Endocrinology Submission Form - Veterinary Diagnostic Laboratory

Endocrinology Submission Form
Phone: (612) 625-8787
Fax: (612) 624-8707
Toll Free: 1-800-605-8787
E-mail: vdl@umn.edu
Web site access/results:
www.vdl.umn.edu
Contact Information - Owner/Producer
Reason/Clinical History - Identify Signs
Owner Name Anorexia Alopecia Pyoderma Calcinosis
Address
City
Premises ID
Phone
Fax
Email
Attending Veterinarian
Veterinarian
Clinic
Address
State
Zip
City State Zip
Phone
Fax
Email
Animal information: Name
Breed
Obesity
PU
Wt Loss
Infertility
Seizures
PD
Diarrhea
HX of Pregnancy loss
Other
Current/recent therapies
None Antibiotics
Hyperpigmentation
PP
Wt gain
Vomiting
Thyroid therapy (e.g. L-thyroxine, methimazole)
Lethargy
Tachycardia
Glucocorticoid (e.g. prednisone, dexamethasone)
Pituitary/adrenal therapy (e.g. lysodren, deprenyl, trilostane)
Anticonvulsant (e.g. phenobarbital)
Purpose of Submission
Differential diagnostic OFA Panel Research
Monitor therapy ( ) hrs post pill ( )
( ) Product ( ) dose
Monitor pregnancy, breeding date
Monitor ovulation
Species
purebred cross Weight
Age
Gender M MN F FS
For Lab Use Only
Sample /Specimen Arrived:
Live Rm Temp Frozen Cold Pk
Fixed Other
Please do not send whole blood or
serum separator tubes (SST).
Use of SST will interfere with some
assays. Hemolysis or lipemia may affect
some tests. If these types of samples
are received we may request a new
sample or give warning comments
regarding possible result inaccuracy.
Complete clinical information will
improve interpretive comments.
Please provide information requested.
Sample Date
Date Sent No.Tubes Sent Sample: serum plasma
If previous submissions for this animal exist, please enter accession number(s)
Adnrenocortical Function Reproductive Function Thyroid Function
*ACTH response test: Gel or Synthetic
Pre ACTH-cortisol
Post
(min/hr) ACTH-cortisol
Post
(min/hr) ACTH-cortisol
*Basal Cortisol
*Low Dose(0.01 mg/kg)Dexamethasone suppression test
Pre Dex-cortisol
Post
(min/hr) Dex-cortisol
Post
(min/hr) Dex-cortisol
*High Dose(0.10 mg/kg)Dexamethasone suppression test
Pre Dex-cortisol
Post
(min/hr) Dex-cortisol
Post
(min/hr) Dex-cortisol
ACTH Endogenous (EDTA plasma)
Growth Hormone
*Progesterone
*Relaxin(canine pregnancy, heparinized or citrate plasma)
Testosterone
Testosterone response test(used to detect testicular tissue)
Testosterone: hCG response test
Pre hCG Post (min) hCG
Testosterone: GnRH response test
Pre GnRH Post (min) GnRH
Progesterone test(used for feline ovarian remnant detection)
*GnRH response test
Post GnRH ( days post) progesterone OR
*hCG response test
*Equine Dexamethasone suppression test(10mg/500 kg IM)
Post hCG (
days post) progesterone
Pre Dex-cortisol
Other
Post
(min/hr)Dex-cortisol
Troponin I , canine
Pituitary Function
Miscellaneous Test(s)
Free T4 (canine)
Free T4 by Dialysis (FT4D)
Thyroglobulin Autoantibody (TgAA, Canine)
Thyrotropin (TSH, Canine)
*Total T4 (thyroxine, TT4)
Total T3 (triiodothyronine)
Canine Thyroid Full Panel (FT4,TgAA,TSH,TT4)
Canine Thyroid Panel First Class
(FT4D, TgAA, TSH, TT4)
Canine Thyroid Panel Economy(FT4,TgAA,TSH)
Non-Canine Thyroid Panel (FT4D, TT4)
OFA Thyroid Registry, canine(FT4, TgAA, TSH)
T3 suppression test, feline
(T4, T3 run on pre and post medication samples)
Pancreatic Function
Insulin ACTH/insulin, equine
C-Peptide (human) C-Peptide (porcine)
Lab Notes
*Tests are done daily M-F. All others are done once per week. Call for growth hormone, troponin I, and C-Peptide schedule. From Rev. 06/08

Veterinary Diagnostic Laboratory - University of Minnesota
Endocrine Protocols
Shipping Instructions
Enclose a completed submission form for each animal. Label tube (owner and animal name, test, time of test) and cover cap with parafilm.
Store samples frozen if they are not shipped on the day of collection. Please visit our website for shipping guidelines. For shipping without
frozen gel pack (T4 and T3 only), place sample(s) in sample mailer without coolant. For shipping with frozen gel packs, place samples in an
insulated sample mailer with 2-3 frozen gel packs. Fill space with insulating material, close and tape box securely. Send samples early in
the week. See shipping recommendations for each test below.
Sample Type and Volume
Most tests require 1 ml of serum. Exceptions are: Thyroid Panels and OFA registry samples (2ml serum), endogenous ACTH (1ml of
EDTA plasma) and Relaxin (0.5ml heparinized or citrate plasma). Do not send whole blood or serum separator tubes. Lipemia or hemolysis
may affect hormone measurements. Please check with laboratory staff before submitting these types of samples.
Serum Collection
Draw blood into a red top vacuum tube, allow blood to clot fully (30-60 minutes) and centrifuge (10-15 min; 2000-2800 rpm). Place serum in
a clearly labeled plastic tube for shipping. Depending on the test, send samples at room temperature, or chilled or frozen with frozen gel
packs.
OFA Canine Thyroid Registry Panel
OFA serum must be kept cold or frozen and received within 24 hours of shipping. Please contact lab for submission information and
scheduling. Serum from freshly collected blood is required. Freeze serum if it will be stored before shipping. Completed OFA test forms
(with a check for the application fee made out to the OFA) must accompany the sample. Results will be mailed or faxed. As per OFA
guidelines: Samples must be rejected if they are lipemic, severely hemolyzed or received by the laboratory in an unchilled state.
Send early in the week.
Protocols
Adrenocortical Function Tests
ACTH, Endogenous: Submit 1 ml EDTA plasma. Fast
animals for 12 hours to avoid lipemia. ACTH is labile and
samples require special handling. Collect a fasting blood
sample into a chilled purple top EDTA tube, gently mix,
centrifuge immediately (10-15 min), transfer plasma into
a plastic tube and freeze. Ship frozen on ice packs or
with dry ice, early in the week using same-day or
overnight service.
ACTH Response Test: Collect a basal serum sample.
Then administer ACTH gel (2.2 IU/kg IM for dogs or
cats). Collect post samples after 1 hr (for cats) or 2 hrs
(for dogs). If you use a synthetic ACTH such as
Cortrosyn, inject 0.25 mg IM (for dogs), or 0.125 mg IM
(for cats or small dogs). For dogs, collect post samples
at 1 hr after injection. For cats, collect samples 0.5 hr
and 1 hr after injection. Ship the serum with frozen gel
packs.
Basal Cortisol: Submit 1 ml of serum. Ship samples
with frozen gel packs.
Low-dose dexamethasone suppression (LDDS) test:
Collect a basal serum sample and then inject 0.01 mg/kg
dexamethasone IM or IV. Collect post dex serum
samples at 4 and 8 hours after injection. Ship the
samples with frozen gel packs.
High-dose dexamethasone suppression (HDDS) test:
Collect a basal sample and then inject 0.1 mg/kg
dexamethasone IM or IV. Collect post dex serum
samples at 4 and 8 hours after injection. Ship the
samples with frozen gel packs.
Equine dexamethasone suppression test:
Collect a baseline serum sample at approximately 5 pm
and give 10 mg/500 kg body weight dex IM. Collect postdex
sample approximately 19 hours later.
Thyroid Function Tests
Free T4: (FT4D,FT4) or Thyrotropin (cTSH)
Submit 1 ml of serum. Samples can be shipped with
frozen gel packs if sent on the day of collection using an
overnight service. Alternatively, freeze samples prior to
packing with cold packs.
Basal Thyroxine (T4), Triiodothyronine (T3) or
Thyroglubulin autoantibodies (TgAA): Submit 1 ml of
serum for each test requested.
Feline T3 suppression test: Obtain a baseline serum
sample (1 ml); store frozen until ready to ship with post
sample. Give 25 µg T3 (Cytomel) PO every 8 hrs for
seven dosages. Collect post-treatment sample 2-4 hrs
after the last dose. Ship pre and post sera together.
Thyroid Panel Tests: Submit 2 ml of serum. Samples
can be shipped with frozen gel packs if sent on the day of
collection using an overnight service. Alternatively, freeze
samples prior to packing with cold packs.
OFA Thyroid Registry: Send with frozen gel packs. See
comments regarding OFA submissions above.
Reproductive Function Tests
Progesterone or Testosterone: Submit 1 ml of serum
for each test requested. Ship samples with frozen gel
packs.
Progesterone, ovarian remnant detection test choices:
Canine: Collect serum (1 ml) 7-14 days after the end of
behavioral estrus OR when the dog is displaying signs of
behavioral estrus perform either hCG (1000 IU/kg: 1/2 IV
+ 1/2 IM, or 220 IU/kg IV) stimulation OR GnRH (50 ug/
dog IM) stimulation test and collect serum 7 days after
giving hCG or GnRH.
Feline: Give hCG (250 IU IM) or GnRH (25 ug/cat GnRH
IM) during behavior estrus. Collect blood sample for
progesterone analysis 10-14 days after injection of
hormone. Ship sera with frozen gel packs. Baseline
sample is not required.
Testosterone-response testes-testicular function
testing:
Equine hCG response test: Obtain a basal serum
sample (1 ml), then inject hCG 6000-12,000 IU/horse IV
or IM; 2500 IU hCG for miniature horses). Collect post
sample 2 hrs later. Ship sera with frozen gel packs.
Canine/Feline hCG or GnRH response test: No basal
sample is required. Administer hCG: 250 to 500 IU IV
(cats); 50 IU/kg IM (dogs). Collect post sample 2 hours
later OR give 25 ug GnRH IM (cats) or 2.2 ug/kg GnRH
IM (dogs)and collect post sample (1 ml) 1 hour later.
Ship sera with frozen gel packs.
Relaxin: Obtain a plasma (heparin or citrate, do not use
EDTA) sample (0.5 ml) 14-33 days post breeding. In
general, if the bitch was bred at the appropriate time in
her estrous cycle, pregnancy may first be determined.
using the relaxin assay between 2 and 31 days post-LH
surge, or between 14 and 33 days post breeding. If a
negative result is determined, you may wish to repeat the
test a week later.
Other Tests
Insulin: Submit 1 ml of serum with frozen gel packs,
freeze if shipping is delayed more than 24 hours. Fasting
dog to glucose