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DS Unit 4 > Hormones > Flashcards

Hormones Flashcards

1
Q

How many different forms of hCGs can be present in a blood sample?

A

-

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2
Q

What is the (1.)source of cell synthesis, (2.)mode of action, and (3.) site of action for hCG?

A
  1. Syncytiotrophoblast
  2. Endocrine
  3. LH/hCG receptor
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3
Q

What is the (1.)source of cell synthesis, (2.)mode of action, and (3.) site of action for sulfated hCG?

A
  1. Gonadotrope
  2. Endocrine
  3. LH/hCG receptor
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4
Q

What is the (1.)source of cell synthesis, (2.)mode of action, and (3.) site of action for sulfated hCG?

A
  1. Cytotrophoblast
  2. Autocrine
  3. TGF beta antagonism
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5
Q

What is the (1.)source of cell synthesis, (2.)mode of action, and (3.) site of action for hCG beta?

A
  1. Advanced malignancies
  2. Autocrine
  3. TGF beta antagonism
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6
Q

What is the (1.)source of cell synthesis, (2.)mode of action, and (3.) site of action for hyperglycosylated hCG beta?

A
  1. Advanced malignancies
  2. Autocrine
  3. TGF beta antagonism
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7
Q

What is the function of hCG (intact)?

A

Functions to advance uterine angiogenesis and promote progesterone production by corpus luteal cells

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8
Q

Where is hCG produced?

A

Produced by syncytiotrophoblast cells in pregnancy and by hydatidiform moles

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9
Q

What are the alpha subunits in hCG similar to?

A

Alpha subunits are similar to hCG-H, pituitary hCG, LH, FSH, TSH

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10
Q

What are the beta subunits of hCG similar to? What are they used for?

A

Beta subunits similar to LH but differentiates hCG, hCG-H and pituitary hCG from other molecules.

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11
Q

What is Hyperglycosylated hCG (hCG-H)?

A
  1. An independent molecule to regular hCG
  2. A structural variant of regular hCG
  3. It is an autocrine or cytokine that promotes growth, invasion and malignancy. It is not a hormone.
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12
Q

Where is Hyperglycosylated hCG (hCG-H) produced?

A

Produced by cytotrophoblast cells of the placenta

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13
Q

What is the function of hyperglycosylated hCG?

A
  1. It is an accurate marker of invasive mole and invasive choriocarcinoma
  2. Very useful in the diagnosis and management of gestational trophoblastic disease
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14
Q

What is the free beta subunit of hCG?

A
  1. Originates from beta subunit of hCG with triantennary N-linked and O-linked hexosamines.
  2. It is autocrine or cytokine
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15
Q

Where is the free beta subunit of hCG produced?

A
  1. Produced in most gynecological malignancies, moles, non-trophoblastic malignancies.
  2. Produced by 68% of ovarian, 51% endometrial, 46% cervical malignancies.
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16
Q

What is the function of the free beta subunit of hCG?

A

It blocks apoptosis in cancer cells and promotes the growth of the malignancy thereby leading to poor outcomes.

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17
Q

How are hCG (intact), hCG-H, and free beta subunits broken down?

A

Protease degradation (tumor macrophages)

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18
Q

What is hCG (intact) broken down into?

A 
1. Nicked
 hCG (Intact)
2a. Nicked
free β subunit
2b. Free alpha subunit
3. Beta-subunit core fragments
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19
Q

Why is testing for alpha subunits not a specific way to check for pregnancy?

A

Alpha subunits are similar to hCG-H, pituitary hCG, LH, FSH, TSH

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20
Q

What is the most specific test for pregnancy?

A

Beta subunit hCG but false positives are still possible due to variant hCGs

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21
Q

How is the pituitary hCG similar/different from regular hCG?

A

Has the same amino acid structure as regular hCG but is a sulfated variant of hCG (instead of sialylated oligosaccharide) produced at low levels during the menstrual cycle.

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22
Q

What is the function of pituitary hCG?

A

Functions similarly to LH

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23
Q

What is the FDA approved use of hCG tests?

A

FDA approved assay for pregnancy diagnosis

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24
Q

How is hCG relevant to ectopic pregnancy?

A

Workup of suspected ectopic pregnancy, serial hCG testing is used (along TVU: transvaginal ultrasound)

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25
Q

What are the uses of hCG tests?

A
  1. Pregnancy test
  2. Ectopic pregnancy
  3. tumor marker
  4. Maternal serum screening for fetal aneuploidies
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26
Q

What is maternal serum screening for fetal aneuploidies?

A
  1. Maternal serum screening for fetal aneuploidies (e.g., fetal trisomy 21-Down’s syndrome)
    A. Quad test
    -Alpha fetoprotein, estriol, inhibin A, hCG
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27
Q

What do hCG assays measure?

A

hCG assays measure the intact (whole) molecule, it does not measure the free alpha-or beta-subunits.

28
Q

What do total beta-hCG assays measure?

A

Total β-hCG assays measure both the intact hCG and free beta subunits.

29
Q

What hCG assay would be used as a tumor marker?

A

a total β-hCG assay may be preferred, because cancer patients produce significant amounts of free beta subunit

30
Q

What is the high dose hook effect?

A

The concentration of hCG is so high that it exceeds the optimum performance of the assay and usually yields a false low result.

31
Q

What diseases are asst. with hCG testing?

A
  1. Gestational trophoblastic disease
    A. Hydatidiform moles
    B. Trophoblastic malignancy
    -Placental site trophoblastic tumors (cytotrophoblast cells arising from the placental implantation site)
    -Choriocarcinoma (both cytotrophoblastic and syncytiotrophoblastic elements)
  2. Non-gestational malignancy
  3. Testicular cancer
32
Q

What is important to remember about hCG test ordering?

A

Assay sensitivity is a key issue when ordering hCG tests.

33
Q

What is the variant hook effect?

A
  1. Occurs in women who are more than five weeks pregnant.
  2. If a device was developed to only measure intact hCG, it has problem when there’s too much of the variant hCG from five week’s gestation and later
34
Q

What are examples of detection limits forhCG?

A

Urine home pregnancy test kits : 50 U/L
Urine Qualitative hCG test in lab : 25 – 50 U/L
Serum Quantitative hCG test in lab: 1 – 2 U/L
Serum Quantitative β-hCG test in many labs: 1 – 3 U/L
Serum Quantitative β-hCG test in our lab: 0.1U/L

35
Q

what may hCG assays detect?

A 
hCG
hCG-beta
Nicked hCG
Hyperglycosylated hCG (hCG-H)
Hyperglycosylated hCG-beta
hCG and hCG-Beta missing the C-terminal peptide
36
Q

Where is GnRH secreted from?

A

Hypothalamus

37
Q

Where are LH and FSH secreted from?

A

Anterior pituitary

38
Q

What triggers the release of LH and FSH from the ant. pit?

A

GnRH (gonadotropin-releasing hormone)

39
Q

What is the function of LH?

A

LH binds to the Leydig cell receptors to enhance conversion of cholesterol to testosterone

40
Q

What is the function of FSH?

A

FSH activates the seminiferous tubules for sperms production.

41
Q

How are the structures of LH and FSH similar/different?

A

LH and FSH each consists of two subunits; both sharing the same α-subunit but with different β-subunits that confer their functional specificities.

42
Q

What is the relationship between (primary) gonadal steroids and pituitary gonadotropins?

A

As a rule, in primary states, gonadal steroids and pituitary gonadotropins are inversely correlated.

43
Q

How are levels of pituitary hormones regulated?

A

The negative feed-back signals from the gonadal steroids cause elevation, if deficient, or depression, if excessive, of the pituitary hormones.

44
Q

How are disorders of the reproductive system hormones classified?

A

Disorders of reproductive systems may generally be viewed from the stand-point of hormone deficiency or excess, and of primary (gonadal) or secondary (pituitary) origin.

45
Q

What is the relationship between (secondary) gonadal steroids and pituitary gonadotropins?

A

In the secondary state, gonadal steroids and pituitary gonadotropins are directly correlated since deficient or excessive gonadotropins secretion would act to inhibit or stimulate the target hormone productions accordingly.

46
Q

What is the clinical usefulness of LH and FSH?

A
  1. Evaluate infertility
  2. Diagnosis menopause in order to initiate hormone replacement therapy
  3. Diagnosis of conditions
47
Q

What conditions are asst. with increased LH and FSH?

A

Gonadal failure (turner syndrome) Klinefelter syndrome, polycystic ovaries
Preconscious puberty
Pituitary adenoma

48
Q

What conditions are asst. with decreased LH and FSH?

A

Pituitary failure
Hypothalamic failure
Anorexic nervosa
Stress

49
Q

What factors may interfere with FSH and LH assays?

A

hCG and TSH may interfere with various immunoassays due to similarities in the alpha and/or beta subunits.
Patients with hCG producing tumors and hypothyroidism may produce falsely elevate LH or FSH levels.
Several therapeutic and abused drugs can cause an increase or decrease in blood levels of LH and FSH.

50
Q

Where is prolactin released?

A

produced by the lactotrophs of the pituitary.

51
Q

What is the function of PRL?

A

major function of PRL is the initiation and maintenance of milk production.

52
Q

What is the major circulating form of PRL?

A

nonglycosylated monomer.

53
Q

What is the normal PRL level?Why is it this level?

A

Normal level is low (<25 F) because of the inhibitory actions of prolactin-inhibiting factor (PIF) a.k.a. dopamine from the hypothalamus.

54
Q

How often should PRL samples be drawn when assessing for hyperprolactinemia? Why?

A

PRL secretion is pulsatile with a short half-life, more than one sample should be drawn at 30 minute intervals when screening a patient for hyperprolactinemia.

55
Q

When are PRL levels elevated?

A

Elevated during sleep and peaks in early morning hours.

56
Q

Why is PRL clinically significant?

A
  1. PRL is a sensitive indicator of pituitary dysfunction

2. Test for prolactinemia

57
Q

What isthe most common pituitary hormone hypersecretion syndrome in both males and females?

A

Hyperprolactinemia is the most common pituitary hormone hyper secretion syndrome in both males and females

58
Q

What type of tumors can raise the PRL level to >1000 ng/ml?

A

Pituitary tumors >1000 ng/mL

Tumors arising from lactotrope cells account for about half of all functioning pituitary tumors.

59
Q

What are normla physiologic causes of elevated PRL levels?

A

pregnancy and lactation are the important physiologic causes of elevated PRL levels.

Third trimesters: 95 – 473 ng/mL

60
Q

What occurs with PRL levels in women with amenorrhea and/or galactorrhea?

A

Hyperprolactinemia i

Three quarters of patients with amenorrhea and/or galactorrhea.

61
Q

What physiologic and pathologic factors (as well as medications) raise PRL levels that rarely exceed 200 ng/mL?

A

Stress

Phenothiazines, oral contraceptives, opiates and estrogens

62
Q

What conditions cause hypoprolactinemia?

A
  1. Pituitary apoplexy (Sheehan syndrome)

2. Any condition that results in pituitary destruction

63
Q

What is Pituitary apoplexy (Sheehan syndrome)

A

Women who develop severe hemorrhage after obstetric delivery and experience circulatory collapse, bleeding into the pituitary gland (apolexy), resulting in an infarcted pituitary.

64
Q

What conditions can cause falsely low PRL levels?

A

Falsely lowered results may occur because of assay artifacts; sample dilution is required to measure these high values accurately (hook effect).

65
Q

What conditions can cause falsely high PRL levels?

A

Falsely elevated values may be caused by aggregated forms of circulating PRL, which are biologically inactive as macroprolactinemia.

66
Q

Why is the first response ovulation test unique?

A

It’s the ovulation test that actually detects your own personal LH surge. It detects and tracks your personal daily baseline levels of luteinizing hormone (LH) to detect your personal surge, unlike some other ovulation tests that use a preset “average” level to determine an LH surge.

DS Unit 4 (9 decks)

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