Hormonal studies
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| levels of GnRH | low with hypothalamic hypogonadism, dopamine, opiates. Elevated with primary hypopituitary hypogonadism, epinephrine
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| Elevated FSH | Levels elevated with primary gonadal failure1, castration, alcoholism
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| Low FSH | Levels low with secondary gonadal failure2, stress, malnutrition/anorexia, severe illness, hyperprolactemia, pregnancy
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| FSH specimen type | 24 hour urine or draw several specimens at different time intervals of serum. (pulsatile secretion).
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| Use of measuring FSH | Assays done to diagnose menopause, menstrual irregularities, gonadal failure, predicting ovulation1, evaluating infertility, pituitary disorders
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| Highest levels of FSH occur when in a women's life? | Post menopausal women (RR 51-134)
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| _____Stimulates follicular production of estrogen, ovulation and formation of corpus luteum1 | LH
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| gonadal failure2, precocious puberty, pituitary adenoma, menopause, PCOS cause what change in LH? | elevation
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| pituitary failure4, hypothalamic failure5, severe stress, anorexia, malnutrition, severe illness, pregnancy, hemochromatosis, sickle cell anemia, hyperprolactemia cause what change in LH? | Low levels
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| Specimen type for LH | serum or urine (24 hour). Best time to obtain single specimen between 11am-3pm
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| 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
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| LH surge | on maximum day of fertility
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| 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)
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| In PCOS | Estrogen is low, LH is high and Progesterone is high
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| Levels of Progesterone are low in | preeclampsia (problem with the pregnancy), threatened abortion, placental failure, fetal demise, ovarian neoplasm, amenorrhea, ovarian hypofunction
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| Levels of Progesterone are elevated in | ovulation, pregnancy (b/c the placenta is making progesterone), hyperadrenocorticalism, adrenocortical hyperplasia2, luteal cysts3, molar pregnancy, choriocarcinoma
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| Ectopic pregnancies have ___ progesterone | low levels of
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| Specimen type used to evaluate progesterone | serum. Levels rise rapidly after ovulation
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| Highest levels of Progesterone occur in | the third trimester
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| derivation of estrogen | primarily by conversion of androgens from theca cells
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| Elevated of estrogen occur in | precocious puberty1, ovarian tumor, adrenal tumor, gonadal tumor, normal pregnancy, cirrhosis2, liver necrosis, hyperthyroidism3
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| Low levels of estrogen occur in | failing pregnancy4, Turner’s syndrome5, hypopituitarism, hypogonadism, Stein-Leventhal syndrome6, menopause, anorexia
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| Estrogen levels peak in the | ovulatory phase
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| ______ is the major circulating estrogen after menopause | Estrone (E1)
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| ___is the major estrogen in pregnancy | Estriol (E3). Produced by the placenta. Index of fetal well being
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| Physiologically most important form of estrogen | Estradiol (E2). Feedback mechanism for secretion of FSH/LH
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| Specimen types used to measure estrogen | serum, urine, salivary
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| _____serial studies in pregnancy beginning 28-30 weeks gestation, repeated weekly; part of maternal serum quad test3 | Estriol
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| _____ is measured for for menstrual and fertility problems, menopausal status, sexual maturity | Estradiol
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| Factors that can affect estrogen levels | maternal illness, glycosuria, UTI, drugs
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| 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
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| Which is the active form of testosterone | unbound form (about 2%)
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| Decreased levels of testosterone causes | decline in libido, mood changes
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| Testosterone daily pattern | Slight diurnal variation in secretion, maximal values around 7am and 8pm
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| FSH binds to | granulosa cells and stimulates estradiol secretion
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| In a state of estrogen deficiency, what occurs with FSH? | more FSH is secreted, b/c not enough estrogen is present for negative feedback
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| During the luteal phase, FSH and LH are | suppressed to low levels
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| Estrogen in the menstrual cycle | Provides negative feedback to decrease secretion of FSH and positive feedback to increase LH
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| Most common cause of amenorrhea | pregnancy
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| __________arises after having had normal cycling, then problem with hypothalamic-pituitary-gonadal axis develops that disrupts normal hormonal cycles | Secondary Amenorrhea
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| In normal cycle _________surge inhibits FSH/LH and leads to withdrawal bleeding | progesterone
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| ____ is done to simulate physiologic condition of withdrawal bleeding | Progesterone Withdrawal Test
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| Prolactin is secreted by | the anterior pituitary
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| Prolactin surge occurs when? | with breast stimulation, pregnancy, nursing, stress, exercise, during sleep
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| Fear of blood draws may affect Prolactin how? | Increase Prolactin levels
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| When should Prolactin levels be checked? | 3-4 hours after waking (since levels increase during sleep)
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| 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
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| ___ is the placental glycoprotein hormone | Human Chorionic Gonadotropin (hCG)
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| whole hCG | less specific with high false positive results
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| How long after conception is it possible to see a positive hCG test? | 3-7 days
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| Hepatocellular cancers can be screened and watched by measuring | hCG
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| abnormal pregnancy that does not produce a nl fetus; can produce cancerous tissue, abnl levels of hCG | molar pregnancy
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| Highest levels of hCG occur in what part of pregnancy? | 2nd and 3rd month
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