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GYN DM Hormones
Hormonal studies
| Question | Answer |
|---|---|
| levels of GnRH | low with hypothalamic hypogonadism, dopamine, opiates. Elevated with primary hypopituitary hypogonadism, epinephrine |
| Elevated FSH | Levels elevated with primary gonadal failure1, castration, alcoholism |
| Low FSH | Levels low with secondary gonadal failure2, stress, malnutrition/anorexia, severe illness, hyperprolactemia, pregnancy |
| FSH specimen type | 24 hour urine or draw several specimens at different time intervals of serum. (pulsatile secretion). |
| Use of measuring FSH | Assays done to diagnose menopause, menstrual irregularities, gonadal failure, predicting ovulation1, evaluating infertility, pituitary disorders |
| Highest levels of FSH occur when in a women's life? | Post menopausal women (RR 51-134) |
| _____Stimulates follicular production of estrogen, ovulation and formation of corpus luteum1 | LH |
| gonadal failure2, precocious puberty, pituitary adenoma, menopause, PCOS cause what change in LH? | elevation |
| pituitary failure4, hypothalamic failure5, severe stress, anorexia, malnutrition, severe illness, pregnancy, hemochromatosis, sickle cell anemia, hyperprolactemia cause what change in LH? | Low levels |
| Specimen type for LH | serum or urine (24 hour). Best time to obtain single specimen between 11am-3pm |
| Assays of LH are performed to evaluate | infertility, endocrine problems with precocious puberty, testicular dysfunction, disorders of sexual differentiation, ovulation prediction. Basically, fertility and ovulation |
| LH surge | on maximum day of fertility |
| In non-pregnant women, progesterone is produced by | corpus luteum cyst which stimulates the lining of the uterus (if no pregnancy results, then levels drop) (in pregnant women, the placenta produces progesterone and levels continue to rise) |
| In PCOS | Estrogen is low, LH is high and Progesterone is high |
| Levels of Progesterone are low in | preeclampsia (problem with the pregnancy), threatened abortion, placental failure, fetal demise, ovarian neoplasm, amenorrhea, ovarian hypofunction |
| Levels of Progesterone are elevated in | ovulation, pregnancy (b/c the placenta is making progesterone), hyperadrenocorticalism, adrenocortical hyperplasia2, luteal cysts3, molar pregnancy, choriocarcinoma |
| Ectopic pregnancies have ___ progesterone | low levels of |
| Specimen type used to evaluate progesterone | serum. Levels rise rapidly after ovulation |
| Highest levels of Progesterone occur in | the third trimester |
| derivation of estrogen | primarily by conversion of androgens from theca cells |
| Elevated of estrogen occur in | precocious puberty1, ovarian tumor, adrenal tumor, gonadal tumor, normal pregnancy, cirrhosis2, liver necrosis, hyperthyroidism3 |
| Low levels of estrogen occur in | failing pregnancy4, Turner’s syndrome5, hypopituitarism, hypogonadism, Stein-Leventhal syndrome6, menopause, anorexia |
| Estrogen levels peak in the | ovulatory phase |
| ______ is the major circulating estrogen after menopause | Estrone (E1) |
| ___is the major estrogen in pregnancy | Estriol (E3). Produced by the placenta. Index of fetal well being |
| Physiologically most important form of estrogen | Estradiol (E2). Feedback mechanism for secretion of FSH/LH |
| Specimen types used to measure estrogen | serum, urine, salivary |
| _____serial studies in pregnancy beginning 28-30 weeks gestation, repeated weekly; part of maternal serum quad test3 | Estriol |
| _____ is measured for for menstrual and fertility problems, menopausal status, sexual maturity | Estradiol |
| Factors that can affect estrogen levels | maternal illness, glycosuria, UTI, drugs |
| Testosterone derivation | In females (~50%) made by conversion of DHEA1 to testosterone in peripheral fat, (~30%) by conversion of DHEA in adrenal gland, and (~20%) by ovaries.Main role is estrogen precursor; also, exerts anabolic effects and influences behavior |
| Which is the active form of testosterone | unbound form (about 2%) |
| Decreased levels of testosterone causes | decline in libido, mood changes |
| Testosterone daily pattern | Slight diurnal variation in secretion, maximal values around 7am and 8pm |
| FSH binds to | granulosa cells and stimulates estradiol secretion |
| In a state of estrogen deficiency, what occurs with FSH? | more FSH is secreted, b/c not enough estrogen is present for negative feedback |
| During the luteal phase, FSH and LH are | suppressed to low levels |
| Estrogen in the menstrual cycle | Provides negative feedback to decrease secretion of FSH and positive feedback to increase LH |
| Most common cause of amenorrhea | pregnancy |
| __________arises after having had normal cycling, then problem with hypothalamic-pituitary-gonadal axis develops that disrupts normal hormonal cycles | Secondary Amenorrhea |
| In normal cycle _________surge inhibits FSH/LH and leads to withdrawal bleeding | progesterone |
| ____ is done to simulate physiologic condition of withdrawal bleeding | Progesterone Withdrawal Test |
| Prolactin is secreted by | the anterior pituitary |
| Prolactin surge occurs when? | with breast stimulation, pregnancy, nursing, stress, exercise, during sleep |
| Fear of blood draws may affect Prolactin how? | Increase Prolactin levels |
| When should Prolactin levels be checked? | 3-4 hours after waking (since levels increase during sleep) |
| Rise and fall of prolactin | Levels rise late in pregnancy, peak with initiation of lactation, and surge each time suckles. If you don't breast feed, it will return to nl after 2-3 weeks |
| ___ is the placental glycoprotein hormone | Human Chorionic Gonadotropin (hCG) |
| whole hCG | less specific with high false positive results |
| How long after conception is it possible to see a positive hCG test? | 3-7 days |
| Hepatocellular cancers can be screened and watched by measuring | hCG |
| abnormal pregnancy that does not produce a nl fetus; can produce cancerous tissue, abnl levels of hCG | molar pregnancy |
| Highest levels of hCG occur in what part of pregnancy? | 2nd and 3rd month |
Created by:
ltm12