Services A to Z

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

North Glasgow Biochemistry is a medical testing laboratory accredited to ISO 15189:2012 by the United Kingdom Accreditation Service (UKAS). Our UKAS Medical Accreditation number is 9572. A full list of accredited tests can be found on our schedule of accreditation. Tests not on this list are not accredited; please contact the laboratory for further information if required.

The laboratory participates in external quality assurance schemes where available. Performance details are available upon request. If you wish to provide feedback on the North Glasgow Biochemistry service, please contact our Quality Manager.

The Biochemistry department utilises the Telepath Laboratory Information Management System (LIMS) and TrakCare.  Due to the limitations of this software, we are currently unable to fully meet the requirements of the UKAS publication GEN-6 – Reference to accreditation and multilateral recognition signatory status.

This publication sets out the requirements of reports/results released by the laboratory to contain the appropriate use of UKAS logos and identify any tests that are accredited and those that are not.  The department have risk assessed this.  Due to the number of analytes that can be listed on a Biochemistry report, the number of  tests that are UKAS accredited and the number of auto comments already added, it is agreed by the laboratory management team that an additional auto comment would detract from the clinically relevant comments and potentially could push these onto a second page where they may be missed altogether.  The risk is magnified by the way TrakCare displays results, as any result with a comment has an icon displayed next to it.  If an icon is displayed next to almost every result, the alert loses its impact and may lead to clinicians missing critical icons and comments.

Although we are not able to present this information on our reports, the department’s user’s handbook and website provide full details of our accreditation.

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: 1.5 mL
• Reference Range:
  • Adults (upright): 130 – 800 pmol/L
  • Neonates <1 month: 1000 – 5500 pmol/L
  • Infants (1-6 months): 500 – 4500 pmol/L
  • Infants (6-12 months): 160 – 3000 pmol/L
  • Children (2-4 years): 130 – 1000 pmol/L
  • Children (5-15 years): 130 – 600 pmol/L

• Turnaround Time: 14 days
• Method: IDS iSYS
• 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

Therapeutic Design and Art Strategies have been successfully delivered in new Acute Hospitals developments at:

Therapeutic Design and Art Strategies have been successfully delivered within new Community Health and Social Care Centres at:

Approximately 1 in 8 men and 1 in 24 women have some degree of alcohol dependence. Excess drinking puts long term health at significant risk. Excessive alcohol consumption is associated with an increased risk of a range of illnesses that collectively contribute to a massive impact on morbidity and mortality.  Please see Alcohol Consumption Questions and the Fast Alcohol Screening Test (FAST) 

For more information visit

• Drinkaware A Charity promoting responsible drinking.
• Alcohol Focus Scotland – is the national charity working to reduce alcohol harm.
• DrinkSmarter  A Scottish Government practical website with many handy tools, supporting healthier drinking habits. 
• Glasgow Council on Alcohol (GCA) Providing support, counselling, advice, information, group work and training for those affected by alcohol misuse. 
• Alcohol Concern   A charity campaigning for effective alcohol policy and improved services for people whose lives are affected by alcohol-related problems. 
• Al-Anon Family Groups provide support to anyone whose life is, or has been, affected by someone else’s drinking, regardless of whether that person is still drinking or not.

 Key points for community pharmacy

• Offer advice on sensible drinking
• Give advice on prescription and Over the Counter (OTC) medicines about interactions with alcohol.
• Signpost patients to local services offering support
• Further Information, Resources and Support (including “Alcohol Before, During and After Leaflet) Alcohol and Pregnancy Leaflet 

Some pharmacies may

• Offer alcohol brief interventions using a FAST tool

It is estimated that 1 in 3 people in Scotland will develop some form of cancer during their lifetime.

This is a wide ranging topic and there are many different types of cancer. Some are more likely to occur in females e.g. cervical and breast cancer while others in men e.g. prostate cancer.

Many forms of cancer can now be successfully treated if they are identified in their early stages and we now have screening for the commonly occurring breast, bowel and cervical cancers.

Some cancers such as melanoma (skin cancer) may be prevented by health protection measures such as avoiding the sun and using sunscreens. Smoking cessation remains one of the most important health improvement measures to avoid developing cancer.

For more information visit

• Scottish Cancer Index provides links to cancer related websites specific to Scotland.  
• Cancer Research UK  Helpline 0808 800 4040  Mon – Fri 9-5pm
• Bowel cancer UK providing support and advice. Telephone: 020 7940 1760
•  Encourage completion and return of Bowel Screening Kits information at this website
• Breast Cancer Care providing information and assistance for those affected by breast cancer. Freephone Helpline 0808 800 6000.  
• Cancer Support Scotland  Cancer Support Scotland offers counselling, support groups and complementary therapies to anyone affected by cancer, including family members and carers: before, during and after treatment.
• Sun Smart   This Cancer Research UK website provides a wealth of information including, information on skin cancer, sunburn and how it damages your skin, advice on protective measures to take – applying sunscreen, staying in the shade, wearing protective clothing and sunglasses, and advice on protecting children from the sun.    
• British Lung Foundation provides advice on all diseases affecting the lungs including lung cancer. 
• Leukaemia Care provides support for people with leukaemia, lymphomas and related disorders. Tel: Helpline: 08088 010 444 or chat via WhatsApp on 07500068065
• Lymphoma Action provides support for those affected by Hodgkin’s disease and non-Hodgkin’s lymphoma. Tel. Helpline no: 0808 808 5555
• Macmillan Cancer Support is a national charity providing expert care and support for people living with cancer. Tel. Helpline: 0808 808 0000
• Maggies Centre provides support organisation for those affected by cancer. One of the centres is in Glasgow.   
• Marie Curie Cancer Care. Dedicated to the cure of people affected by cancer and the enhancement of their quality of life through its caring services, research and education.  Telephone Support Line: 0800 090 2309
• Oesophageal Patients Association Telephone: 0121 704 9860 (Mon – Fri 9am – 5pm)
• Orchid: Fighting Male Cancer  Good range of leaflets on testicular and prostate cancer.  National male cancer helpline: 0808 802 0010
• Prostate Cancer UK Telephone:  Helpline: 0800 0748383 

 Key points for community pharmacy

• Signpost patients to appropriate support organisations.
• Many quality, free resources can be ordered to support from Quick Guide for Community Pharmacies on where to access Patient Resources 
• Be alert to red flag symptoms such as a persistent cough which might suggest a patient should be referred to their GP for investigation.
• Encourage patient’s participation in national screening programmes e.g. cervical screening whenever possible.
• Only sell a minimum of SPF 15 sun protection products. 

Many factors go together to improve an individual’s health. Their health needs change through life as they get older and different issues might impact on men’s and women’s health. However, a healthy lifestyle is important at any stage of an individual’s life.

Diet and nutrition, exercise, smoking cessation and managing alcohol intake are modifiable lifestyle factors that can be addressed to improve health.

Other factors may not be readily addressed by individuals but rely upon society working together to promote healthy living and working environments.

Health inequalities arise when individuals or communities are not empowered to make healthy lifestyle choices.

For more information visit

 Child Health

• Breast Feeding Network  Offers advice and support to breastfeeding mothers
• Immunisation

 Health in older age

• Alzheimer’s Society Dementia Connect support line T: 0333 150 3456
• Carers UK or Carers Scotland (part of Carers UK)
• Parkinson’s UK or telephone 0808 800 0303
• Age UK  

 Healthy Living 

• BMI calculator a useful tool to calculate body mass index
• Scottish Slimmers and WeightWatchers  Both offer successful programmes for weight loss.
• Alcohol and Drugs – NHSGGC
• Stop Smoking Support – Quit your way – NHSGGC

Community Pharmacy – Signpost patients to appropriate support organisations.

Beware of your patients particular needs. Check out your locality’s health profile.

The effective management of long term health conditions (LTHC) can greatly improve a patient’s health and wellbeing. Examples of these conditions include epilepsy, cardiovascular disease, diabetes asthma and chronic obstructive pulmonary disease (COPD).

In addition to taking appropriate medication LTHC patients are often asked to make lifestyle changes such as smoking cessation or alcohol reduction. But at the same time they may be struggling with psychological issues caused by the impact of their diagnosis.

So in addition to understanding the clinical management of patients and the guidelines that are in place for these it is important to consider the patient as a whole and understand their attitudes to their condition and its management.  

For more information visit

• The British Heart Foundation  
• British Hypertension Society    
• Chest Heart and Stroke Scotland
• Stroke Association  
• Epilepsy Scotland
• Diabetes UK
• Thyroid UK
• Asthma UK
• British Lung Foundation

Key points for community pharmacy

• Signpost patients to appropriate support organisations.
• Know when to call for medical assistance in the event of a heart attack and how to deliver basic resuscitation (CPR) for patients who have collapsed. Details of suitable courses may be found at St Andrews Ambulance Brigade
• Advise on use of inhaler devices for asthma and COPD patients

 Some pharmacies may

• Offer health screening such as blood pressure or glucose monitoring

Mental health is a complex topic affecting a significant percentage of people in the UK at any one time. Issues might include depression (including postnatal depression) bipolar affective disorders, stress, anxiety disorders, phobias, eating disorders, schizophrenia and others. Some individuals may suffer from a combination of symptoms.

The management of patients suffering mental health problems may range from self help approaches to in patient care at a psychiatric specialist hospital or facility.

Regardless of how patients are managed, good mental health is underpinned by a healthy lifestyle. Good diet, smoking cessation, exercise, sleep hygeine and alcohol management will not necessarily cure a patient but they will significantly contribute to their recovery.

For more information visit

• Heads Up – Mental Health Support – NHSGGC For extensive information on mental health care available in Greater Glasgow and Clyde.   
• NHS24 Tel 111. Can provide or source help for a patient in crisis when their GP is not available
• Breathing Space Scotland Tel: 0800 83 85 87. Free, confidential phone and web based service for people in Scotland experiencing low mood, depression or anxiety.
• Mind Tel 0300 123 3393. Mental Health Charity aimed to ensure anyone with a mental health problem has somewhere to turn to for advice and support, and offer useful leaflets and publications.
• Samaritans Provide confidential emotional support 24/7 to those experiencing despair, distress or suicidal feelings.

Key points for community pharmacy

• Signpost patients to appropriate support organisations
• Support patients on long term medication such as lithium by ensuring they undergo appropriate blood monitoring.
• Provide appropriate relaxation and sleep hygiene advice (click on links below)o    Help with Sleep – Information for Carerso    Relaxation  Guideo    Sleep Guide

This service is provided by a network of 70 pharmacies across the NHS Greater Glasgow & Clyde area. These pharmacies maintain

• a stock of specific core medicines
• provision of advice and useful contact numbers for specialist palliative care advice
• a support network to other pharmacies within their localities. 

Some participating pharmacies are available to dispense out-of-hours urgent prescriptions. This can be arranged through NHS 24. A courier service protocol is available to ensure timely supplies of medicines to palliative care patients in emergencies. The aim is for the first pharmacy contacted (regardless of being a part of the Palliative Care network or not) to ascertain the urgency of the prescription and resolve any supply issues, in order to avoid patients, carers, or nurses needing to phone or visit multiple pharmacies. All community pharmacies are provided with a list of the network pharmacies for this purpose and the specific core medicines list. For more details on the Palliative Care Service, click here  or contact: Palliative Care Specialist Pharmacists on the below telephone numbers: 07876 478140 or 07880 786659 or 07775 012560

NHSGGC are responsible for a wide range of tobacco projects including the “Quit Your Way” Pharmacy Service.

Suitable pharmacotherapy (Nicotine Replacement Therapy [NRT] or varenicline) together with personalised advice and support is provided from the community pharmacy for usually up to 12 weeks.

For further details, please contact any participating pharmacy or the Quit Your Way Pharmacy Team (T:0141 201 4945 or e: pharmacyhit@ggc.scot.nhs.uk)

• List of Pharmacies involved in Quit Your Way.
• Guidance Notes for Service Delivery.
• Quit Your Way Questions & Answers (for Community Pharmacy)

View and order resources