Male/Female labs Flashcards
hormone flow chart
why male labs
-cancers
-dysfunction
-infertility
-infections
prostate cancer
-prostate specific antigen- PSA
-predication of the course of ds
-prediction of stage of ds
-follow up after tx
-controversial in screening!!!
-Not recommended screening unless suspicion!
-only order if palpate nodule, urinary symptoms etc
-Correlation with size of prostate
-Elevation in Prostate Carcinoma and Benign Prostatic Hypertrophy (BPH)
-Increased after exam or biopsy
-If elevated after 2-3 months
-excellent for post cancer screening and removal
PSA screening criteria
-men aged 55-69 years - cat C
-1 test
-many pros and harms of testing
-based on family hx, race/ethnicity, cormorbid medical conditions, pt values ab benefits and harms of screening and tx specific outcomes
-dont screen men who do not express preference for screening
-70+ men- dont screen (cat D)
-digital rectal exam elevates PSA -> send script
testicular cancer
-types:
-1. germ cell tumors 90%- seminomas, non-seminomatous germ cell
-2. sex cord/stromal tumors 10%- leydig, sertoli
-labs:
-hCG, AFP, LD (LD-1)
-if testes dont descend- stay in abdomen -> cancer
-stage 1- in testes
-stage 2- in lymph nodes too
-stage 3- in other others too
bladder cancer
-painless hematuria
-urine cytology for cancer cells
-darker urine
-trace blood in urine -> suspect this
-no pain receptors on bladder
-more growth into deeper tissue- greater stage
-smoking #1 cause
gonadal dysfunction
-Partial androgen deficiency
-Advanced age “andropause”
-Decreased testosterone with normal gonadrotropin levels
-40’s: 7%, 50’s: 30%, 60’s: 50%, 80’s: 90%
-Symptoms
-Mood Changes
-Sexual dysfunction
-muscle atrophy
-bone density
-poor memory
-hair growth
evaluation of low testosterone in males
-test low and LH and FSH not elevated -> secondary hypogonadism -> check T4, cortisol, prolactin, ferritin, transferrin saturation, MRI
-test low, LH, FSH elevated -> primary hypogonadism -> genetic testing for klinefelter syndrome
-R/O cancer tx, alkylating agent or testicular radiation, trauma, mumps orchitis
partial androgen deficiency
-Replacement increases muscle mass, increase bone mass, protect against falls & reduces bone fractures
-Side Effects: pathogenesis of BPH & prostate cancer, decrease sperm count, dyslipidemia, increased CAD
-Testosterone Levels
-If low LH then pituitary or hypothalmic problem
-If high LH then secondary cause of low androgen level
causes of primary hypogonadism in males
causes of hypogonadotropic (secondary) hypogonadism
infertility in males
-Failure to conceive after 1 year, 15% of couples, male infertility 50% cases (females also 50%)
-Production, blockage, morphology , motility
-tight clothes
-computer on lap
-Semen Analysis
-2-5 days abstinence
-Viscosity
-Completeness of liquefaction
-Appearance
-pH
-Motility pattern- Beating flagella and Progressive motility
-Viability- is sperm dead
-Sperm agglutination / antibodies
estrogen effects
-cardioprotective
-breast growth
-memory function
-libido
-body temp regulation
-liver- cholesterol production
-bone strength
-skin- antiaging effect
-pregnancy
cervical cancer screening: pap smear
-21-29- every 3 years with cytology alone
-30-65 years- every 3 years with cytology alone -> every 5 years with hrHPV testing alone or every 5 years with costesting
-younger than 21 and women >65 with prior screening, and women with hysterectomy -> do not screen
pregnancy test
-Urine hCG- 14 days post conception -> implantation!
-first urine in the morning
-beta hCG- 8-11 days post conception
-doubles every 1.5-2 days for the first 8 weeks
-order this to r/o preg in ER
maternal serum screening
-fetal abnormalities:
-neural tube defects
-trisomy 21/down’s syndrome
-trisomy 18
-1st trimester work up:
-AFP
-hCG
-PAPP- pregnancy assoc plasma protein
-nucal US
-2nd trimester work up “Quad”-
-AFP
-hCG
-estriol
-inhibin A
-trisomy 18- all low
-trisomy 21- AFP & estriol low, hCG & inhibin A elevated
fetal DNA
-maternal serum
-dose not tell of neural tube defects
-gender
-chromosomal abnormalities
-recommended for:
-mother > 35 yo
-US suggest neural tube defects
-previous pregnancy
-lab abnormal
ectopic pregnancy
-1.3 – 2% of pregnancies
-Maternal death
-MC fallopian tubes
-Increased:
-Tubal damage ( infections)
-Smoking
-Infertility
-Previous
-symptoms:
-mostly asymptomatic
-lower abdominal pain
-vaginal bleeding
-adnexal mass
-work up:
-hCG
-US
-medical tx with methotrexate
-surgical intervention
spontaneous abortion
-miscarriage
-10-20% of all pregnancies < 20 weeks
-increased risk - maternal age, previous, smoking, ETOH, drugs
-50% occur secondary to chromosomal abnormalities
-recurrent if 3 or more consecutive
-1-5% recurrent
-8 weeks should have heart beat
trophoblastic tissue
-Disease process of the placenta
-Can have malignancy
-Dx: No fetal heart beat, ELEVATED hCG, shortened hCG doubling
-D & E, follow post surgical hCG to assure reduction
preeclampsia/eclampsia
-increased morbidity and mortality
-preeclampsia- HTN & proteinuria (2-8%)
-eclampsia- above plus seizures
-also occurring:
-coagulapathies
-elevated LFTs
-renal failure
-cerebral ischemia
-symptom control till delivery
HELLP syndrome
-Hemolysis
-E&L- elevated liver enzymes
-L&P- low platelets (thrombocytopenia)
-27-36
-can occur with preeclampsia
-bruising !!
fatty liver in pregnancy
-Nausea & Vomiting, RUQ pain, lethargy
-36 weeks
-Liver Biopsy
-AST>ALT, elevated bilirubin, hypoglycemia, hyperuricemia, elevated PTT, elevated PT, decreased fibrogen
female infertility
-causes:
-Ovarian
-Hormonal
-Tubal
-Cervical
-Uterine
-Psychosocial
-Iatrogenic
-Immunological
indications and timing of infertility eval
infertility eval: hx
hystersalpingogram
-occlusions at isthmus of both fallopian tubes
-test for infertility blocks
eval of suspected menopause in females >40
breast screening criteria
-women 50-74- every other year screening
-women 40-49- high risk
->75 or older- no screening
-you can screen anyone with a hx or hx of cancer
breast cancer
-1 in 8 women
-1% in males
-spiculated
-Risk:
-Increased age
-Family history
-Hormonal Hx
-Clinical density -> US bc hard to see
-Obesity
-ETOH
management for pts with abnormal mamo
breast cancer: tx
-Breast conserving surgery
-Radiation
-Mastectomy
-radical mastectomy- takes lymph nodes too and some of pec
-Chemotherapy
-Hormone Therapy
breast cancer prognosis
-Tumor size
-Axillary node involvement
-Histological type
-Histological grade- disorganization
-Lymphatic & vascular invasion
-Biomarkers
breast cancer labs: tumor markers
-not genetic -> we are testing the tumor
-Estrogen Receptor:
-is tumor thriving in estrogen environment
-Estrogen dependent
-70% of breast cancer
-Favorable prognosis
-Progesterone Receptor
-Endocrine treatments Selective ER modulators:
-Tamoxifen- blocks estrogen
-Ovarian ablation
labs: HER-2
-Chromosomal gene
-Cell proliferation & survival gene
-10%- 15% have gene amplified
-More aggressive and poor outcome
-Focused therapy with trastuzumab -> Cardiotoxic (dilated)
-this drug stops proliferation while you do surgery/resection/chemo
breast cancer biomarkers
-none currently that are elevated in all pts
-other markers can be elevated in metastatic ds
-other markers can also rise during chemo
hereditary breast and ovarian cancer: BRCA 1 and BRCA 2
-Hereditary mutation
-Breast & Ovarian Cancer
-Tumor suppressor genes / gene stability deleted
-BRCA typically suppresses cancer
-Risk for mutation:
-Early Breast Cancer onset < 50 yo
-Bilateral Cancer
-Breast & Ovarian
-Autosomal dominant
-Breast Cancer in male relative
-BRCA 1 and BRCA 2- if mutation present 60-80% occurrence of breast cancer
-BRCA 1- lifetime ovarian cancer 15-60%
-BRCA 2- lifetime ovarian cancer 10-27%
-increased melanoma, prostate CA, and pancreatic CA
hereditary breast and ovarian cancer management
-Intensive Screening
-Chemoprevention
-Mastectomy
-Prophylactic oophorectomy:
-After childbearing
-Decrease risk of Breast and Ovarian
