Hormones are special substances that are
synthesized and secreted by certain cells in humans and animals and can
regulate the physiological activity of the body. The word “hormone”
comes from The Greek language and means “rise up” or “stir”.
All chemicals that transmit information
through blood circulation or tissue fluid are now called hormones.
Hormone secretion is very small,
nanogram (one billionth of a gram) level, but its regulatory effect is very
obvious.
Check for sex hormones common sense
Sex hormones (including progesterone,
estrogen) should not be used for at least one month prior to the testing of the
underlying hormones, otherwise the results are unreliable (except sex hormones
that need to be reviewed after treatment).
Check the endocrine is best in the
3rdto5th day after menstruation tide, this period belongs to the
early follicles, can reflect the function of the ovary.
But for menstruation long-term not tide and also eager to understand the results of the inspection, can be checked at any time, this time is the default for the
premenstrual time, the results also refer to the yellow period of the
inspection results.
Determine is
the 3rdto5th day
of menstruation, check the sex hormone 5 can be, can not check progesterone, progesterone should be checked
during the progesterone (21 days after
menstruation or 7 days after
ovulation); The data can approximate the period of the menstrual cycle). People with
ambipree and amenorrhea, such as urine pregnancy test negative, vaginal B ultra-checked double-sided ovaries
without 10 mm follicles,EM thickness of5mm,can also be used as a basic state.
Folly Stimulator(FSH)
It is a glycoprotein hormone secreted by
alkaline cells in the pituitary front, whose main function is the maturation of
the ovaries and the secretion of estrogen. The
concentration of blood FSH is 1.5to10 mIU/mLin
the pre-ovulation period, 8to20 mIU/mL,and 2to10mIU/mLin
theovulation stage. Generally 5 to40 mIU/mL as normal. FSH values are low during estrogen therapy, Sihan’s syndrome, etc. FSH is highly common in ovarian premature aging, ovarian insensitivity
syndrome, primary amenorrhea, etc. If FSH is higher than 40mIU/mL,it is not effective for
ovulation drugs such as cromion.
Projumite oxytocin(LH)
It is also a glycogen hormone secreted
by alkaline cells in the pituitary front. The main function is to promote
ovulation and progesterone production to promote progesterone and estrogen
secretion in the progesterone. The concentration of blood LH is 2to15 mIU/mLin
the pre-ovulation period, 30to100mIU/mL,and 4to10mIU/mLin theovulation stage. The normal value during the non-ovulation
period is 5to25 mIU/mL. Less than 5mIU/mL suggests under-functionality of
gonadotropins, as seen in Sihan’s syndrome.
During the normal menstrual cycle, the
early follicle (menstrual 2 to 3 days) blood FSHandLH are maintained at low levels, and the lH rises rapidly before ovulation,withLH
reaching 3 to 8 times the base value, up to 160IU/L Even higher, FSH is only about 2 times the base value, rarely30IU/L,afterovulation FSH,LH quickly returns to follicle levels.
Monitoring the FSHandLH
levels in the early stages of follicle
sits can determine the function of the gonad axis. FSH is more valuable
than LH in
determining ovarian potential.
1. Ovarian failure: The underlying FSHs 40IU/L,LH elevated or40IU/L,forhypersexual gonadotropin(Gn),i.e. ovarian failure;
2. The basic FSH and LH are both low Gn amenorrhea, indicating hypothalamus or dyslerating
of the dyphthain, and the difference between the two is tested with
gonadotropin release hormone (GnRH).
3. Ovarian reserve dysfunction
(DOR):Basic FSH/LHs2to3.6 hintS DOR(FSH can be in normal model), is an early manifestation of ovarian dysfunction, often prompting patients on overolyofecation(COH) If
the response is poor, the COH scheme and the dose of Gn should be adjusted in a timely manner to improve the responsiveness
of the ovaries and obtain the ideal pregnancy rate. Because the
increase in FSH/LH only reflects the DOR,rather than
thereduced ability to conceive, the ideal pregnancy rate can
still be obtained once ovulation is obtained.
4. Foundation FSHs12IU/L,next cycle review, continuous 12IU/L prompt DOR.
5. Polycystic ovary syndrome (PCOS): Basal LH / FSH ﹥ 2 to 3, which can be used as the main indicator for the diagnosis of PCOS (basic LH level IU 10IU / L is an increase, or LH maintains normal levels, while basal FSH is relatively Low levels result in increased LH to FSH ratios).
6. Check 2 basic FSHs20IU/L,which can be considered a lateovary
period of concealment, indicating that it may be amenorrhea after 1 year.
Progesterone (P)
Under normal circumstances, follicle
blood P has been at a low level, less than 3.2nmol/L,after ovulation ovary progesterone, the level rose rapidly, the
blood concentration after the mid-LH peak
of the
6thto8th day reached a peak, the first 4 days of menstruation gradually
dropped to follicle level. Serum progesterone levels increase dissonant
levels with pregnancy, mainly from ovary progesterone during 6 weeks of pregnancy, and are mainly secreted by the
placenta in the middle and late stages of pregnancy.
Progesterone usually works at the estrogen level, mainly by converting the
endometrium into secretion, facilitating the embryo’s bed
and preventing uterine contractions, leaving the uterus stationary before
delivery. At the same time, progesterone can also promote the development of
breast glandular bubbles, for the
lactation preparation.
Throughout the yellow body period, the
change in p-content of peripheral blood is
parabolic.
1. Judgement of ovulation: Mid-yellow
(28 days of menstrual cycle for women on the 21st of menstruation) Ps15.9nmol/L prompts ovulation. When using ovulation-promoting drugs, the
effect of ovulation can be observed using blood progesterone levels.
2. Diagnosis of yellow function
insufficiency(LPD):the level ofprogesterone in the yellow
body is lower than the physiological value, indicating insufficient yellow
function, ovulation-type uterine dysfunction bleeding. The blood
progesterone value is still higher than the physiological level of the 4to5 days of menstruation tide,
indicating incomplete yellow body atrophy.
3. Judgement of in vitro fertilization – Embryo transfer(IVF-ET)prognosis:
The P level before ovulation can be estimated for IVF-ET prognosis. Muscle Note HCG Day P s 3.18nmol/L (1.0ng/mL) should be considered
elevated, the planting rate and clinical pregnancy rate are
reduced,Ps4.77nmol/L (1.5ng/mL) suggests premature ephenism. In IVF-ET long-term procedure surgation, muscle injection HCG day, even if there is no increase in LH concentration, if P (ng/mL) x 1000/E2(pg/mL)1,promptfollicles Premature lintin, and the clinical pregnancy rate of this type of patients decreased significantly. Premature pheromation is also a manifestation of DOR.
4. Identification of ectopic pregnancy:
Low blood P levels in ectopic pregnancy,
blood P47.7nmol/L (15 ng/mL)in multiple patients. Only 1.5%
of patients were
79.5nmol/L (25 ng/mL). P 90%of normal
intrauterine pregnancypersons is78nmol/L. Blood P levels can be used as a reference basis in the differential diagnosis of intrauterine and ectopic pregnancy.
5. Auxiliary diagnostic precursor
abortion: within 12 weeks of pregnancy, progesterone levels are low and the risk of early miscarriage is
high. Progesterone values may be aborted if there is a downward trend in
progesterone.
6. Observe placental function:
Progesterone levels in the blood decrease when placental function is reduced
during pregnancy. Single serum progesterone level s 15.6nmol/L(5ng/mL),indicated as stillbirth.
Estrogen (E2)
The base value is 25to45pg/mL. During
the normal menstrual cycle, the early eofoam
E2 is about 183.5pmol/L
(50pg/mL),the first peakreaches before ovulation,
up to 917.5to1835pmol/L(250to500pg),then
gradually declines, reaches the lowest point afterovulation,
and then begins to rise again The yellow ums formed a second
peak, below the first peak, about 458.8pmol/L(124.80pg),after a periodofmaintenance,
when the yellow body shrinks to the level of early follicle period, i.e. the 3rd day of menstruation should be 91.75- 183.5pmol/mL(25to50pg/mL).
1.Basic E2> 165.2 ～ 293.6pmol / L (45 ～ 80pg / mL), regardless of age and FSH, it indicates that fertility is decreased.
2、When the basic E2 is ≥ 367pmol / L (100pg / mL), the ovarian response is worse. Even if FSH is 15IU / L, there is almost no possibility of pregnancy.
3.Monitoring indicators offollicle maturation and ovarian hyperstimulation syndrome(OHSS)
（1）Follicular stimulation: When superovulation is promoted, when the follicle is ≥ 18 mm and blood E2 reaches 1100pmol / L (300pg / mL), HMG is stopped and HCG10000IU is injected on the same day or 24 to 36 hours after the last HMG injection.
（2）E2﹤3670pmol/L(1000pg/mL)，OHSS generally does not occur.
（3）E2﹥9175pmol/L(2500pg/mL)，in order to occur high-risk factors of OHSS, timely disabling or reducing the amount of HMG and disabling HCG to support the corpus luteum function can avoid or reduce the occurrence of OHSS.
（4）E2 ﹥ 14800pmol / L (4000pg / mL), nearly 100% of OHSS occurs and can rapidly develop into severe OHSS.
4. Diagnosis of ovulation: no periodic
changes in hormones during absence from ovulation, commonly found in
non-ovulation-free dysfunction uterine bleeding, polycystic ovary syndrome, and
certain postmenopausal bleeding.
5. Diagnosis of female sexual
precociousness: clinically mostly prior to the second sexual
characteristics of precocious development
before the age of 8, blood E2 levels increased275pmol/L as one of the hormone indicators for diagnostic precociousness.
Prolactin (PRL)
PRL is synthesized and secreted by the
pitel eosinophilic PRL cells. Double regulation of hormones released by hypothalamus inhibitors
(mainly dopamine) and prolactin. The main
functions of PRL are to
promote breast development and lactation, as
well as to promote breast catheterand and gland
development prior to childbirth in conjunction with ovarian steroid hormones. The
measurement level and biological effects of PRL are not necessarily parallel, such as milk-free in people
with high PRL, whereas those with NORMAL
PRL may have milk spills.
PRL secretion is unstable, mood,
exercise, sexual intercourse, hunger and eating can all affect its secretion
status, and with the menstrual cycle there are small fluctuations, with
sleep-related rhythm. After falling asleep, it rises to a
24-hour peak before waking up in the morning,
dropping rapidly after waking up, and dropping to mid-day lows
from 10 a.m.
to 2 p.m.
Therefore, according to this rhythmic secretion characteristics,
should be 10 to 11 a.m. time and space abdominal blood pumping
(quiet and awake state). Generally speaking, normal lactin levels are normal and do not require
review, and elevated PRL levels may
be caused by the confusion of the above factors.
PrL significant elevated, can be
determined by a single examination,PRL elevation at the normal maximum of 3 times below, should be a second examination,
not easily diagnosed with hyperlactinemia(HPRL)abuse brominated pavilion
treatment.
PRL is 25 ng/mL or above the unit test
normal value is HPRL,PRLis50 ng/mL,andapproximately 20% has prolomas. PRL,100ng/mL,about 50% have prolomas, can be selectively performed for pituitary CT or magnetic resonance. PRL,200ng/mL,often microadenomas, must be done pituitary CT or magnetic resonance. Elevated PRL levels are also seen in precocious sex, reduced primary thyroid function,
premature ovary aging, poor yellow function, long-term breastfeeding, neuropsychiatric
stimulation (e.g. chloropropyl, birth control pills, large amounts of estrogen,
blood equality). Patients with polycystic ovary syndrome are
mildly high prolactinemia, which may be caused by persistent estrogen
stimulation.
PRL reduction: hypothermia, lack of
simple prolgive delivery, use of anti-PRL drugs such as brominated
pavilions, left-handed doba, VitB6, etc.
Androgen (T)
Androgens are secreted by the ovary and
adrenal cortex. Androgens are divided into testosterone and andene diketones. Premenopausal, serum testosterone is the main indicator of the
source of ovary androgens, and the adrenal cortex is the main source of androgens.
The normal range of serum total testosterone is <1.4nmol / L during follicular phase, <2.1nmol / L during ovulation, <1.7nmol / L during luteal phase, and <1.2nmol / L after menopause.
1. Ovarian masculinity tumors: women in
the short term to develop excessive symptoms of sex exacerbation and serum
androgen softening often prompt sorovarian masculinity tumors.
2. Polycystic Ovary Syndrome:
Testosterone levels usually do not exceed 2 times the upper limit of the normal range, male oleones are often elevated, dehydrogenated
pyrodone is normal or mildly elevated. If the level of androgens is raised before treatment, it should
be reduced after treatment, so serum androgen level can be used as one of the
indexes to evaluate the efficacy.
3. Abnormal lyrogen seroandhormone
serotonin in adrenal cortical hyperplasia tumors.
4. Gender malformations: male
pseudo-gender malformations and true gender malformations, testosterone levels
within the normal value of men;
5. Female hair yaphosis: When serum
testosterone levels are measured, multiple hair follicles are sensitive to
androgens.
6. The use of androgen preparations or
endocrine drugs with androgen effects, such as Dana, is used to monitor
androgen levels during the drug use.
7. Hyperlactinemia: Women have excessive
androgen symptoms and signs, but androgen levels in the normal
range, serum prolactin levels
should be measured.
It was the other day.White text to attend the first hospital of Peking University in the course of study The content of the teacher’s lecture,Here’s followed byShare it.
Get sex hormone test sheet, to read in the following order
1、FSH(follicle stimulator)
2、LH(Yellow seromer) andFSHProportion
3、T(Testosterone)
4、PRL（泌Lactosine)
5、E2(estradiol)
6、P(Progesterone)
Step 1:FSH
In general, the lowest point is in the yellow body period0.5 IU/LThe highest point is during ovulation< 20IU/L。
Clinical significance: less than1IU/LTips for the hypothalamus-Poor function;20IU/LSuggests ovarian failure.
Predicting Ovarian Reserve Capacity, Cromefen Stimulation Trial: Menstrual Cycle No.5Day, daily oral cromivenin100mg, total5Days, in menstruationCycle No.10Days, testsFSH。 IfFSH>20IU/L, which indicates that the ovary reserve function is reduced.
LH
In general, the highest point is in ovulation and can be higher than20IU/L。
Clinical significance: less than1IU/L, tips for the hypothalamus-To have low function;LH13-25IU/L，FSHNormal, promptPCOSIt makes more sense to increase the early and mid-follicle periods. Urine testingLHpeak, predictable ovulation.
Hanging function test:GnRHExcitement test, method:GnRH100micrograms, one-time intravenous injections, after medication30-90Minutes, measuredLH、FSH。 Results:LHIncrease3Times andFSHUnchanged, good function;LHNo response, then the drooping function is poor;FSH、LHReaction to advance orFSHReaction slowerLHInthes of progress, ovarian function declines.
Step 2:LH & FSHProportion
Mainly used to infer the yellow function, if>2.5, considering polycystic ovaries or yellow ingress;<1, consider ovarian function decline.
Step 3: Testosterone
Women are0.5-3.0nmol/l(20-80ng/dl), the exception is100ng/dl。
about 80% Testosterone andSHBGcombined, the values were total testosterone, free testosterone (FAIIt makes more sense.
Testosterone Source:50% Since the outer week maleeneDiketone (adrenal production) conversion, each25%From the adrenal glands and ovaries.
Clinical implications: Testosterone is less than or equal200ng/dl（6.9nmol/l), possibly forPCOSgreater than200ng/dl（6.9nmol/l), a tumor that secretes androgens.
Sulphate dehydrogenation methadone (normal range)250-300ng/dl,0.7-0.8umol/l) less than or equal to700ng/dl, possibly forPCOSgreater than700ng/dl, adrenal or ovarian tumors.
17-Oxyprogesterone (normal range)<2ng/ml,6.1nmol/l)，>4ng/ml 12.1nmol/lThe dexamethasone suppression test is required.
Dexamethasone Suppression Test: Method: The Day Before11PM-12PMOral dexamethasone between1mgDay8AMBlood.
Results: Cortisol>138nmol/L，Tip Cushing syndrome。
Step 4:PRL
During the day, the level of secretion fluctuates (5-27ng/ml),every 24hour, late follicle about14pulses, yellow late about9pulses. Stress (venous punctures) can lead to increased secretion. Time to draw blood: morning9-11point, fasting, quiet.
Diagnosis criteria for hyperlactinemia: twice>30ng/ml or 880mIU/L
MeasuredPRLIncluding small molecules, large molecules.PRL, large moleculePRLNo function.
Some normal womenPRLCan be high, if the menstruation is normal, can be observed, if amenorrhea or menstrual thinning, need to retest.
Step 5: estradiolE2
The most physiologically active estrogen in the body, normal50-500pg/ml, the ovulation period reaches a peak, if below normal, accompanied byFSH、LHReduce and consider hypothalamus amenorrhea.
Estrogen (estradiol) normal bloodConcentration: Early follicle40-60pg/ml
Mid-cycle250-350pg/ml
Yellow mid-body100-200pg/ml
ESTRADIOL PRODUCED BY THE OVARIES60-600ug/d
Step 6: Progesterone
Timing: Pre-menstrual5-8Days. Objective: To determine whether there is ovulation or not.>30nmol/lThat is, prompt for ovulation.
Normal blood concentration of progesterone (progesterone): follicle period<3ng/ml
Yellow mid-bodyGreater than or equal to10ng/ml
Pregnancy,PRelated to placental growth, early pregnancy30-45nmol/l
Mid-pregnancy75-150nmol/l
Late pregnancy150-600nmol/l, related to the birth weight of the newborn and the weight of the placenta.
Tips for the test sheet:
FSH、LHNormal range,E2Lower, hypothalamus amenorrhea.
FSH、LHReduceE2Lower, pituitary amenorrhea, hypothalamus amenorrhea.
FSHIncreaseFSH/LH>1, ovarian function is declining.
LHSignificantly higher,LH/FSH>2.5,PCOS。
PRLElevated, hyperlactinemia.
TElevated, and hyperpositive hormoneemia.
Each is generally normal, uterine amenorrhea.
