Urine

Question 1

What is urine derived from?

What is it mainly?

Answer 1

Urine is derived from filtration of blood by the nephrons in the kidneys.

Urine is mainly water with a small percentage of solutes.
All end products of metabolism and all potentially harmful materials are excreted in the urine

Question 2

What does urine generally reflect?

Answer 2

Urine generally reflects blood levels – if blood level for a substance is elevated and kidneys are functioning well, the urine level will also be high

Question 3

What are the reasons for Urine Testing

Answer 3

To diagnose renal or urinary tract disease (proteinuria may indicate glomerulonephritis).
To monitor renal or urinary tract disease (urine cultures to monitor treatment of UTI).
To detect metabolic or systemic diseases not directly related to the kidneys (glucose in the urine may indicate diabetes)

Question 4

When may urinalysis be preferred over blood tests?

Answer 4

Identification of UTI
24 hour urine collection will reflect homeostasis and disease better than a blood test
Some products are rapidly cleared by the kidneys and may not show in the blood
Urine testing is easily performed and noninvasive
Many urine tests are cheaper than blood tests

Question 5

What are the 5 types of urine specimens?

Answer 5

First morning specimen
Random specimen
Timed urine collection
Double voided specimen
Urine specimen for culture and sensitivity

Question 6

What is the first morning specimen?

Answer 6

Urine in the bladder overnight represents all of the urine for the previous 6-8 hours so more accurately reflects a 24 hour urine.

First morning specimen allows diurnal variation to be factored in.

Urine will be concentrated and more likely to detect positive findings, such as proteins and nitrates and pregnancy.

Disadvantage: Not the most convenient to obtain. Patient must be given instructions and collection container in advance. Specimen must be preserved if not delivered within 2 hours of collection

Question 7

What is the Random Specimen?

Answer 7

Obtained during daytime hours without any preparation.
Most often used for routine screening .
Also used for illegal drug screening.

Question 8

What is the timed urine collection specimen?

Answer 8

Two types of timed collections:
Specimen collected at a predetermined time (2 hours after a meal).
Specimen collected at a specific time of day.

To collect the specimen, the patient voids and discards the first specimen to start the test. All subsequent urine is collected and at the end of the time period the patient voids to complete the collection process

Can range from 2-24 hours

Question 9

Why use a timed urine collection specimen?

Answer 9

Hormones, proteins, and electrolytes are variably excreted over 24 hours and are affected by exercise, posture, hydration, and body metabolism, so quantitative tests may require a timed collection.

Question 10

What is the double voided specimen?

Answer 10

Used to obtain and evaluate fresh urine.

Used to monitor glucose and ketones.

Patient first empties the bladder and then voids again, which is the specimen that is used

Question 11

What is the Urine Specimen for culture and sensitivity?

Answer 11

Collected for examination of bacteria.

Must be in a sterile container and placed as aseptically as possible.
Meatus must be cleaned and a midstream collection will cleanse the urethral canal of contaminant bacteria.

Culture should be started within 1 hour of collection.

Question 12

What are the two MAIN types of collection methods?

Answer 12

Common methods

Special methods

Question 13

What are the common collection methods?

Answer 13

Routine void specimen

Midstream and clean catch specimens

24 hour collection

Question 14

What are the special collection methods?

Answer 14

Urethral catheterization

Suprapubic aspiration

Pediatric collections

Question 15

What is the routine void specimen?

Answer 15

No preparation required.
Nonsterile.
Random and first morning specimens are collected this way

Question 16

What is the Midstream and clean catch specimen?

Answer 16

Used if culture and sensitivity study is required or if likely to be contaminated by vaginal discharge or bleeding.

Meatus must be cleansed to reduce contamination.
For midstream, patient begins to urinate to wash out the distal urethra and then stops. Then the patient voids into a sterile container.

Question 17

What is the 24 hour collection?

Answer 17

Discard the first specimen to start the 24 hour collection.
Collect all urine for the next 24 hours, ending with the specimen at the end of 24 hours
Specimen should be refrigerated during collection
All urine in that 24 hour period must be collected

Question 18

What is the Urethral catheterization?

Answer 18

This may cause infection.
Used when patients are unable to void or cannot void when the specimen is required.
In patients with an indwelling catheter in place, the specimen is obtained from the catheter distal to the sleeve leading to the balloon.
Urine in the reservoir bag should never be used

Question 19

What is the Suprapubic aspiration?

Answer 19

Insert needle through the abdominal wall into the bladder

Question 20

What is the Pediatric collections?

Answer 20

Pediatric collection bag

Question 21

What does the urine reagent strip estimate?

How is it performed?

Answer 21

Estimates glucose, albumin, hemoglobin, and bile concentrations, as well as urinary pH, specific gravity, protein, ketone bodies, nitrates, and leukocyte esterase.

Strip of paper is dipped into the urine and observed for color changes on the strip and compared to the color chart on the bottle of the test strips

Question 22

When is Urinalysis (UA) done?

Answer 22

Part of routine diagnostic and screening evaluations.
Routinely done on patients admitted to the hospital, pregnant women, and presurgical patients.
Done diagnostically in patients with abdominal pain, back pain, dysuria, hematuria, or urinary frequency.
Also part of routine monitoring in patients with chronic renal disease and some metabolic diseases

Question 23

What are Urinalysis (UA) normal findings?

Those performed by dipstick i.e. Appearance, color, pH, proteins, glucose

Answer 23

Appearance – clear
Color – amber yellow
Odor – aromatic
pH- 4.6-8.0
Protein - 0-8 mg/dL; 50-80 mg/24 hours
Specific gravity – 1.005 – 1.030
Leukocyte esterase – neg
Nitrites, ketones, bilirubin, crystals, casts – none
Urobilinogen – 0.01 -1 Ehrlich unit/mL
Glucose – Fresh specimen – none; 24 hour specimen – 50-300 mg/24 hours

Question 24

What are Urinalysis (UA) normal findings?

Those performed microscopically i.e. cells

Answer 24

WBCs – 0-4 per low power field
WBC casts – none
RBCs – less than or equal to 2
RBC casts - none  
Bacteria – none
Crystals - none

Question 25

What does color of urine indicate?

Answer 25

Urine may be pale yellow to amber. Color indicates the concentration of the urine and varies with specific gravity. Dilute urine is straw colored and concentrated urine is deep amber

Question 26

What does cloudy urine indicate?

Answer 26

Normal urine is clear. Cloudiness may be caused by pus (necrotic WBCs), RBCs, or bacteria or from ingestion of certain foods

Question 27

What could cause abnormal appearance and color results?

Answer 27

Infection – may cause turbid, foul smelling urine Gross hematuria – trauma, tumors, stones, infection, and renal pathology. (Bleeding from the kidneys produce dark red urine while bleeding from the lower tract produces bright red urine.) Overhydration, diuretic therapy, glycosuria – clear urine Fever, dehydration, jaundice (Urobilinogen or bilirubin) – dark yellow or orange urine Hemoglobinuria, myoglobinuria – wine colored or dark brown urine Drug therapy Beets may cause red urine, and rhubarb may cause brown urine

Question 28

What causes the normal odor of urine? What pathological conditions cause abnormal odors?

Answer 28

Aromatic odor of normal urine is caused by volatile acids. Abnormal: DKA patient’s urine (Ketoonuria) has a strong, sweet smell of acetone (Fruity) due to poor glucose tolerance UTI may have a foul odor Enterovesical fistula (Colon to bladder connection) – stool odor

Question 29

What is urine pH helpful in looking for or showing?

Answer 29

Urine reflects the kidneys maintaining normal pH homeostasis. The kidneys assist in acid-base balance by reabsorbing sodium and excreting hydrogen pH also is helpful in identifying crystals in urine and determining predisposition to form certain types of kidney stones

Question 30

What can cause acidic urine (Decreased pH)?

Answer 30

Acidemia from metabolic or respiratory acidosis, starvation, dehydration. Diabetes mellitus, starvation – ketone acids in urine. Respiratory acidosis – hydrogen ions excreted Associated with uric acid and calcium oxalate stones – treatment is to keep the urine alkaline

Question 31

What can cause alkaline urine (Increased pH)?

Answer 31

Alkalemia. UTI - urea splitting bacteria convert urea to ammonia. Gastric suction, vomiting, renal tubular acidosis – reduced hydrogen ion excretion causing increased pH Associated with other calcium and magnesium salts that form stones – treatment is to keep the urine acidic

Question 32

What can cause abnormal protein levels in urine?

Answer 32

Nephrotic syndrome , glomerulonephritis, malignant hypertension, nephrotoxic drug therapy. If the glomerular membrane is injured (glomerulonephritis), spaces in the glomerular filtrate membrane become larger and protein can seep through. This can lead to hypoproteinemia if it persists at a significant rate and lead to decreased capillary oncotic pressure to cause interstitial edema (nephrotic syndrome). Trauma – destruction of blood-urine barrier allows protein to spill into urine. Multiple myeloma – large amount of protein (Bence-Jones protein) in urine. Preeclampsia, CHF – albumin leaks from damaged glomeruli. Urethritis or prostatitis – inflammation in periurethral glands or urethra

Question 33

What degree of protein loss leads to signs and symptoms of nephrotic syndrome?

Answer 33

Protein loss of more than 3000 mg/24 hours leads to signs and symptoms of nephrotic syndrome It is sensitive indicator of kidney function, not normally present in the urine.

Question 34

What does Specific gravity measure?

Answer 34

Measures concentration of particles in the urine Used to evaluate the concentrating and excretory power of the kidneys. Renal disease diminishes the kidneys’ ability to concentrate urine, leading to low specific gravity. Assesses hydration. A high specific gravity indicates concentrated urine and a low specific gravity indicates dilute urine

Question 35

What is leukocyte esterase used for? | What does a positive result indicate?

Answer 35

Screening test to detect WBCs in the urine. Positive results indicate a UTI. In some labs, microscopic exam is only done if this test is positive Has about a 90% accuracy for detecting WBCs in the urine

Question 36

What would cause high levels of ketones in the urine?

Answer 36

Poorly controlled diabetics and those with hyperglycemia, alcoholism, fasting, starvation, prolonged vomiting and high protein diets due to impaired glucose metabolism causes catabolism of fat for production of energy to form ketones which spill into the urine. Acute febrile illnesses, especially in infants and children or severe stress or illness -hypermetabolic states cause excessive use of glucose so fats are then broken down

Question 37

What would cause increased levels of bilirubin in the urine?

Answer 37

Gallstones, extrahepatic duct obstruction (tumor, inflammation, gallstone, scarring, surgical trauma), extensive liver metastasis – direct physical obstruction of bile flow causes elevated serum levels of conjugated bilirubin (disease affecting bilirubin metabolism after conjugation & bilirubin is water soluble so it can be excreted in the urine. Urine will be dark yellow or orange

Question 38

What would cause increased levels of urobilirubin in the urine?

Answer 38

Hemolytic anemia, pernicious anemia, hemolysis due to drugs – hemolysis results in RBC destruction with more heme catabolized to bilirubin and more bilirubin excreted into the bowel, converted to urobilinogen, and reabsorbed from the gut. Hematoma, excessive ecchymosis – RBCs break down in these areas

Question 39

What would cause glucose to be present in the urine? (Should be negative normally)

Answer 39

Used as a screening test for diabetes mellitus or other causes of glucose intolerance (ex. pregnancy) When blood glucose exceeds the ability of renal threshold to reabsorb glucose (about 180 mg/dL), it spills over into the urine. Glucosuria may occur after eating a high carbohydrate meal or in patients receiving IV dextrose.

Question 40

What are Nitrites used for? | What does a positive result indicate?

Answer 40

Screening test for UTI. Many bacteria produce an enzyme called reductase which can reduce urinary nitrates to nitrites. Positive test indicates possible need for a culture

Question 41

What are in the microscopic examination of urine?

Answer 41

``` Crystals Casts Epithelial cells WBCs RBCs ```

Question 42

What do crystals in the urine indicate?

Answer 42

Crystals indicate stone formation is happening or has already happened. Uric acid crystals occur with high serum uric acid levels Phosphate and calcium oxalate crystals occur with parathyroid abnormalities or malabsorption states

Question 43

What are casts?

Answer 43

Casts are rectangular clumps of materials or cells formed in renal distal and collecting tubules. pH must be acidic and urine must be concentrated. Casts are usually associated with proteinuria and stasis in the renal tubules

Question 44

What are the two major types of casts?

Answer 44

Hyaline Casts Cellular

Question 45

What are Hyaline casts? Indicate what?

Answer 45

Made of proteins and are indicative of proteinuria. The presence of a few are normal especially after exercise

Question 46

What are Cellular casts? What are the types of them?

Answer 46

Made of degenerated cells. Types include granular, fatty, waxy, epithelial, WBC, and RBC

Question 47

What can epithelial cells in the urine indicate?

Answer 47

Can shed from bladder due to tumor, infection, or polyps | Can be from contamination by vaginal or urethral secretions

Question 48

What can WBCs in the urine indicate?

Answer 48

Few are normal, but 5 or more indicates UTI. Differentiates cystitis from urethritis with two specimen technique – void 20 mL into one container and the rest into another – more WBCs in the first container indicates urethritis, more in the second container indicates cystitis

Question 49

What can RBCs in the urine indicate?

Answer 49

Any disruption of blood urine barrier causes RBCs to enter the urine. Hematuria may be microscopic or gross Primary renal diseases (glomerulonephritis, acute tubular necrosis, pyelonephritis) – deterioration of blood-urine barrier Renal tumor – neoplasms are friable and hypervascular Renal trauma – lacerations, contusions, and hematomas Kidney stones, bladder or prostate infection, tumors of ureters and bladder, traumatic catheterization, bladder trauma

Question 50

Interfering Factors in regards to appearance and color?

Answer 50

Sperm in urethra after recent or retrograde ejaculation will cause cloudiness Refrigerated urine > 1 hour will make urine cloudy Foods can affect color (carrots = dark yellow, beets = red, rhubarb = reddish or brownish) Prolonged standing will darken urine Drugs

Question 51

Interfering Factors in regards to odor?

Answer 51

foods (asparagus) or prolonged standing (ammonia)

Question 52

Interfering Factors in regards to pH?

Answer 52

Prolonged standing produces alkaline urine due to urea splitting bacteria producing ammonia. Uncovered specimen will become alkaline as carbon dioxide vaporizes. Diet may affect the pH of the urine. (Citrus fruits, cranberries, high meat -> acid) (Dairy, vegetables -> alkaline)

Question 53

Interfering Factors in regards to protein?

Answer 53

Contamination with prostate or vaginal secretions Diets high in protein Highly concentrated urine has higher concentration of protein

Question 54

Interfering Factors in regards to Leukocyte esterase?

Answer 54

False positive results with contaminants from vaginal secretions (blood or discharge) that contain WBCs

Question 55

Interfering Factors in regards to ketones?

Answer 55

Special diets (carbohydrate free, high protein, high fat) cause ketonuria

Question 56

Interfering Factors in regards to Bilirubin and Urobilirubogen?

Answer 56

Bilirubin is not stable in urine, especially with light exposure Phenazopyridine (Pyridium) colors urine orange – false impression of jaundice

Question 57

Interfering Factors in regards to WBCs?

Answer 57

vaginal discharge contamination

Question 58

Interfering Factors in regards to RBCs?

Answer 58

Traumatic catheterization causes RBCs Overaggressive anticoagulant therapy or bleeding disorders

Question 59

What do increased levels of specific gravity indicate?

Answer 59

Dehydration – kidneys absorb all available free water so urine is concentrated Pituitary tumor or trauma – SIADH causes excessive water reabsorption Glycosuria and proteinuria

Question 60

What do decreased levels of specific gravity indicate?

Answer 60

Overhydration – excess water is excreted Renal failure – kidney loses ability to concentrate urine through water reabsorption Diuresis – diuretics cause dilute urine

Question 61

What is a urine culture used for? What is normal? What do labs also report?

Answer 61

Used to diagnose UTI in patients with dysuria, frequency, or urgency. Also indicated with patients with fever of unknown origin or when UA suggests infection. Normal: negative < 10,000 bacteria/ml urine; positive > 100,000 bacteria/mL urine. Lab also reports sensitivity to various antibiotics of any bacteria growing

Question 62

What are interfering factors for urine culture?

Answer 62

Contamination of urine with stool, vaginal secretions, hands, or clothing will cause false positive results Drugs including other antibiotics may affect results

Question 63

What is urine osmolality used for? | Normal range?

Answer 63

Used to evaluate fluid and electrolyte abnormalities – determines the kidney’s concentrating capabilities. Used to evaluate ADH abnormalities (diabetes insipidus) and inappropriate ADH secretion. Normal range: 12-14 hour fluid restriction > 850 mOsm/kg H2O; random specimen 50-1200 mOsm/kg H2O

Question 64

What is more exact urine osmolality or specific gravity?

Answer 64

Urine Osmolality is more exact measurement of urine concentration than specific gravity. SG depends on weight and density of particles in the urine and requires correction for presence of glucose or protein as well as temperature. Osmolality only depends on number of particles of solute in a unit of solution

Question 65

What causes increased levels of urine osmolality? (More concentrated)

Answer 65

SIADH – ADH inappropriately secreted so large amounts of water are reabsorbed by the kidney. Paraneoplastic syndromes due to carcinoma (lung, breast, colon) – autonomous ectopic source for secretion of ADH. Shock – kidneys absorb all free water possible to minimize loss of free body water. Hepatic cirrhosis, CHF – water retention due to reduced perfusion of kidneys

Question 66

What causes decreased levels of urine osmolality? (More dilute)

Answer 66

Diabetes insipidus – insufficient secretion of ADH diminishes kidney’s ability to concentrate urine. Excess fluid intake – free water overload is excreted into the urine. Renal tubular necrosis, severe pyelonephritis – concentrating ability of kidneys is reduced

Question 67

What is Urine Drug Testing and Toxicology used for?

Answer 67

Used to identify metabolites of illegal drugs used by person being tested. Drug screen is typically performed to detect small amounts of metabolites of commonly used drugs If positive then a more accurate quantitative test can be performed on the same specimen

Question 68

What are the most common substances screened for in Urine Drug Testing and Toxicology?

Answer 68

``` Amphetamines Barbiturates Benzodiazepines Cocaine Opiates Cannabinoids Phencyclidine (PCP) Sometimes tricyclic antidepressants ```

Question 69

What are the interfering factors in Urine Drug Testing and Toxicology?

Answer 69

Poppy seeds can cause false positive opiate results. Second hand marijuana smoke can cause false positive results. Cold remedies can cause false positive amphetamine or opiate result. Aggressive diuretic use can decrease drug levels in the urine

Question 70

What is measuring sodium in the urine used for? Normal values?

Answer 70

Evaluate fluid and electrolyte abnormalities , especially Na+. Useful in evaluating volume depletion, acute renal failure, adrenal disturbances, acid-base imbalances Normal (24 hours): 40-220 mEq/day

Question 71

What causes increased levels of sodium in the urine?

Answer 71

Dehydration : Free water reabsorbed by kidney, urine Na+ more concentrated Adrenocortical insufficiency: Aldosterone & corticosteroids cause Na+ reabsorb. W/o these hormones Na+ will not be reabsorbed" Diuretic Therapy: Diminish Na+ reabsorb & increase Na+ loss Syndrome of Inappropriate ADH (SIADH): ADH stimulates water reabsorb, have high ADH so Na+ more concentrated Diabetic Ketoacidosis: Osmotic diuresis due to hyperglycemia -> diminish Na+ reaborb Chronic Renal Failure: Renal reabsorption of Na+ is diminished

Question 72

What causes decreased levels of sodium in the urine?

Answer 72

Congestive Heart Failure: Renal blood flow diminished b/c reduced cardiac output. Renin-angiotensin system activated, aldosterone production stimulated -> reabsorb Na+" Malabsorption, Diarrhea: Intestinal absorption of Na+ reduced, so reduce Na+ loss in urine Cushing's disease: Corticosteroids have aldosterone like effect on kidney -> reabsorb Na+ Aldosteronism: Aldosterone stimulates Na+ reabsorption

Question 73

What are the interfering factors for sodium in the urine?

Answer 73

Dietary Salt Intake may increase | Drugs may increase or decrease

Question 74

What is measuring Potassium in the urine used for? Normal values?

Answer 74

Evaluate electrolyte (esp. hypokalemia) balance, acid-base balance & renal and adrenal diseases Normal: 25-100 mEq/L/day

Question 75

What causes increased levels of potassium in the urine?

Answer 75

Chronic Renal Failure: Na+ loss increased, K+ loss follows Na+ loss Renal tubular acidosis: Reduced excretion of H+ increases excretion of K+ Starvation: Protein & fat containing tissues broken down -> cells expell K+ into blood, so K+ excreted in urine Cushing syndrome, Hyperaldosteronism: Aldosterone & glucocorticoids increases K+ excretion Excessive intake of Licorice: Licorice has and Aldosterone like effect Alkalosis: H+ reabsorbed in kidney in exchange for K+ Diuretic therapy: increase K+ excretion

Question 76

What causes decreased levels of potassium in the urine?

Answer 76

Dehydration: Decreased renal blood flow, diminishes K+ excretion Addison disease: diminished aldosterone (aldosterone usually ^ K+ excretion), reduced K+ excretion Malnutrition, vomitting, diarrhea, malabsorption: Diminished intake of K+ Acute renal failure: urinary excretion of K+ diminished. Most common cause of hyperkalemia

Question 77

What are the interfering factors for potassium in the urine?

Answer 77

Dietary intake Excessive Intake of Licorice increases K+ excretion Drugs may increase

Question 78

What is measuring Chloride in the urine used for? Normal values?

Answer 78

Indicate state of electrolyte or acid/base imbalance Measure effectiveness of diets with restricted salt (NaCl) Normal: 110-250mEq/day

Question 79

What causes increased levels of Chloride in the urine?

Answer 79

Dehydration, starvation, diuretic therapy, Addison disease: (Na+ followed by Cl-) reabsorption is decreased Increased Salt intake, Intravenous saline infusion: Output = input, so Cl- excretion increases to maintain homeostasis

Question 80

What causes decreased levels of Chloride in the urine?

Answer 80

Cushing syndrome, Conn Syndrome, Steroid therapy, Congesitve Heart Failure: (Na+ followed by Cl-) so reabsorption is increased Malabsorption syndrome, Prologned gastric suction or vomiting, diarrhea, pyloric obstruction, Diaphoresis, Reduced Salt intake: Serum Cl- levels decreased, so excretion decreased

Question 81

What are the interfering factors for Chloride in the urine?

Answer 81

Urine volume and preparation Dietary salt intake or saline infusion Drugs may increase

Question 82

What is measuring Cortisol in the urine used for? Normal values?

Answer 82

Suspected hyperfunction or hypofunction of adrenal gland Normal: < 100 mcg/24 hr or <276 nmol/day

Question 83

What causes increased levels of Cortisol in the urine?

Answer 83

Cushing disease, Ectopic ACTH-producing tumors, stress: ACTH overproduced, cortisol levels rise Cushing syndrome (adrneal adenoma or carcinoma): neoplasms produces cortisol Hyperthyroidism: Metabolic rate increased, cortisol levels rise to maintain glucose needs Obesity: All sterols increasedd

Question 84

What causes decreased levels of Cortisol in the urine?

Answer 84

Adrenal hyperplasia: Congenital absence of enzymes that synthesize cortisol Addison Disease: hypofunctiong adrenal gland, cortisol decreases Hypopituitarism: ACTH not produced, so adrenal gland not stimulated Hypothyroidism: Normal cortisol levels not required for reduced metabolic rate

Question 85

What are the interfering factors for Cortisol in the urine?

Answer 85

Pregnancy causes increase Physical and emotional stress cause increase Drugs can increase or decrease

Question 86

What is measuring 17-Hydroxycorticoidsteroid (17-OCHS) in the urine used for? Normal values?

Answer 86

Assess adrenocortical function by measuring cortisol metabolites (17-OCHS). Indirect measurement of adrenal function Normal: Male: 3-10 mg/24 hr or 8.3-27.6 mmol/day Female: 2-8 mg/24 hr or 5.2-22.1 mmol/day

Question 87

What causes increased levels of 17-Hydroxycorticoidsteroid (17-OCHS) in the urine?

Answer 87

Cushing disease, Ectopic ACTH-producing tumor: overproduction ACTH Stress: Stimulates ACTH production, 17-OCHS rises Cushing Syndrome (adrenal adenoma or carcinoma): Neoplasm produce cortisol, 17-OCHS rises Hyperthyroidism: Metabolic rate increase, cortisol and 17-OCHS rises to maintain glucose needs Obesity: All sterols increased

Question 88

What causes decreased levels of 17-Hydroxycorticoidsteroid (17-OCHS) in the urine?

Answer 88

Adrenal hyperplasia: Congenital absence of enzymes that synthesize cortisol Addison Disease due to adrenal infarcation, adrenal hemorrhage, surgical removal of adrenal glands, congenital enzyme deficiency or adrenal suppression from steroid therapy: hypofunctiong adrenal gland, cortisol decreases and 17-OCHS decreases Hypopituitarism: ACTH not produced, so adrenal gland not stimulated Hypothyroidism: Normal cortisol levels not required for reduced metabolic rate

Question 89

What are the interfering factors for 17-Hydroxycorticoidsteroid (17-OCHS) in the urine?

Answer 89

Emotional and Physical stress (e.g. infection) and licorice ingestion -> increased adrenal activity Drugs may increase or decrease

Question 90

Is cortisol or 17-OCHS more acurate?

Answer 90

Urine and plasma levels of cortisol are more accurate