adrenal gland (ACTH control) and gonads (LH or HCG control) and also by peripheral conversion from testosterone. Androstenedione has 20% of the androgenic potency of testosterone.

Androstenedione is most commonly measured in women for the investigation of polycystic ovarian syndrome (PCOS).

Androstenedione may be helpful in disorders of puberty. It is raised in cases of congenital adrenal hyperplasia (CAH) due to deficiency of the 21- or 11β-hydroxylase enzymes and may be useful in the diagnosis of these conditions and in the monitoring of glucocorticoid replacement therapy. Androgen secreting tumours of both the adrenal (adenoma and carcinoma) and ovary (arrhenoblastoma, hilar cell and granulosa cell) may result in high serum levels of androstenedione.

17-Hydroprogesterone (17OHP)

17-hydroxyprogesterone (17OHP) is a 21-carbon progestagen, produced by the adrenal gland (ACTH control) and gonads (LH or HCG control). 17OHP is a precursor to 11-deoxycortisol (11DOC) and is elevated in the most common form of congenital adrenal hyperplasia (CAH), 21-hydroxylase deficiency.

CAH is a group of inherited metabolic disorders of adrenal steroid hormone biosynthesis. The clinical features derive from a combination of under-production of either cortisol or aldosterone or both, and increased production of adrenal androgen precursors. The incidence of the classical disorder in Scotland is approximately 1/15,000.

Cortisol is the major glucocorticoid hormone synthesised from cholesterol in the adrenal cortex. Synthesis is stimulated by the anterior pituitary adrenocorticotrophic hormone (ACTH), which is under control of the hypothalamic peptide, corticotrophin-releasing hormone (CRH). 

As cortisol concentrations increase, the binding capacity of cortisol binding globulin in the circulation is exceeded, resulting in a disproportionate rise in urine cortisol concentrations. Urine cortisol measurement is useful as a screening test for cortisol excess (Cushing’s syndrome). Urine cortisol measurement can also be used as part of a dexamethasone suppression test. Multiple EMU cortisol measurements may also be useful in the investigation of possible cyclical Cushing’s.

Sample Requirements and Reference Ranges

• Sample Type: Urine (24 hr, random or early morning urine)
• Container: Plain urine container (no preservative)
• Precautions: None
• Minimum Volume: 10 mL
• Reference Range:
  • Adults (EMU): <40 nmol/mmol creatinine
  • Adults (24 hour): <165 nmol/24 hour
  • Children (≤10 yrs): <40 nmol/mmol creatinine

• Turnaround Time: 14 days
• Method: Liquid chromatography-tandem mass spectrometry
• Quality Assurance: UK NEQAS

A urine steroid profile includes all major metabolites of steroids, including glucocorticoids, mineralocorticoids and precursors.

The test is used to identify genetic disorders of steroid metabolism, though the screening or diagnostic test for congenital adrenal hyperplasia should be serum 17-hydroxyprogesterone. Steroid profiling is also useful to detect abnormal steroid secretion from adrenal and gonadal tumours.

Sample Requirements and Reference Ranges

• Sample Type: Urine (Aliquot of 24 hour urine for adults or children aged 11 and over; random for children <11 years)
• Container: Plain urine container (no preservative)
• Precautions: None
• Minimum Volume: 10 mL preferred. Smaller volume acceptable for babies (min. 2 mL).

• Reference Range: Age and sex dependent. Interpretation accompanies each report.
• Turnaround Time: 28 days
• Method: Gas chromatography-mass spectrometry
• Quality Assurance: Sample exchange programme

Vitamin D is required for absorption of calcium and phosphate from the gut. The majority of vitamin D is produced in the skin when exposed to sunlight and the remainder obtained in the diet.

25-hydroxy vitamin D (25OHD) is the most abundant vitamin D metabolite in the circulation. It is relatively inactive but its measurement is the best indicator of vitamin D status.  25OHD exists in two forms, D3 and D2, and both are equally measured by the LC/TMS method.

Assessment of vitamin D status is important in patients with abnormal calcium or phosphate levels, possible osteomalacia and malabsorption, and osteoporotic patients before giving the first dose of IV bisphosphonates (to reduce the risk of drug induced hypocalcaemia).

NB. Request intervention procedures have been set up to reduce unnecessary testing. The request intervention interval for vitamin D is 340 days. All repeat requests within this period are reviewed by the Duty Biochemist and may be over-ridden if appropriate clinical details are provided.

Please refer to the NHSGGC Vitamin D Requesting and Prescribing Guidelines

Sample Requirements and Reference Ranges

• Sample Type: Serum
• Container: SST
• Precautions: None
• Minimum Volume: 500 μL (140 μL for neonates)
• Reference Range:
  • <25 nmol/L: Vitamin D deficient, consider supplementation
  • 25 – 50 nmol/L: Borderline low vitamin D, risk of secondary hyperparathyroidism, consider increase in vitamin D intake
  • >50 nmol/L: Adequate vitamin D

• Turnaround Time: 14 days
• Method: Liquid chromatography-tandem mass spectrometry
• Quality Assurance: UKNEQAS

1,25-dihydroxy vitamin D (1,25DHD) is the active form of vitamin D, produced primarily by the kidney by hydroxylation of 25-hydroxy vitamin D. 1,25DHD is the form of vitamin D that stimulates resorption of calcium from bone, intestinal absorption and renal reabsorption.

NB. 1,25DHD should not be used to determine vitamin D status; 25-hydroxy vitamin D is the best marker for this purpose.

Indications for 1,25DHD are limited. Measurement may be useful in the investigation of possible vitamin D-dependent rickets and in patients with hypercalcaemia to investigate possible excess 1,25DHD production e.g. granulomatous diseases (sarcoidosis, TB or lymphoma). 

Sample Requirements and Reference Ranges

• Sample Type: Serum
• Container: SST
• Precautions: None
• Minimum Volume: 250 μL
• Reference Range: 20 – 120 pmol/L (interim range pending further evaluation)
• Turnaround Time: 35 days
• Method: IDS iSYS
• Quality Assurance: DEQAS

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