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26149 Autoimmune Dysautonomia Evaluation (DYS2)

Autoimmune Dysautonomia Evaluation (DYS2)
Test Code: DYS2SO
Synonyms/Keywords
​Acetylcholine Receptor (Muscle AChR) Antibodies
AChR (Acetylcholine Receptor)
ANNA (Antineuronal Nuclear Antibody)
Anti-CV2
Anti-Enteric Neuronal Antibody
Anti-GAD65 (Anti-Glutamic Acid Decarboxylase)
Anti-Hu
Anti-Skeletal Muscle Antibodies
Antineuronal
Calcium Channel Blockers
Cantoxin (Receptor Antibodies)
Cerebellar Antibodies
Chorea
Collapsin Response-Mediator Protein-5 Antibody (CRMP-5), Serum
Cramp-fasciculation
CRMP-5, IgG
Dorsal Root Ganglion Antibody
DPPX
dipeptidyl aminopeptidase-like protein 6
Glutamate Decarboxylase Antibodies (GAD65)
Hu Antibody
Isaacs disease
Motor End-Plate Antibody
Motor Nerve Terminal Antibodies
Muscle (Skeletal) Antibodies
Muscle Culture Antibodies
Myoid Antibody
N-Type Calcium Channel Antibody
Neuromuscular hyperexcitability
Neuromyotonia
Neuronal ganglionic acetylcholine receptor antibody
Neuronal Nuclear Antibody Panel
Neuronal Potassium Channel Ab
Neuronal-Anti
P/Q Type Calcium Channel Antibody
Paraneoplastic Antibodies
Paraneoplastic Autoantibody Evaluation
Paraneoplastic Neurological Autoimmunity
Potassium Channel Antibodies (specify)
Stiff-man Syndrome
Striational (Striated Muscle) Antibodies
VGCC (Voltage-Gated Calcium Channel) Antibodies
VGKC
VGPC
Voltage-Gated Potassium Channel Ab
Test Components
​ ADEi - Dysautonomia, Interpretation, S ANNlS - Anti-Neuronal Nuclear Ab, Type 1
STR - Striational (Striated Muscle) Ab, S (Available Separately) CCN - N-Type Calcium Channel Ab
ARBI - ACh Receptor (Muscle) Binding Ab (Available Separately) GANG - AChR Ganglionic Neuronal Ab, S
VGKC  - Neuronal  (V-G) K+ Channel Ab, S
GD65S - GAD65 Ab Assay, S (Available Separately) CCPQ - P/Q-Type Calcium Channel Ab
DPPIS - DPPX Ab IFA, S
 
Potential Reflex Testing Includes -
WBN - Paraneoplastic Autoantibody WBlot,S CRMWS - CRMP-5-IgG Western Blot, S
ARMO - ACh Receptor (Muscle) Modulating Ab ABLOT - Amphiphysin Western Blot, S
NMDCS - NMDA-R Ab CBA, S AMPCS - AMPA-R Ab CBA, S GABCS - GABA-B-R Ab CBA, S
NM DIS - NMDA-R Ab IF Titer Assay, S AMPIS - AMPA-R Ab IF Titer Assay, S GABIS - GABA-B-R Ab IF Titer Assay, S ANN2S - Anti-Neuronal Nuclear Ab, Type 2 ANN3S - Anti-Neuronal Nuclear Ab, Type 3
PCABP - Purkinje Cell Cytoplasmic Ab Type 1 PCAB2 - Purkinje Cell Cytoplasmic Ab Type 2 PCATR - Purkinje Cell Cytoplasmic Ab Type Tr AMPHS - Amphiphysin Ab, S
CRMS - CRMP-5-IgG, S LGlCS - LGil-IgG CBA, S CS2CS - CASPR2-IgG CBA, S DPPCS - DPPX ab CBA, S DPPTS - DPPX Ab IFA Titer,S
Useful For

Investigating idiopathic dysautonomic symptoms

Directing a focused search for cancer in patients with idiopathic dysautonomia

Investigating autonomic symptoms that appear in the course or wake of cancer therapy and are not explainable by recurrent cancer or metastasis (detection of autoantibodies in this profile helps differentiate autoimmune dysautonomia from the effects of chemotherapy)

Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
N​o​ ​Serum ​Serum Separator Tube (SST) ​Red Top Tube (RTT) ​4 mL ​2.5 mL ​
Collection Processing Instructions
​
1.   For optimal antibody detection, specimen collection is recommended prior to initiation of immunosuppressant
medication.
 
2.   This test should not be requested in patients who have recently received radioisotopes, therapeutically or diagnostically, because of potential assay interference. The specific waiting period before specimen collection will depend on the isotope administered, the dose given, and the clearance rate in the individual patient. Specimens will be screened for radioactivity prior to analysis. Radioactive specimens received in the laboratory will be held 1 week and assayed if sufficiently decayed, or canceled if radioactivity remains.
 
3.   Patient should have no general anesthetic or muscle-relaxant drugs in the previous 24 hours.
Specimen Stability Information
Specimen Type Temperature Time
​Serum ​ ​ ​Refrigerate (preferred) ​28 days
​Room Temperature ​72 hours
​Frozen ​28 days
Rejection Criteria
Gross Hemolysis
​Gross Icterus
Interference
Negative results do not exclude autoimmune dysautonomia or cancer.
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Mayo Clinic Laboratories ​Monday throughSunday ​7-10 days ​Indirect lmmunofluorescence Assay (IFA), Cell Binding Assay (CBA), Live Cell Assay (LCA), Western Blot (WB), lmmunoprecipitation Assay (IPA), and Enzyme Immunoassay (EIA).
Reference Lab
Mayo Clinic Laboratories
Reference Range Information
See Report
Interpretation

Antibodies directed at onconeural proteins shared by neurons, muscle, and glia are valuable serological markers of a patient's immune response to cancer. These autoantibodies are not found in healthy subjects, and are usually accompanied by subacute neurological symptoms and signs. It is not uncommon for more than 1 autoantibody to be detected in patients with autoimmune dysautonomia.

These include: Plasma membrane cation channel antibodies (neuronal ganglionic [alpha-3] and muscle [alpha-1] acetylcholine receptor; neuronal calcium channel N-type or P/Q-type, and neuronal voltage-gated potassium channel antibodies).

All of these autoantibodies are potential effectors of autonomic dysfunction. -Antineuronal nuclear autoantibody-type 1 -Neuronal and muscle cytoplasmic antibodies (CRMP-5 IgG, glutamic acid decarboxylase and striational) A rising autoantibody titer in previously seropositive patients suggests cancer recurrence.

Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​83519 ​ ​5 ​ ​
​83520 ​ ​1 ​ ​
​86255 ​ ​2 ​ ​
​86341 ​ ​1 ​ ​
​83519 ​ ​1 ​ ​If needed
​86255 ​ ​14 ​ ​If needed
​86256 ​ ​5 ​ ​If needed
​84182 ​ ​3 ​ ​If needed
Synonyms/Keywords
​Acetylcholine Receptor (Muscle AChR) Antibodies
AChR (Acetylcholine Receptor)
ANNA (Antineuronal Nuclear Antibody)
Anti-CV2
Anti-Enteric Neuronal Antibody
Anti-GAD65 (Anti-Glutamic Acid Decarboxylase)
Anti-Hu
Anti-Skeletal Muscle Antibodies
Antineuronal
Calcium Channel Blockers
Cantoxin (Receptor Antibodies)
Cerebellar Antibodies
Chorea
Collapsin Response-Mediator Protein-5 Antibody (CRMP-5), Serum
Cramp-fasciculation
CRMP-5, IgG
Dorsal Root Ganglion Antibody
DPPX
dipeptidyl aminopeptidase-like protein 6
Glutamate Decarboxylase Antibodies (GAD65)
Hu Antibody
Isaacs disease
Motor End-Plate Antibody
Motor Nerve Terminal Antibodies
Muscle (Skeletal) Antibodies
Muscle Culture Antibodies
Myoid Antibody
N-Type Calcium Channel Antibody
Neuromuscular hyperexcitability
Neuromyotonia
Neuronal ganglionic acetylcholine receptor antibody
Neuronal Nuclear Antibody Panel
Neuronal Potassium Channel Ab
Neuronal-Anti
P/Q Type Calcium Channel Antibody
Paraneoplastic Antibodies
Paraneoplastic Autoantibody Evaluation
Paraneoplastic Neurological Autoimmunity
Potassium Channel Antibodies (specify)
Stiff-man Syndrome
Striational (Striated Muscle) Antibodies
VGCC (Voltage-Gated Calcium Channel) Antibodies
VGKC
VGPC
Voltage-Gated Potassium Channel Ab
Test Components
​ ADEi - Dysautonomia, Interpretation, S ANNlS - Anti-Neuronal Nuclear Ab, Type 1
STR - Striational (Striated Muscle) Ab, S (Available Separately) CCN - N-Type Calcium Channel Ab
ARBI - ACh Receptor (Muscle) Binding Ab (Available Separately) GANG - AChR Ganglionic Neuronal Ab, S
VGKC  - Neuronal  (V-G) K+ Channel Ab, S
GD65S - GAD65 Ab Assay, S (Available Separately) CCPQ - P/Q-Type Calcium Channel Ab
DPPIS - DPPX Ab IFA, S
 
Potential Reflex Testing Includes -
WBN - Paraneoplastic Autoantibody WBlot,S CRMWS - CRMP-5-IgG Western Blot, S
ARMO - ACh Receptor (Muscle) Modulating Ab ABLOT - Amphiphysin Western Blot, S
NMDCS - NMDA-R Ab CBA, S AMPCS - AMPA-R Ab CBA, S GABCS - GABA-B-R Ab CBA, S
NM DIS - NMDA-R Ab IF Titer Assay, S AMPIS - AMPA-R Ab IF Titer Assay, S GABIS - GABA-B-R Ab IF Titer Assay, S ANN2S - Anti-Neuronal Nuclear Ab, Type 2 ANN3S - Anti-Neuronal Nuclear Ab, Type 3
PCABP - Purkinje Cell Cytoplasmic Ab Type 1 PCAB2 - Purkinje Cell Cytoplasmic Ab Type 2 PCATR - Purkinje Cell Cytoplasmic Ab Type Tr AMPHS - Amphiphysin Ab, S
CRMS - CRMP-5-IgG, S LGlCS - LGil-IgG CBA, S CS2CS - CASPR2-IgG CBA, S DPPCS - DPPX ab CBA, S DPPTS - DPPX Ab IFA Titer,S
Ordering Applications
Ordering Application Description
​Cerner ​Autoimmune Dysautonomia Evaluation (DYS2)
​Clinical Order Manager ​Autoimmune Dysautonomia Evaluation (DYS2)
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
N​o​ ​Serum ​Serum Separator Tube (SST) ​Red Top Tube (RTT) ​4 mL ​2.5 mL ​
Collection Processing
​
1.   For optimal antibody detection, specimen collection is recommended prior to initiation of immunosuppressant
medication.
 
2.   This test should not be requested in patients who have recently received radioisotopes, therapeutically or diagnostically, because of potential assay interference. The specific waiting period before specimen collection will depend on the isotope administered, the dose given, and the clearance rate in the individual patient. Specimens will be screened for radioactivity prior to analysis. Radioactive specimens received in the laboratory will be held 1 week and assayed if sufficiently decayed, or canceled if radioactivity remains.
 
3.   Patient should have no general anesthetic or muscle-relaxant drugs in the previous 24 hours.
Specimen Stability Information
Specimen Type Temperature Time
​Serum ​ ​ ​Refrigerate (preferred) ​28 days
​Room Temperature ​72 hours
​Frozen ​28 days
Rejection Criteria
Gross Hemolysis
​Gross Icterus
Interference
Negative results do not exclude autoimmune dysautonomia or cancer.
Useful For

Investigating idiopathic dysautonomic symptoms

Directing a focused search for cancer in patients with idiopathic dysautonomia

Investigating autonomic symptoms that appear in the course or wake of cancer therapy and are not explainable by recurrent cancer or metastasis (detection of autoantibodies in this profile helps differentiate autoimmune dysautonomia from the effects of chemotherapy)

Test Components
​ ADEi - Dysautonomia, Interpretation, S ANNlS - Anti-Neuronal Nuclear Ab, Type 1
STR - Striational (Striated Muscle) Ab, S (Available Separately) CCN - N-Type Calcium Channel Ab
ARBI - ACh Receptor (Muscle) Binding Ab (Available Separately) GANG - AChR Ganglionic Neuronal Ab, S
VGKC  - Neuronal  (V-G) K+ Channel Ab, S
GD65S - GAD65 Ab Assay, S (Available Separately) CCPQ - P/Q-Type Calcium Channel Ab
DPPIS - DPPX Ab IFA, S
 
Potential Reflex Testing Includes -
WBN - Paraneoplastic Autoantibody WBlot,S CRMWS - CRMP-5-IgG Western Blot, S
ARMO - ACh Receptor (Muscle) Modulating Ab ABLOT - Amphiphysin Western Blot, S
NMDCS - NMDA-R Ab CBA, S AMPCS - AMPA-R Ab CBA, S GABCS - GABA-B-R Ab CBA, S
NM DIS - NMDA-R Ab IF Titer Assay, S AMPIS - AMPA-R Ab IF Titer Assay, S GABIS - GABA-B-R Ab IF Titer Assay, S ANN2S - Anti-Neuronal Nuclear Ab, Type 2 ANN3S - Anti-Neuronal Nuclear Ab, Type 3
PCABP - Purkinje Cell Cytoplasmic Ab Type 1 PCAB2 - Purkinje Cell Cytoplasmic Ab Type 2 PCATR - Purkinje Cell Cytoplasmic Ab Type Tr AMPHS - Amphiphysin Ab, S
CRMS - CRMP-5-IgG, S LGlCS - LGil-IgG CBA, S CS2CS - CASPR2-IgG CBA, S DPPCS - DPPX ab CBA, S DPPTS - DPPX Ab IFA Titer,S
Reference Range Information
See Report
Interpretation

Antibodies directed at onconeural proteins shared by neurons, muscle, and glia are valuable serological markers of a patient's immune response to cancer. These autoantibodies are not found in healthy subjects, and are usually accompanied by subacute neurological symptoms and signs. It is not uncommon for more than 1 autoantibody to be detected in patients with autoimmune dysautonomia.

These include: Plasma membrane cation channel antibodies (neuronal ganglionic [alpha-3] and muscle [alpha-1] acetylcholine receptor; neuronal calcium channel N-type or P/Q-type, and neuronal voltage-gated potassium channel antibodies).

All of these autoantibodies are potential effectors of autonomic dysfunction. -Antineuronal nuclear autoantibody-type 1 -Neuronal and muscle cytoplasmic antibodies (CRMP-5 IgG, glutamic acid decarboxylase and striational) A rising autoantibody titer in previously seropositive patients suggests cancer recurrence.

For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Mayo Clinic Laboratories ​Monday throughSunday ​7-10 days ​Indirect lmmunofluorescence Assay (IFA), Cell Binding Assay (CBA), Live Cell Assay (LCA), Western Blot (WB), lmmunoprecipitation Assay (IPA), and Enzyme Immunoassay (EIA).
Reference Lab
Mayo Clinic Laboratories
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​83519 ​ ​5 ​ ​
​83520 ​ ​1 ​ ​
​86255 ​ ​2 ​ ​
​86341 ​ ​1 ​ ​
​83519 ​ ​1 ​ ​If needed
​86255 ​ ​14 ​ ​If needed
​86256 ​ ​5 ​ ​If needed
​84182 ​ ​3 ​ ​If needed
For most current information refer to the Marshfield Laboratory online reference manual.