lab med final lecture 19

hCG

what are All pregnancy tests based on detection of

serum

Before 4 weeks post conception will you see hcg in the serum or urine

Both

AFTer 4 weeks post conception will you see hcg in the serum or urine

Beta-Human Chorionic Gonadotropin

Hormone secreted by placenta after ovum is fertilized- helps maintain pregnancy

A)Urine tests collected around day 10-14 of the patient's menstrual cycle will show lack of LH surge

A 27-year-old obese female presents to the OB/GYN clinic for evaluation of infertility. She and her husband have been trying to conceive for 2 years and have been unsuccessful. She reports irregular menstrual periods with heavy bleeding that typically lasts 2 days. You are concerned the patient is experiencing anovulatory bleeding. Which of the following is true?

A)Urine tests collected around day 10-14 of the patient's menstrual cycle will show lack of LH surge

B)A random blood sample of LH can be taken at any point in the patient's menstrual cycle to determine if ovulation is occurring

C)Serum LH, measured on day 10 of the menstrual cycle, will show levels too high to cause rupture of the mature ovarian follicle.

Gonadal

what is primary Hypogonadism a problem with

Pituitary

what is Secondary Hypogonadism a problem with

Hypothalamic

what is Tertiary Hypogonadism a problem with

klinefelter syndrome

a primary gonadal failure/primary hypogonadism with high FSH and High LH is what condition in men

turner syndrome

a primary gonadal failure/primary hypogonadism with high FSH and High LH is what condition in girls

- Virilization- facial hair, voice deepening, clitoromegaly

- Male-pattern baldness

- Hirsutism

- Acne

when to order a testosterone test in women

- Reduced libido

- FatigueDepression

- Gynecomastia

- Infertility

when to order a testosterone test in males

- alcohol

- digoxin

- steriods

- ketoconazole

- spirolactone

what medications can decrease testosterone production

- anticonvulsants

- barbiturates

- estrogen

- OCPS

what medications can cause overproduction of testosterone

- doubles every 3 days for the first 6 weeks

- declines after 1st trimester; levels out after 20 weeks

- Falls to pre-pregnancy levels after delivery, miscarriage, or pregnancy termination

- Important as it aids in diagnosis of pregnancy abnormalities (ex: molar pregnancy), miscarriage

what are the hCG trends

ectopic pregnancy

Serial monitoring demonstrating abnormally low or slowly rising hCG can suggest

possible molar pregnancy

Abnormally high serum hCG =

serum hCG

A 15-year-old teenage girl presents to your clinic with her mother. She complains that her period is 2 weeks late and admits to being sexually active. She performed a home urine pregnancy test this morning, which was negative. She endorses some mild fatigue. What test (s) do you order?

serum hCG

or

Urine hCG

serum hCG

Amanda is a 37 - year - old female presenting for a follow-up from an ED visit one week ago where she was diagnosed with having a miscarriage. So far she has had two previous hCG readings showing a decline in levels. Currently, she is not experiencing any vaginal bleeding or pelvic pain. What test do you order?

serum hCG

or

Urine hCG

Urine hCG

A 27-year-old female with no past medical history has been trying for pregnancy for the last 4 months. She is currently 3 days past her missed menstrual period. She is curious if she is pregnant and would like to test at home.

serum hCG

or

Urine hCG

- Available at home or POC in clinic

- Low cost, rapid results

- Qualitative NOT quantitative

what are some facts to urine beta hCG

high

are high or low false negatives common in urine hcg

- Testing before levels detectable in urine (prior to missed menses)

- Diuretics and promethazine

why are High false-negative rate seen in urine hcg

- Anticonvulsants, antiparkinsonian drugs, hypnotics, tranquilizers

- Ovarian cancer, some lung/GI cancers

why are low false positives rate common in urine hcg

low

are high or low false positives seen in urine hcg

- Most sensitive in detecting early pregnancy

- Qualitative AND quantitative

- Ability to trend HCG levels

- Serial measures monitor appropriate progression of pregnancy

- Ensure complete evacuation of products of conception (miscarriage, post-termination of pregnancy)

what is some facts about serum hcg

anterior pituitary gland

what produces LH

GnRH

Lh has a positive influence from

estrogen and progesterone

Lh has a negative influence from

stimulates follicular production of estrogen, ovulation and formation of corpus luteum (mid-cycle LH surge)

how does Lh act on the ovaries

stimulates testosterone production from Leydig cells

how does Lh act on the testes

anterior pituitary gland

what produces FSH

GnRH

What causes Positive influence on FSH

- estrogen

- progesterone

- testosterone

What causes Negative feedback for LSH

Menopause

permanent cessation of menstruation

high

No eggs will cause our FSH leveled to be

Leydig cells in testicles

Where is testosterone produced in males

- peripheral fat

- adrenal gland

- ovaries

where is testosterone produced in Women

maturity

Levels of testosterone vary by stage of

7 AM

When is best to draw testosterone levels

- Ambiguous sex characteristics

- Precocious puberty

- Virilizing syndromes in females

- Infertility or impotency in males

what is testosterone is Used to evaluate

Sex hormone vital in development of secondary sex characteristics

What best describes testosterone