Endocrinology
The University of Florida Endocrine Autoantibody Laboratory provides autoantibody marker testing for the following disorders:
- autoantibody marker(s)
- type 1 diabetes mellitus (T1DM)
- islet cell cytoplasmic autoantibodies (ICA)
- glutamic acid decarboxylase autoantibodies (GADA)
- insulinoma-2-associated autoantibodies (IA-2A)
- insulin autoantibodies (IAA) - autoimmune thyroid disease (AITD)
- thyroid microsomal autoantibodies (TMA)
- thyroglobulin autoantibodies (TGA) - autoimmune Addison disease
- adrenal cytoplasmic autoantibodies (ACA) - autoimmune gonadal failure
- steroidal cell autoantibodies (SCA) - pernicious anemia
- parietal cell autoantibodies (PCA)
Islet autoantibodies (a collective term for ICA, GADA, IA-2A and IAA), when positive, are diagnostic for type 1 diabetes. This may be helpful when a physician is unclear as to whether or not a patient with diabetes should be treated with insulin. Individuals with type 1 diabetes should be treated with insulin and not oral hypoglycemic agents. Islet autoantibodies in the absence of diabetes are highly predictive of the later development of type 1 diabetes. Such testing may be helpful in the lean patient with episodic hyperglycemia, impaired fasting glucose or impaired glucose tolerance when type 2 diabetes is unlikely.
Autoimmune thyroid disease is very common in the general population and even more so in people with type 1 diabetes. Finding either of the thyroid autoantibodies in the setting of goiter or hypothyroidism is usually diagnostic for Hashimoto thyroiditis. Identifying either of the thyroid autoantibodies in the setting of hyperthyroidism is usually diagnostic for Graves disease. Lastly, recognition of either of the thyroid autoantibodies in otherwise asymptomatic patients predicts an increased risk for subsequent thyroid disease (e.g., goiter, hypothyroidism or hyperthyroidism). Many experts advise yearly TSH testing in euthyroid patients with thyroid autoantibodies to anticipate the development of clinical thyroid disease. This can permit early treatment of thyroid disorders. Experts also advise that all patients with type 1 diabetes be screened for thyroid autoimmunity.
Identification of adrenal cytoplasmic autoantibodies in a patient with adrenal insufficiency establishes the diagnosis of autoimmune Addison disease. Autoimmune Addison disease is a key element in the diagnosis of either autoimmune polyglandular syndrome type 1 or type 2. Adrenal cytoplasmic autoantibodies in asymptomatic patients are predictive of the later development of Addison disease. Many experts advise yearly cortrosyn stimulation testing and renin measurements in this circumstance in anticipation of adrenal failure. This can allow early treatment of adrenal insufficiency.
Testing for steroidal cell autoantibodies uses 3 tissues: placenta, ovary and testes. In women with premature ovarian failure, positivity by indirect immunofluorescence on any of these substrates indicates an autoimmune etiology. Steroidal cell autoantibodies can be observed in the autoimmune polyglandular syndromes and can predict ovarian failure. Autoimmunity to the gonads is a common component of autoimmune polyglandular syndrome type 1.
While not an endocrine disorder, pernicious anemia is commonly associated with autoimmune endocrine disorders such as autoimmune thyroid disease and type 1 diabetes. Finding parietal cell autoantibodies in the setting of pernicious anemia is diagnostic for an autoimmune etiology (e.g., chronic lymphocytic gastritis). Parietal cell autoantibodies in asymptomatic patients are predictive of the later development of pernicious anemia. Many experts advise yearly vitamin B12 and ferritin testing in this circumstance. This can allow early treatment of pernicious anemia.
The Endocrine Autoantibody Laboratory was founded by Noel K. Maclaren, MD. The current medical director since 1997, William E. Winter, MD, was a research fellow of Dr. Maclaren's. Dr. Winter holds boards in Pediatrics, Pediatric Endocrinology and Chemical Pathology from the American Board of Pathology. Dr. Winter is also a diplomate of the American Board of Clinical Chemistry. Dr. Winter is the principle investigator for the Islet Cell Autoantibody core laboratory for the NIH-funded study entitled "Type 1 Diabetes TrialNet."
Endocrinologists should request that their endocrine autoantibody testing be sent to the University of Florida for the following reasons: 1) we are licensed by CLIA and the State of Florida and we are accredited by the College of American Pathologists (CAP), 2) we have over 25 years experience with autoantibody assays, 3) we are involved in major research trials using islet cell autoantibodies, and 4) we offer free consultation with our laboratory medical director (William E. Winter, MD) who has extensive clinical and laboratory experience in the field of autoimmune endocrine disorders. Dr. Winter has published extensively on the topic of endocrine autoantibodies and autoimmune endocrine disorders.
Sample Reports: Endocrine
Test List
Adrenocortical Autoantibodies (William E. Winter, M.D.)
| Test Order Number: | 0022 | |
| Methodology: | Indirect immunofluorescence | |
| Specimen Requirements: | 1-2 mL serum | |
| Specimen Handling: | Transfer to a plastic vial. Ship with frozen coolpack for overnight delivery. | |
| In-house turnaround time: | 10 working days | |
| Reference Values: | Negative (Interpretive report provided) | |
| CPT Code: | 88347 | |
| Notes: |
Endocrine Autoantibodies (William E. Winter, M.D.)
| Test Order Number: | 0024 | |
| Methodology: | Indirect immunofluorescence, Hemagglutination | |
| Specimen Requirements: | 1-2 mL serum | |
| Specimen Handling: | Transfer to a plastic vial. Ship with frozen coolpack for overnight delivery | |
| In-house turnaround time: | 10 working days (see Note) | |
| Reference Values: | Negative | |
| CPT Code: | 88347 (x6), 86376, 86800 | |
| Notes: | Includes Adrenocortical, Gastric Parietal Cell, Islet Cell, Steroidal (ovarian, placental, testicular), Thyroglobulin, and Thyroid Microsomal. If Insulin Autoantibodies are requested, a preliminary report will be issued whenever the Insulin Autoantibodies, which have an in-house turnaround of 20 working days, are not completed with the other tests. A final report will be issued upon completion |
Gastric Parietal Cell Autoantibodies (William E. Winter, M.D.)
| Test Order Number: | 0021 | |
| Methodology: | Indirect Immunofluorescence | |
| Specimen Requirements: | 1-2 mL serum | |
| Specimen Handling: | ||
| In-house turnaround time: | 10 working days | |
| Reference Values: | Negative | |
| CPT Code: | 88347 | |
| Notes: |
Glutamic Acid Decarboxylase Autoantibody (GAD65) (William E. Winter, M.D.)
| Test Order Number: | 0277 | |
| Methodology: | RIA | |
| Specimen Requirements: | 1-2 mL serum | |
| Specimen Handling: | Transfer to a plastic vial. Ship with frozen coolpack for overnight delivery. | |
| In-house turnaround time: | 10 working days | |
| Reference Values: | < 1.1 u/mL | |
| CPT Code: | 86341 | |
| Notes: |
IA-2 Autoantibody (William E. Winter, M.D.)
| Test Order Number: | 0278 | |
| Methodology: | RIA | |
| Specimen Requirements: | 1-2 mL serum | |
| Specimen Handling: | Transfer to a plastic vial. Ship with frozen coolpack for overnight delivery. | |
| In-house turnaround time: | 10 working days | |
| Reference Values: | < 0.76 u/mL | |
| CPT Code: | 86341 | |
| Notes: |
Insulin Autoantibodies (William E. Winter, M.D.)
| Test Order Number: | 0018 | |
| Methodology: | RIA | |
| Specimen Requirements: | 1-2 mL serum | |
| Specimen Handling: | Transfer to a plastic vial. Ship with frozen coolpack for overnight delivery | |
| In-house turnaround time: | 20 working days | |
| Reference Values: | < 120 nU/mL | |
| CPT Code: | 86337 | |
| Notes: |
Islet Cell / Insulin Autoantibodies (William E. Winter, M.D.)
| Test Order Number: | 0162 | |
| Methodology: | Indirect Immunofluorescence; RIA | |
| Specimen Requirements: | 1-2 mL serum | |
| Specimen Handling: | Transfer to a plastic vial. Ship with frozen coolpack for overnight delivery | |
| In-house turnaround time: | 10 working days (see Notes) | |
| Reference Values: | Negative (Quantitative results reported in JDF units) | |
| CPT Code: | 88347, 86337 | |
| Notes: | Insulin Autoantibodies have an in-house turnaround time of 20 working days. Therefore, a preliminary report is issued upon completion of the Islet Cell Autoantibodies. A final report will be issued when the Insulin Autoantibodies are complete |
Islet Cell Autoantibodies (William E. Winter, M.D.)
| Test Order Number: | 0017 | |
| Methodology: | Indirect Immunofluorescence | |
| Specimen Requirements: | 1-2 mL serum | |
| Specimen Handling: | Transfer to a plastic vial. Ship with frozen coolpack for overnight delivery. | |
| In-house turnaround time: | 10 working days | |
| Reference Values: | Negative (< 5 JDF) | |
| CPT Code: | 88347 | |
| Notes: |
Ovarian Autoantibodies (William E. Winter, M.D.)
| Test Order Number: | 0039 | |
| Methodology: | Indirect Immunofluorescence | |
| Specimen Requirements: | 1-2 mL serum | |
| Specimen Handling: | Transfer to a plastic vial. Ship with frozen coolpack for overnight delivery | |
| In-house turnaround time: | 10 working days | |
| Reference Values: | Negative | |
| CPT Code: | 88347 | |
| Notes: |
Placental (syncytrophoblast) Autoantibodies (William E. Winter, M.D.)
| Test Order Number: | 0108 | |
| Methodology: | Indirect Immunofluorescence | |
| Specimen Requirements: | 1-2 mL serum | |
| Specimen Handling: | Transfer to a plastic vial. Ship with frozen coolpack for overnight delivery. | |
| In-house turnaround time: | 10 working days | |
| Reference Values: | Negative | |
| CPT Code: | 88347 | |
| Notes: |
Testicular Autoantibodies (William E. Winter, M.D.)
| Test Order Number: | 0040 | |
| Methodology: | Indirect Immunofluorescence | |
| Specimen Requirements: | 1-2 mL serum | |
| Specimen Handling: | Transfer to plastic vial. Ship with frozen coolpack for overnight delivery | |
| In-house turnaround time: | 10 working days | |
| Reference Values: | Negative | |
| CPT Code: | 88347 | |
| Notes: |
Thyroglobulin Autoantibodies (William E. Winter, M.D.)
| Test Order Number: | 0020 | |
| Methodology: | Hemagglutination | |
| Specimen Requirements: | 1-2 mL serum | |
| Specimen Handling: | Transfer to a plastic vial. Ship with frozen coolpack for overnight delivery. | |
| In-house turnaround time: | 10 working days | |
| Reference Values: | Negative | |
| CPT Code: | 86800 | |
| Notes: |
Thyroid Microsomal Autoantibodies (William E. Winter, M.D.)
| Test Order Number: | 0019 | |
| Methodology: | Hemagglutination | |
| Specimen Requirements: | 1-2 mL serum | |
| Specimen Handling: | Transfer to a plastic vial. Ship with frozen coolpack for overnight delivery. | |
| In-house turnaround time: | 10 working days | |
| Reference Values: | Negative | |
| CPT Code: | 86376 | |
| Notes: |