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17-OH progesterone is a blood test that measures the amount of 17-OH progesterone, a hormone produced by the adrenal glands and gonads.

17-hydroxyprogesterone; Progesterone - 17-OH

Blood is typically drawn from a vein, usually from the inside of the elbow or the back of the hand. The site is cleaned with germ-killing medicine (antiseptic). The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood.

Next, the health care provider gently inserts a needle into the vein. The blood collects into an airtight vial or tube attached to the needle. The elastic band is removed from your arm.

Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.

In infants or young children, a sharp tool called a lancet may be used to puncture the skin and make it bleed. The blood collects into a small glass tube called a pipette, or onto a slide or test strip. A bandage may be placed over the area if there is any bleeding.

The blood sample is sent to a laboratory for examination.

Your doctor may tell you to stop taking any drugs that may cause false test results. Such drugs include corticosteroids and birth control pills.

Your doctor may also recommend that the test be done at a specific time of day, since it is sensitive to circadian rhythms, the natural highs and lows that the body experiences during a 24-hour period.

When the needle is inserted to draw blood, you may feel moderate pain, or only a prick or stinging sensation. Afterward, there may some throbbing.

This test is mainly used to check infants for congenital adrenal hyperplasia (CAH). It is often performed on infants who are born with outer genitals that do not have the typical appearance of a boy or a girl.

This test is also used to identify persons with nonclassical adrenal hyperplasia. This condition occurs when the body does not product enough of a substance that helps the adrenal gland make cortisol.

Your doctor may recommend this test if you are a woman who has excessive hair growth in places where adult men grow hair, or if you have other signs of virilization.

Normal and abnormal values differ for babies born with low birth weight. In general, normal results are as follows:

• Cord blood - 1,000 - 3,000 ng/dL
• >24 hours - less than 100 ng/dL
• Adults - less than 200 ng/dL

Note: ng/dL = nanograms per deciliter.

Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

High levels of 17-OH progesterone may be due to:

• Adrenal tumors
• Congenital adrenal hyperplasia (CAH)

In infants with CAH, 17-OHP levels range from 3,000 - 40,000 ng/dL. In adults, a level greater than 200ng/dL may be due to nonclassical adrenal hyperplasia.

Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.

Other risks may include:

• Excessive bleeding
• Fainting or feeling lightheaded
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)

Your doctor may suggest an ACTH test if your 17-OH progesterone level is between 200 - 800 ng/dL.

Speroff L, Fritz MA, eds. Normal and Abnormal Sexual Development in Clinical Gynecologic Endocrinology & Infertility. Baltimore, Md: Williams & Wilkins; 2005.

Anisocoria is unequal pupil size. The pupil is the black part in the center of the eye. It gets larger in dim light and smaller in bright light.

Enlargement of one pupil; Pupils of different size; Eyes/pupils different size

It is normal for a person's two pupils to be up to 1 mm (.05 inch) different in size.

Babies born with different sized pupils may not have any underlying disorder. If other family members also similar pupils, then the pupil size difference is possibly genetic and nothing to worry about.

Also, for unknown reasons, pupils may temporarily differ in size. If there are no other symptoms and if the pupils return to normal, then it is nothing to worry about.

Unequal pupil sizes of more than 1 mm, that develop later in life and do NOT return to equal size, may be a sign of a brain, blood vessel, or nerve disease.

The use of eyedrops are a common cause of a harmless change in pupil size. Other medicines that get in the eyes, including medicine from asthma inhalers, can change pupil size.

Other causes of unequal pupil sizes may include:

• Aneurysm
• Bleeding inside the skull caused by head injury
• Brain tumor or abscess
• Excess pressure in one eye caused by glaucoma
• Infection of membranes around the brain caused by meningitis or encephalitis
• Migraine headache
• Seizure (pupil size difference may remain long after seizure is over)
• Tumor, mass, or lymph node in the upper chest or lymph node causing pressure on a nerve may cause decreased sweating, a small pupil, or drooping eyelid all on the affected side (Horner syndrome)

Treatment depends on the cause of the unequal pupil size. You should see a doctor if you have sudden changes in pupil size.

You should see a doctor if you have persistent, unexplained, or sudden changes in pupil size. The new development of different sized pupils may be a sign of a very serious condition.

If you have differing pupil size after an eye or head injury, get medical help immediately.

Always seek immediate medical attention if differing pupil size occurs along with:

• Blurred vision
• Double vision
• Eye sensitivity to light
• Fever
• Headache
• Loss of vision
• Nausea or vomiting
• Severe eye pain
• Stiff neck

The medical history will be obtained and a physical examination performed.

Medical history questions documenting differing pupil size in detail may include:

• Is this new for you or have your pupils ever been different sizes before?
• When did it start?
• What other symptoms are also present?
  • Is there a headache?
  • Is there nausea?
  • Is there vomiting?
  • Is there blurred vision?
  • Is there double vision?
  • Is there a fever?
  • Is there a stiff neck?
  • Are the eyes light-sensitive (photophobia)?
  • Is there eye pain?
  • Is there loss of vision?

The physical examination will include a neurological examination.

Diagnostic tests that may be performed include:

• Blood studies such as CBC and blood differential
• Cerebrospinal fluid studies (lumbar puncture)
• CT scan of the head
• EEG
• Head MRI scan
• Tonometry (if glaucoma is suspected)
• X-rays of the skull
• X-rays of the neck

Depending on the diagnosis, medication may include drugs to control migraine, corticosteroids (to diminish swelling of the brain tissue), anticonvulsant drugs (to control seizures), pain relievers, antibiotics (for bacterial meningitis), or anticancer drugs.

Baloh RW. Neuro-ophthalmology. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier. 2007: chap 450.

Griggs RC, Jozefowicz RF, Aminoff MJ. Approach to the patient with neurologic disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier. 2007: chap 418.

HDL stands for high-density lipoprotein. It's also sometimes called "good" cholesterol. Lipoproteins are made of fat and protein. They carry cholesterol, triglycerides, and other fats, called lipids, in the blood from other parts of your body to your liver.

This article discusses the blood test used to measure the level of HDL cholesterol in your blood.

See also:

• LDL ("bad") cholesterol test
• Lipid profile
• High blood cholesterol and triglycerides
• Total cholesterol test

High-density lipoprotein test

A blood sample is needed.

Blood is typically drawn from a vein, usually from the inside of the elbow or the back of the hand. The site is cleaned with germ-killing medicine (antiseptic). The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood.

Next, the health care provider gently inserts a needle into the vein. The blood collects into an airtight vial or tube attached to the needle. The elastic band is removed from your arm.

Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.

You may be told not to eat or drink anything for 9 - 12 hours before the test.

The health care provider may tell you to stop taking certain drugs before the procedure.

When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.

This test is done to check the level of cholesterol in your blood and to see if you are at high risk for a heart attack, stroke, or other cardiovascular problem. Studies of both men and women have shown that the higher your HDL, the lower your risk of coronary artery disease. This is why HDL is sometimes referred to as "good" cholesterol.

The main function of HDL is to help soak up excess cholesterol from the walls of blood vessels and carry it to the liver, where it breaks down and is removed from the body in the bile.

The laboratory test for HDL actually measures how much cholesterol is in each high-density lipoprotein particle, not the actual amount of HDL in the blood.

In general, your risk for heart disease, including a heart attack, increases if your HDL cholesterol level is less than 40 mg/dL.

An HDL 60 mg/dL or above helps protect against heart disease.

Women tend to have higher HDL cholesterol than men.

Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

Low HDL levels may be a sign that you have an increased risk for atherosclerotic heart disease.

A low HDL level may also be associated with:

• Familial combined hyperlipidemia
• Noninsulin-dependent diabetes (NIDD)
• Use of certain drugs such as anabolic steroids, antipsychotics, beta blockers, corticosteroids, and protease inhibitors

There is very little risk involved with having your blood taken. Veins and arteries vary in size from one patient to another and from one side of the body to the other. Taking blood from some people may be more difficult than from others.

Other risks associated with having blood drawn are slight but may include:

• Excessive bleeding
• Fainting or feeling light-headed
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)

HDL may be done as part of an overall lipid profile, where "bad" cholesterol (LDL) and triglycerides will also be measured. The combined information gathered from all of these tests may help your risk of heart attack, stroke, and peripheral vascular disease.

Your health care provider may recommend therapy if your risk is found to be high. Regular exercise can increase HDL levels by several points.

Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001;285:2486-2497. Updated 2004.

U.S. Preventive Services Task Force. Screening for lipid disorders in adults: U.S. Preventive Services Task Force recommendation statement. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2008 Jun.

U.S. Preventive Services Task Force. Screening for Lipid Disorders in Children. US Preventive Services;Task Force recommendation statement. Pediatrics. 2007;120(1):e215-9.

Semenkovich CF. Disorders of lipid metabolism. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 217.