Proinsulin

Clinical use
Differential diagnosis of documented spontaneous hypoglycaemia.

Application
Autonomous secretions of some, but not all, insulinomas contain an abnormally high proportion of immunoreactive proinsulin. An elevated blood level can confirm this diagnosis but a low (normal) result cannot exclude it.

Patient preparation
Hypoglycaemia, spontaneous or whilst fasting, must first be established by regular monitoring of blood glucose levels. Blood (10 mL) collected in a plain vacutainer or syringe, when the whole blood glucose concentration (confirmed by laboratory analysis) is less than 2.2 mmol/L (or less than 2.5 mmol/L in patients over 60 years), should be used for the tests. Vacutainers (7 mL, red top) may be used for blood collection.

Sample preparation
Transfer the blood to a plain tube. Separate the serum, preferably within 30 min of collection and freeze at -20C. Larger volumes of sample (5 mL) are required for additional studies such as IGF-1 measurements or sulphonylurea identification. Small blood samples from neonates should be transferred to a heparin tube so that the maximum volume of plasma may be collected. A minimum volume of 0.5 mL should be stored at -20C. Visible haemolysis may invalidate the result.

Send samples to the SAS laboratory. Ensure they remain frozen during transport. Record the blood glucose concentration on the request form.

Reference range
An interpretation of the result(s) will be provided where sufficient information accompanies the request. For further clarification please contact the SAS laboratory.

Centre offering this assay
Guildford RSH Peptide Hormone Laboratory

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