SIRA Logo

The endocrine system

AMA5 Chapter 10 (p 211) applies to the assessment of permanent impairment of the endocrine system, subject to the modifications set out below. Before undertaking an impairment assessment, users of the Guidelines must be familiar with:

  • the Introduction in the Guidelines
  • chapters 1 and 2 of AMA5
  • the appropriate chapter(s) of the Guidelines for the body system they are assessing
  • the appropriate chapter(s) of AMA5 for the body system they are assessing.

The Guidelines take precedence over AMA5.

Introduction

13.1 AMA5 Chapter 10 provides a useful summary of the methods for assessing permanent impairment arising from disorders of the endocrine system.

13.2 Refer to other chapters in AMA5 for related structural changes – the skin (eg pigmentation, in Chapter 8), the central and peripheral nervous system (eg memory, in Chapter 13), the urinary and reproductive system (eg infertility renal impairment, in Chapter 7), the digestive system (eg dyspepsia, in Chapter 6) and the cardiovascular system (in chapters 3 and 4) and visual system (Chapter 8 AMA4).

13.3 The clinical findings to support the impairment assessment are to be reported in the units recommended by the Royal College of Pathologists of Australia. (See Appendix 13.1).

13.4 Westergren erythrocyte sedimentation rate (WSR) is equivalent to ESR.

Adrenal cortex

13.5 AMA5 (p 222) first paragraph: disregard the last sentence, ‘They also affect inflammatory response, cell membrane permeability, and immunologic responses, and they play a role in the development and maintenance of secondary sexual characteristics’. Replace with: ‘Immunological and inflammatory responses are reduced by these hormones and they play a role in the development and maintenance of secondary sexual characteristics.’

13.6 AMA5 example 10-18 (pp 224–25): See reference to ESR (paragraph 13.4, above).

13.7 AMA5 example 10-20, regarding history (p 225): Instead of ‘hypnotic bladder’, read ‘hypotonic bladder’.

Diabetes mellitus

13.8 AMA5 (p 231): refer to the Australian Diabetes Association Guidelines with regard to levels of fasting glucose. (The position statement from the Australian Diabetes Society is reprinted in Appendix 13.2).

13.9 AMA5 (p 231): At the end of the second paragraph insert, ‘The goal of treatment is to maintain haemoglobin A1c within 1% of the normal range (4.0–6.3%)’.

Mammary glands

13.10 AMA5 example 10-45, regarding current symptoms (p 239): Disregard the last sentence, ‘Both bromocriptine and cabergoline cause nausea, precluding use of either drug’. Replace with: ‘Routine use of bromocriptine and cabergoline is normal in Australia. It is rare that nausea precludes their use’.

Criteria for rating permanent impairment due to metabolic bone disease

13.11 AMA5 (p 240): Impairment due to a metabolic bone disease itself is unlikely to be associated with a work injury and would usually represent a pre-existing condition.

13.12 Impairment from fracture, spinal collapse or other complications may arise as a result of a work injury associated with these underlying conditions (as noted in AMA5 Section 10.10c) and would be assessed using the other chapters indicated, with the exception of Chapter 18, on pain, which is excluded from the Guidelines.

Appendix 13.1: Interpretation of pathology tests

From the Manual of use and interpretation of pathology tests, 3rd edition. Reprinted with kind permission of the Royal College of Pathologists of Australasia.

Reference ranges, plasma or serum, unless otherwise indicated

Alanine aminotransferase (ALT)(adult)<35 U/L
Albumin(adult)32-45 g/L
Alkaline phosphatase (ALP)(adult, non-pregnant)25-100 U/L
Alpha fetoprotein(adult, non-pregnant)<10 g/L
Alpha-1-antitrypsin 1.7-3.4 g/L
Anion gap 8-16 mmol/L
Aspartate aminotransferase (AST) <40 U/L
Bicarbonate (total CO2) 22-32 mmol/L
Bilirubin (total)(adult)<20 μmol/L
Calcium(total)2.10-2.60 mmol/L
 (ionised)1.17-1.30 mmol/L
Chloride 95-110 mmol/L
Cholesterol (HDL)(male)0.9-2.0 mmol/L
 (female)1.0-2.2 mmol?L
Cholesterol (total) (National Heart Foundation (Australia) recommendation)<5.5 mmol/L
Copper 13-22 μmol/L
Creatine kinase (CK)(male)60-220 U/L
 (female)30-180 U/L
Creatinine(adult male)0.06-0.12 mmol/L
 (adult female)0.05-0.11 mmol/L
Gamma glutamyl transferase (GGT)(male)<50 U/L
 (female)<30 U/L
Globulinadult25-35 g/L
Glucose(venous plasma) - (fasting)
(venous plasma) - (random) 
3.0-5.4 mmol/L
3.0-7.7 mmol/L 
Lactate dehydrogenase (LD)(adult)110-230 U/L
Magnesium(adult)0.8-1.5 mmol/L
Osmolality(adult)280-300 m.osmoll/kg water
pCO2(arterial blood)4.6-6.0 kPa (35-45 mmHg)
pH(arterial blood)7.36-7.44 (36-44 nmol/L)
Phosphate 0.8-1.5 mmol/L
pO2(arterial blood)11.0-13.5 kPa (80-100 mmhg)
Potassium(plasma)3.4-4.5 mmol/L
 (serum)3.8-4.9 mmol/L
Prolactin(male)150-500 m U/L
 (female)0-750 m U/L
Protein, total(adult)62-80 g/L
Sodium 135-145 mmol/L
Testosterone and related androgensSee Table A below

Table A: Reference intervals for testosterone and related androgens (serum)

 MaleFemale
Pre-pubertalAdult (age related)Pre-pubertalAdult (age related)
Free testosterone (pmol/L) 170-510 <4.0
Total testosterone (nmol/L)<0.58-35<0.5<4.0
SHBG (nmol/L)55-10010-5055-10030-90 (250-500 in the third trimester)
Dihydrotestosterone (nmol/L) 1-2.5 

Reference ranges, whole blood

Haemoglobin (Hb)(adult male)
(adult female) 
130-180 g/L
115-165 g/L 
Red cell count (RCC)(adult male)
(adult female)
4.5-6.5 x 1012/L
3.8-5.8 x 1012/L 
Packed cell volume (PCV)(adult male)
(adult female)
0.40-0.54
0.37-0.47 
Mean cell volume (MCV) 80-100 fL
Mean cell haemoglobin (MCH) 27-32 pg
Mean cell haemoglobin concentration (McHC) 300-350 g/L
Leucocyte (white cell) count (WCC) 4.0-11.0 x 109/L

Leucocyte differential count

  • Neutrophils
  • Eosinophils
  • Basophils
  • Monocytes
  • Lymphocytes

Platelet count

 

2.0-7.5 x 109/L
0.04-0.4 x 109/L
<0.1 x 109/L
0.2-0.8 x 109/L
1.5-4.0 x 109/L
150-400 x 109/L 
Erythrocyte sedimentation rate (ESR)male 17-50 yrs
male >50 yrs
female 17-50 yrs
female >50 yrs 
1-10 mm/hour
2-14 mm/hour
3-12 mm/hour
5-20 mm/hour 
Reticulocyte count 10-100 x 109/L
(0.2-2.0%)

Reference ranges, citrated plasma

Activated partial thromboplastin time (APTT)

  • Therapeutic range for continuous infusion heparin

25-35 seconds

1.5-2.5 x baseline

Prothrombin time (PT)11-15 seconds

International normalised ration (INR)

  • Therapeutic range for oral anticoagulant therapy


1.0-4.5 
Fibrinogen1.5-4.0 g/L

Reference ranges, serum

Rheumatoid factor (nephelometry)<30 IU/L
C30.9-1.8 g/L
C40.16-0.50 g/L
C-reative protein<5.0 mg/L

Immunoglobin:

  • IgG
  • IgA
  • IgM


6.5-16.0 g/L
0.6-4.0 g/L
0.5-3.0 g/L

Reference intervals for lymphocyte subsets

 Adult
Total lymphocytes1.5-4.0
CD30.6-2.4
CD4 (T4)0.5-1.4
CD8 (T8)0.2-0.7
CD190.04-0.5
CD160.2-0.4
CD4/CD8 ratio1.0-3.2

Appendix 13.2: New classification and criteria for diagnosis of diabetes mellitus