Sorted By Test Name - Mayo Medical Laboratories

ALPA
500155
Tanner II-IV*: < or =1.2 ng/mL
ADULTS
Males: < or =0.5 ng/mL
Premenopausal females: < or =1.2 ng/mL
Postmenopausal females: < or =1.8 ng/mL
Pediatric and adult reference values based on Mayo studies.
*Puberty onset (transition from Tanner stage I to Tanner stage II) occurs for boys at a median age of
11.5 (+/-2) years and for girls at a median age of 10.5 (+/-2) years. There is evidence that it may occur up
to 1 year earlier in obese girls and in African American girls. For boys, there is no proven relationship
between puberty onset and body weight or ethnic origin. Progression through Tanner stages is variable.
Tanner stage V (adult) should be reached by age 18.
Clinical References: 1. Preissner CM, Klee GG, Scheithauer BW, Abboud CF: Free alpha subunit
of the pituitary glycoprotein hormones. Am J Clin Pathol 1990;94:417-421 2. Mainieri AS, Viera JGH,
Elnecave RH: Response of the free alpha-subunit to GnRH distinguishes individuals with "functional"
from those with permanent hypogonadotropic hypogonadism. Horm Res 1998;50:212-216 3. Samejima
N, Yamada S, Takada K, et al: Serum alpha-subunit levels in patients with pituitary adenomas. Clin
Endocrinol 2001:54:479-484 4. Mainieri AS, Elnecave RH: Usefulness of the free alpha-subunit to
diagnose hypogonadotropic hypogonadism. Clin Endocrionol 2003;59:307-313 5. Socin HV, Chanson P,
Delemer B, et al: The changing spectrum of TSH-secreting pituitary adenomas: diagnosis and
management in 43 patients. Eur J Endocrinol 2003;148:433-442
Alprazolam, Serum
Clinical Information: Alprazolam (Xanax), a drug used to treat panic and anxiety disorders, is a
triazolobenzodiazepine with the same ring structures as triazolam. It is considered an intermediate
benzodiazepine with a half-life of 6 to 20 hours and a rapid onset of action with peak plasma levels
reached within 1 to 2 hours of dosing. Typical daily doses range from 0.75 to 3.0 mg and Xanax tablets
are available in 0.25 mg, 0.5 mg, 1 mg, or 2 mg doses. Hepatic biotransformation of alprazolam produces
hydroxylated metabolites, which are excreted in urine as glucuronide metabolites. Alprazolam has 2 major
metabolites: alpha-hydroxy-alprazolam and 4-hydroxyalprazolam. A benzophenone derivative is also
found in humans. Only the hydroxy-alprazolams are biologically active with approximately one half the
activity of the parent drug. Since the metabolites are only present in trace amounts in serum, quantitation
of metabolites is not clinically significant. Alprazolam may have central nervous system (CNS)
depressant effects. Patients using alprazolam should avoid other CNS depressant drugs, as well as
ingestion of alcohol. When discontinuing therapy in patients who have used alprazolam for prolonged
periods, the dose should be decreased gradually over 4 to 8 weeks to avoid the possibility of withdrawal
symptoms, especially in patients with a history of seizures or epilepsy, regardless of their concomitant
anticonvulsant drug therapy. Patients on short-acting benzodiazepines may be switched to longer-acting
drugs (eg, diazepam), which produce a gradual decrease in drug concentration and decrease the risk of
withdrawal symptoms.
Useful For: Monitoring patient compliance Helping to achieve desired blood levels and avoid toxicity
Interpretation: The assessment of treatment with alprazolam should be based on clinical response.
Effectiveness of treatment can be determined by the reduction of symptoms of anxiety and panic
disorders.
Reference Values:
Therapeutic range: 5-25 ng/mL
Some patients respond well to levels of 25-55 ng/mL.
Clinical References: 1. Malseed RT, Harrigan GS: Antianxiety drugs. In Textbook of Pharmacology
and Nursing Care. JB Lippincott Company 1989, p 519 2. Fraser AD, Bryan W: Evaluation of the Abbott
ADx and TDx serum benzodiazepine immunoassays for analysis of alprazolam. J Anal Toxicol
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