Table Some physiological parameters in stress amenable to

laboratory measurement
Increased levels Adrenocorticotropic hormone (ACTH)
-Endorphins
Catecholamines
Cortisol and other glucocorticoids
Cytokines
Glucagon
Prolactin
Vasopressin
Decreased levels Follicle stimulating hormone
Gonadotropin releasing hormone
Insulin
Killer T cells (chronic stress)
Luteinizing hormone
Testosterone levels (with prolonged stress)
Thyroid hormones
Total oestrogens

Table Recommended first-line laboratory tests in patient presenting

with a stress reaction
Domain Laboratory tests Notes
Clinical biochemistry Blood glucose Usually increased; impaired
glucose tolerance may be seen
CRP May be raised
LFT May show increased protein
TFT May reveal hyperthyroidism
U&E Urea may be increased in
presence of normal creatinine
Urinalysis (urine dipstick
and possibly urine drug
screening)
May help to reveal an underlying
cause
Haematology FBC Eosinophils may be decreased
Immunology No specific investigations
Microbiology

Table Additional laboratory investigations for patients with stress

reactions
Domain Laboratory tests
Clinical biochemistry HbA1c
Lipid screen
Lumbar puncture/CSF analysis
Magnesium
Porphyria screen
Prolactin
Serum B12/folate
Serum caeruloplasmin
Urinalysis (urine osmolality, urine toxicology for heavy
metals, substances of abuse, anabolic steroids;
uroporphyrins, porphobilinogen)
Haematology ESR
Haematinics
Immunology Autoantibodies (ANA, Rh factor, Ro, La, U1 ribonuclear
protein)
HIV serology
Syphilis serology
Microbiology Blood/urine cultures

Table Non-routine laboratory tests in the investigation of stress

reactions
Parameter Notes
Acetoacetate (ketone bodies) Levels may be increased in stress reactions
Aldosterone Levels may be increased in stress
Antidiuretic hormone (urine) Levels may be increased in stress
Apolipoprotein B Levels increased in emotional stress
Basophils Levels may be decreased in stress
Cortisol Levels increased in emotional stress
Free glycerol Levels may be increased in stress
Globulins ( 1 and 2) Levels may be increased in stress
Growth hormone Levels increased in emotional stress
17-Hydroxycorticosteroids Levels may be increased in stress
Iron Levels may be decreased in stress
17-Ketosteroids Levels may be increased in severe stress
Low-density lipoprotein
cholesterol
Levels may be decreased in acute stress
Myoglobin Levels increased in long-term, prolonged stress
Neutrophil alkaline
phosphatase
Levels may be increased in stress
Oxytocin Levels may be decreased in acute stress
Prolactin Levels may be increased in stress
Tissue plasminogen activator Levels may be increased in stress
Triglycerides Levels may be increased in stress
Zinc Levels may be decreased in acute stress