Hormone Lab
Prepared By:
Abdulrahman Maher Kharabah
@Abdulrahman Kharabah
Table of Contents
1. Workflow in the Hormone Laboratory ....................................................................... 3
2. Specimen Types & Collection Requirements ............................................................... 4
Common Specimen Types: ..................................................................................... 4
Special Handling Requirements: ............................................................................ 4
3. Result Reporting ...................................................................................................... 6
4. List of tests, TAT, Collection Medium ......................................................................... 7
5. Analyzers Used in the Hormone Laboratory ............................................................... 8
Comparison of Analyzers used in the hormone laboratory: ......................................... 9
6. Recommended books for your knowledge ................................................................. 10
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The Hormone Laboratory is a specialized diagnostic unit dedicated to the analysis of
hormones that regulate vital physiological processes in the human body. It plays a crucial role in
the early detection, diagnosis, and monitoring of endocrine and metabolic disorders. Hormones are
chemical messengers secreted by glands such as the pituitary, thyroid, adrenal, and gonads, and
their accurate measurement is essential for clinical decision-making.
The laboratory utilizes advanced immunoassay techniques and automated analyzers to ensure the
precision and reliability of results. Tests performed in the Hormone Lab support the evaluation of
various medical conditions, including thyroid dysfunction, infertility, growth disorders, adrenal
insufficiency, and diabetes.
This manual provides a comprehensive overview of the laboratory’s workflow, equipment,
specimen requirements, testing protocols, and reporting standards to ensure consistent, high-
quality service delivery in accordance with international laboratory guidelines.
1. Workflow in the Hormone Laboratory
1. Sample Reception & Verification
o Check patient info, tube type, and test request.
2. Centrifugation
o Samples are centrifuged based on test requirements.
3. Aliquoting & Storage
o Some samples are stored temporarily or frozen for stability.
4. Analysis
o Samples are loaded into analyzers according to SOPs.
5. Result Validation
o Results are checked by the technologist and reviewed by a pathologist if necessary.
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2. Specimen Types & Collection Requirements
Hormonal assays necessitate meticulous specimen collection and handling to ensure result
accuracy. The type of specimen, collection timing, and handling protocols vary depending on the
specific hormone being tested.
Common Specimen Types:
• Serum (Plain or Gel-Barrier Tubes): Utilized for most hormone tests, including TSH,
FT3, FT4, prolactin, testosterone, estradiol, cortisol, etc.
• Plasma (EDTA Tubes): Required for specific assays like ACTH and renin, which are
sensitive to degradation.
Special Handling Requirements:
ACTH (Adrenocorticotropic Hormone):
• Collection Timing: Preferably between 7:00 AM and 10:00 AM due to diurnal variation.
• Collection Protocol:
o Draw blood into a pre-chilled lavender-top (EDTA) tube.
o Immediately place the tube in an ice bath.
o Centrifuge within 30–60 minutes at refrigerated temperatures.
o Aliquot and freeze plasma immediately.
o
• Stability: Plasma is stable for up to 28 days if frozen.
• Reason: ACTH is highly unstable at room temperature;
immediate cooling and freezing are critical to preserve
hormone levels.
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Cortisol:
• Collection Timing:
o AM Cortisol: Between 7:00 AM and 9:00 AM (peak level).
o PM Cortisol: Between 4:00 PM and 6:00 PM (lowest level).
• Collection Protocol:
o Use SST or plain tubes.
o Label the collection time clearly.
• Stability: Stable at room temp for 24 hrs; refrigeration is preferred.
• Reason: Cortisol follows a diurnal rhythm; correct timing ensures meaningful
interpretation of results.
Aldosterone:
• Collection Considerations:
o Patient should be seated or supine for 15–30 minutes prior.
o Morning sample preferred due to diurnal variation.
• Sample Type:
o Serum (Plain/SST) or Plasma (EDTA) if renin is measured too.
• Handling:
o Keep sample cold or refrigerated.
o Centrifuge promptly; freeze if delayed.
o Protect from light if possible.
• Patient Prep:
o Medications like spironolactone, ACE inhibitors, beta-blockers may interfere and
should be stopped in advance under supervision.
• Reason: Aldosterone levels are sensitive to posture, time of day, and temperature; proper
handling ensures reliable measurement.
Renin (Plasma Renin Activity):
• Sample Type: Chilled EDTA plasma.
• Handling:
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o Keep on ice immediately after draw.
o Centrifuge quickly and freeze plasma.
o Often paired with aldosterone for ARR testing.
• Reason: Enzyme activity in renin is temperature-sensitive; chilling and rapid processing
prevent degradation.
Parathyroid Hormone (PTH):
• Sample Type: Serum or EDTA.
• Handling:
o Separate from cells within 2 hours.
o Store refrigerated or frozen to maintain integrity.
• Reason: PTH degrades quickly if not separated from cells; cold storage maintains hormone
stability.
General Rejection Criteria:
• Hemolyzed, lipemic, or clotted specimens.
• Incorrect collection tube (e.g., ACTH in serum).
• Delay in processing beyond stability window.
• Improper storage (e.g., no refrigeration when required).
• Unlabeled or mislabeled samples.
3. Result Reporting
• Turnaround time: Generally 3 working days for most hormone tests.
• Results are entered into the LIS and sent to clinicians electronically.
• Critical results (e.g., very high cortisol or TSH) are reported urgently.
• Reference ranges differ by age, sex, and method (as listed in lab test reference sheets).
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4. List of tests, TAT, Collection Medium
TEST TAT COLLECTION MEDIUM
TSH 3 working days Serum (plain tube)
FT3 3 working days Serum (plain tube)
FT4 3 working days Serum (plain tube)
FSH 3 working days Serum (plain tube)
LH 3 working days Serum (plain tube)
ESTRADIOL (E2) 3 working days Serum (plain tube)
PROGESTERONE 3 working days Serum (plain tube)
B-HCG (QUANTITATIVE) 3 working days Serum (plain tube)
TESTOSTERONE 3 working days Serum (plain tube)
PROLACTIN 3 working days Serum (plain tube)
GROWTH HORMONE 7 working days Serum (plain tube)
PTH 3 working days Serum (plain tube)
CORTISOL 3 working days Serum (plain tube)
ACTH 3 working days EDTA tube (ice)
PSA (TOTAL) 3 working days Serum (plain tube)
PSA (FREE) 3 working days Serum (plain tube)
CA 19.9 3 working days Serum (plain tube)
CA 15-3 3 working days Serum (plain tube)
CA 125 3 working days Serum (plain tube)
AFP (ALPHA-FETOPROTEIN) 3 working days Serum (plain tube)
CEA (CARCINOEMBRYONIC AG) 3 working days Serum (plain tube)
INSULIN 3 working days Serum (plain tube)
FERRITIN 3 working days Serum (plain tube)
VITAMIN B12 3 working days Serum (plain tube)
1.25 HYDROXYVIT.D 3 working days Serum (plain tube)
FOLATE 3 working days Serum (plain tube)
THYROGLOBULIN 3 working days Serum (plain tube)
ANTI-TPO 3 working days Serum (plain tube)
ANTI-TG 3 working days Serum (plain tube)
C-PEPTIDE 3 working days Serum (plain tube)
EPO 3 working days Serum (plain tube)
DHEAS 3 working days Serum (plain tube)
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5. Analyzers Used in the Hormone Laboratory
1. Cobas 6000 (e601 module)
The Cobas 6000 is a modular analyzer that supports a wide range of immunoassays. Its e601
module uses Electrochemiluminescence Immunoassay (ECLIA) technology, which combines
electrochemistry with chemiluminescence. In this method, an electric current is applied to an
electrode, triggering a chemical reaction that emits light. The intensity of the emitted light is
measured to determine the concentration of the analyte.
This technology is known for its high sensitivity and precision, making it especially suitable for
hormone testing such as TSH, Free T4 (FT4), Prolactin, Cortisol, and many others. The system
offers high throughput and is fully automated, making it ideal for both routine and STAT testing
in clinical laboratories.
2. Beckman Coulter DxI 800
The DxI 800 is a high-capacity chemiluminescent immunoassay (CLIA) analyzer designed for
high-throughput laboratories. It delivers rapid and reliable results across a broad test menu,
particularly in hormone analysis, including testosterone, estradiol, LH, FSH, and more.
CLIA (Chemiluminescent Immunoassay) is a highly sensitive and specific analytical technique
that uses a chemiluminescent reaction to detect the presence of an analyte. In this method, a
chemical reaction produces light as a byproduct, and the intensity of the emitted light is directly
proportional to the concentration of the target substance in the sample. This enables accurate
quantification of hormones even at very low levels.
The DxI 800 features continuous sample and reagent loading, automated maintenance, and high
reagent stability, all of which contribute to an efficient workflow and consistent performance,
making it ideal for large laboratories with high testing demands.
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3. Alinity i – Abbott Diagnostics
The Alinity i system is part of Abbott’s Alinity family and uses Chemiluminescent Microparticle
Immunoassay (CMIA) technology. CMIA is a sensitive diagnostic technique that combines
chemiluminescence with immunoassay principles, where a chemiluminescent substrate emits light
in response to a specific biochemical reaction. This technology allows for the precise detection of
hormones and other biomarkers with high sensitivity and minimal sample volumes.
The Alinity i system is ideal for hormone testing in busy clinical environments due to its high
analytical sensitivity and efficient use of small sample volumes. It emphasizes user-friendly
operation, a compact design, and integration capabilities with Laboratory Information Systems
(LIS) and other Alinity series platforms, offering a seamless and efficient workflow.
Comparison of Analyzers used in the hormone laboratory:
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6. Recommended books for your knowledge
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