When is a hormone panel lab draw recommended?

Hormone Panel Lab Draw Recommendations

Hormone panel lab draws should be performed based on specific clinical indications rather than as routine screening, with testing tailored to the suspected condition and patient presentation.

General Indications for Hormone Panel Testing

• Hormone panels are recommended during treatment with specific medications that affect hormone levels, such as:

  • Immune checkpoint inhibitors (ICIs) - thyroid function tests (TSH, free T4), ACTH, and morning cortisol should be monitored for patients receiving these medications 1
  • Aromatase inhibitors for breast cancer - baseline bone density assessment is recommended 1
  • Interferon therapy for melanoma - thyroid function studies, complete blood counts, liver enzymes, and metabolic panels should be monitored 1

• Hormone testing is indicated when evaluating specific endocrine disorders:

  • For suspected hypophysitis in patients on immunotherapy - additional hormone testing (TSH, free T4, ACTH, morning cortisol) is recommended, with consideration of co-syntropin stimulation test, LH, FSH, testosterone and prolactin tests 1
  • For suspected pituitary dysfunction - drawing both TSH and FT4 is especially important as TSH can remain within normal range in hypophysitis 1

Specific Testing Recommendations by Condition

Cancer Treatment Monitoring

• For patients receiving immune checkpoint inhibitors:

  • Baseline and periodic thyroid function tests (TSH, free T4) 1
  • Additional hormone testing (ACTH, morning cortisol) for patients who develop signs of pituitary dysfunction 1
  • Early referral to an endocrinologist is recommended for abnormal results 1

• For breast cancer patients on adjuvant endocrine therapy:

  • Baseline bone density assessment for patients receiving aromatase inhibitors who are at risk of osteoporosis (e.g., age >65, family history, chronic steroids) 1
  • Sequential evaluation of hormonal status for premenopausal patients to consider alternative endocrine agents 1

Neuroblastoma Surveillance

• For neuroblastoma patients:
  • Thyroid studies including TSH annually through year 3, then as clinically indicated 1
  • Free T4 analysis if TSH is abnormal 1
  • For high-risk disease: thyroid studies every 6 months for years 1-2, then annually for years 3-5 1

Germ Cell Tumors

• For patients with suspected testicular germ cell tumors:
  • Serum AFP and hCG before orchiectomy to help establish diagnosis 1
  • AFP, hCG, and LDH shortly after orchiectomy and before subsequent treatment 1
  • Regular monitoring during treatment and surveillance 1

Testing Frequency and Duration

• For immune checkpoint inhibitor therapy:

  • Laboratory assessment before each infusion (every 3 weeks for ipilimumab) 1
  • Long-term monitoring varies: 40% recommend every 3 months for 2 years, 40% recommend individualizing to each patient 1

• For germ cell tumor surveillance after definitive therapy:

  • AFP and hCG at each visit 1
  • Every 1-2 months in first year 1
  • Every 2-4 months in second year 1
  • Every 3-6 months in third and fourth years 1
  • Every 6 months in fifth year 1
  • Annually thereafter 1

Important Considerations and Pitfalls

• When evaluating thyroid function, both TSH and free T4 should be measured, as TSH alone may be misleading in central hypothyroidism 1

• Critical sequencing is important when replacing multiple pituitary hormones - hydrocortisone must be given first when multiple hormones are missing to prevent adrenal crisis 1

• Laboratory values in transgender patients on hormone therapy typically stabilize within 6 months for most analytes (RBC and creatinine), while others (LDL, HDL, platelets) may continue to change long-term 2

• For suspected polycystic ovary syndrome, total testosterone is the most frequently abnormal biochemical marker (70%), followed by androstenedione (53%) and LH/FSH ratio (41-44%) 3

• Hormone levels change significantly after menopause, with FSH rising by a factor of 13.4 and LH by a factor of 3.0 one year after menopause, reaching peak levels after 2-3 years 4

• Morning serum hormone values are required for accurate assessment of adrenal and pituitary function 1