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