Reproductive Hormones
Hypoestrinism
Ovarian insufficiency, Delayed puberty, Amenorrhea, Turner syndrome.
Precocious puberty
Ovarian tumor, hypothalamic tumor, adrenal tumors (rare), may be difficult to determine.
Estrogens in pregnancy
Placenta is the main source of estrogen synthesis during pregnancy, making estriol. placenta lacks 16alpha-hydroxylase.
Infertility and Irregular menses
Polycystic ovaries, estrogen-producing ovarian tumors, disorders of the hypothalamus or pituitary.
Hyperestrinism in females
Precocious puberty, Infertility and irregular menses, Postmenopausal bleeding
Progesterone Metabolites:
Pregnanediols, pregnanediones, pregnanalones.
Delayed puberty
Primary amenorrhea- due to lack of ovarian function or secondary to disorders of the hypothalamus or pituitary.
Testes hypothalamic-pituitary-gonadal axis
The anterior pituitary secretes FSH which stimulates spermatogenesis, The anterior pituitary secretes LH, which stimulates production of testosterone. FSH and LH is under the control of GnRH. negative feedback to hypothalamus, increased levels of testosterone shut off FSH and LH synthesis.
Turner syndrome
a genetic defect in females partial or complete loss of one of the two X chromosomes,
Ovarian insufficiency
can be primary or secondary to disorders of the hypothalamus or pituitary.
Congenital adrenal hyperplasa (CAH)
caused by an enzyme defect of 21-hyroxylase, which prevents cortisol production and result in accumulation of cortisol precursors, including 17 alpha-hydroxyprogesterone (17-OHP). characterized by increased blood levels of 17-OHP and ACTH and decreased cortisol.
Hypoprogesteronemia
causes infertility, abortion of fetus.
Maternal blood samples
collected at 16-18 weeks gestation
Triple test
consist of alpha1-fetoprotein (AFP), unconjugated estriol(uE3), and human chorionic gonadotropin (hCG). helps to estimate risk of Down syndrome.
Suggestive of increased risk of Down syndrome
decreased AFP - made by fetal liver, found in maternal blood. decreased uE3- made by joint effort of fetus and mother. increased hCG- made by placenta
Corticosteroid-binding globulin (CBG)
delivers progesterone and glucocorticoids.
Post-Testicular Infertility
disorders of sperm transport and function. normal blood level: testosterone, FSH and LH levels.
Pretesticular Infertility- Secondary hypogonadism
due to hypothalamic or pituitary lesions normal or decreased levels: testosterone, FSH and LH levels
Estrogen and Progesterone
exert negative feedback to hypothalamus and pituitary, which controls FSH and LH synthesis.
Follicular phase (Menstrual cycle)
first half characterized by estrogen stimulating growth of the uterine lining, progesterone levels are low.
Human placental lactogen (HPL)
function with hCG to produce estrogen and progesterone during pregnancy. stimulates development of mammary gland important in diagnoses of intrauterine growth retardation.
Measurement of 2-3 follicle-stimulating hormone
good indicator of follicular reserve.
Increased hCG
hydatidiform mole, choriocarcinoma, pre-eclamptic toxemia.
Hypoandrogenemia
in adult males, impotence and loss of secondary sex characteristics occurs in prepubertal males- delayed puberty.
Hyperandrogenemia
in prepubertal males- precocious puberty occurs in female children, development of male secondary sex characteristics/ virilization occurs.
Quadruple (Quad) test
includes analytes of triple test plus inhibin A
Primary Hypoandrogenemia
infections, tumors, congenital disorders- Klinefelter's syndrome
Progesterone
is secreted by the ovarian follicles, mainly the corpus luteum following ovulation and by placenta in pregnancy.
Estradiol -E2
is the principal estrogen synthesized by the ovaries. abundant estrogen in pre menopausal women.
FSH and LH
is under the control of gonadotrophin-releasing hormone.
Sertoli cell-only syndrome
lack of germ cells small testes, diagnosis is confirm by Testicular biopsy.
Klinefelter's syndrome
male possess an extra X-chromosome (XXY). tall with long extremities, small testes, gynecomasia, infertility, low IQ.
Abnormal synthesis of estrogens
may be caused by the ovaries-primary disorder or as a secondary disorder due to a primary disorder of the pituitary or hypothalamus.
Abnormal synthesis of testosterone
may be caused by the testes- primary disorder or as a secondary disorder due to a primary disorder of the pituitary or hypothalamus.
Testicular Infertility- Primary hypogonadism
may be congenital or acquired decreased testosterone levels and increased FSH and LH levels
Estriol -E3
metabolites of estradiol found in maternal urine, secreted by pacenta during pregnancy, marker for Down Syndrome
estrone and estriol
metabolites of intraovarian and extraglandular conversion.
Estrone -E1
most abundant estrogen in post menopausal women.
Testicular Feminization Syndrome
most severe form of androgen resistance syndrome, exhibits female phenotype normal: testosterone, elevated FSH and LH levels
Amenorrhea
occurs at menopause, with radiation or chemotherapy, severe stress, intense athletic training, excessive weight loss.
Decreased HPL
placental malfunction and potential fetal distress.
Hyperprogesteronemia
prevents mentrual cycle from occuring.
Secondary Hypoandrogenemia
primary hypofunction disorders of pituitary or hypothalamus, cause decreased synthesis of LH and FSH.
Dehydroepiandrosterone (DHEA)
principal androgen formed by adrenal cortex, weak androgen. assessment of adrenal cortical function.
Testosterone
principal male sex hormone and secreted by testes. promotes development and maintains the male reproductive system. responsible for development and maintenance of secondary male sex characteristics.
Inhibin A
produced by fetoplacental unit inhibit production of FSH. 4th Down syndrome marker.
Human chorionic gonadotrophin (hCG)
prolongs the viability of the corpus luteum synthesizes progesterone and estrogens in early pregnancy until the placenta can assume the function. HCG levels are highest in the first trimester.
Function of Estrogen
promotes development and maintains the female reproductive system, including the uterus, fallopian tubes, and vagina. responsible for development and maintenance of secondary female sex characteristics.
Kallmann's Syndrome
result of an inherited, X-linked recessive trait that manifest as hypogonadism during puberty. anosmia, cleft palate and lip.
Increased HPL
rises throughout gestation.
Luteal phase (Menstrual cycle)
second half progesterone measurements clinically useful to confirm ovulation.
Function of Progesterone
secreted by the corpus luteum following ovulation, and in pregnancy, secreted by the placenta to maintain the uterus.
Estrogen
secreted by the ovarian follicles and by placenta in pregnancy. Types: estradiol-17B, estrone, and estradiol.
Placenta
synthesize and secretes estrogens, progesterone, human chorionic gonadotrophin, and human placental lactogen.
Karyotyping or FISH typing
test for Down syndrome using amniotic fluid as specimen.
Hyperestrinism in males
testicular atrophy and enlargement of the breasts.
Decreased hCG
threatened abortion, ectopic pregnancy
Sex hormone binding globulin (SHBG)
transports androgens and estrogens
day 21-22 progesterone
used to assess whether cycles are ovulatory.
hCG qualitative measurement
used to detect pregnancy utilize monoclonal antibody to detect hCG in 1-2 days following fertilization.
Menstrual cycle
1. FSH promotes growth of ovarian follicles. 2. Estrogen peak at midcycle, low FSH promoting LH surge. 3. Ovulation of Progesterone and Estrogen. 4. Follicle becomes corpus luteum -more progesterone. 5. Lack of Fertilization 6. Menstruation results, cycle begins again.
Testosterone reference range:
3.9-7.9 ng/mL
Ovaries -hypothalamic-pituitary-gonadal axis
Anterior pituitary secretes follicle-stimulating hormone, which stimulates growth of ovarian follicles and increases the plasma estrogen level. The anterior pituitary secretes luteinizing hormone, which stimulates production of progesterone at ovulation.
Postmenopausal bleeding
Cervical or endometrial carcinoma, estrogen-producing ovarian tumors, exogenous estrogen consumption.
HCG Method
Immunometric- Sandwich method serum and urine samples