Monday, June 29, 2009

Do you know basic facts about testosterone?

Questions:

1.What is the primary sex hormone produced in males which is responsible for the development of penis and testes, growth of facial hair and deepening of voice?

TESTOSTERONE

2.Where is the site of the production for the testosterone hormone?

TESTES, OUTER PART OF THE ADRENAL GLAND(adrenal cortex) and OVARIES (small amount)

3. What is the normal value of testosterone in adult male and in adult female?

Men: 270-1070 ng/dL or 9-38nmol/L (values in elderly men diminish moderately)
Women: 15-70 ng/dL or 0.52-2.4 nmol/L


4.What are the diseases or conditions associated with the person that has high level of testosterone? Give at least three?

Adrenal neoplasms, Ovarian tumor, trophoblastic disease during pregnancy

5.What are the diseases or conditions associated with the person that has low level of testosterone? Give at least three?

HYPOGONADISM, KLINEFELTER'S SYNDROME, HYPOPITUITARISM

6.How is testosterone measured in the body?

If a doctor suspects someone is not producing enough testosterone, he/she will check if the total blood testosterone level falls into the acceptable range.

The doctor also may instruct the laboratory to measure the amount of free or loosely bound testosterone (about 30 percent of the total testosterone is strongly bound to a protein called sex hormone binding globulin, known as SHBG; about 68 percent is weakly bound to another protein called albumin) and the amount of free testosterone (only about two percent circulates freely in the blood).

Blood levels of SHBG increase with age, so older men may have a higher percentage of bound testosterone and a lower percentage of free testosterone.


7.What are the treatment given to the person that has deficient in testosterone?

Testosterone deficiency can be treated by:

Intramuscular injections, generally every two or three weeks
Testosterone patch worn either on the body or on the scrotum (the sac that contains the testicles)

Testosterone gel

Mucoadhesive material applied above the teeth twice a day
hormone replacement

8.What are the causes of testosterone deficiency?

As a man ages, the amount of testosterone in his body gradually declines. This natural decline starts after age 30 and continues throughout life.

Other causes of lowered testosterone levels include:

Ø Injury or infection to the testicles

Ø Chemotherapy or radiation treatment for cancer

Ø Genetic abnormalities such as Klinefelter's Syndrome (extra X chromosome)

Ø Hemochromatosis (too much iron in the body)

Ø Dysfunction of the pituitary gland (a gland in the brain that produces many important hormones)

Ø Inflammatory diseases such as sarcoidosis (a condition that causes inflammation of the lungs)

Ø Medications, especially hormones used to treat prostate cancer and corticosteroid drugs

Ø Chronic illness

Ø Chronic kidney failure

Ø Liver cirrhosis

Ø Stress

Ø Alcoholism


9.What are the differences between testosterone and bio testosterone?

Testosterone is present in the blood as "free" testosterone (2-3%) or bound testosterone. The latter may be bound to either albumin (a serum protein) or to a specific binding protein called Sex Steroid Binding Globulin (SSBG) or Sex Hormone Binding Globulin (SHBG).

The binding of testosterone to albumin is not very tight and is easily reversed; so the term bioavailable testosterone (BAT) refers to the sum of free testosterone plus albumin-bound testosterone.

10.Is Testosterone replacement safe to treat testosterone deficiency?

In general, hormone replacement therapy is safe. It is associated with some side effects, including:

Acne or oily skin

Mild fluid retention

Stimulation of prostate tissue, with perhaps some increased

urination symptoms such as a decreased stream or frequency

Breast enlargement

Case analysis:

1.A 16 year old woman upon physical examination showed excessive growth of axillary and pubic hair than her peers; enlargement of external genitalia and deepening of voice. The patient was subjected to undergone clinical test:

Laboratory results:

Free testosterone: 105 ng/dL
Total Testosterone: 12.5pg/m
LH:11mU/mL
Prolcatin: 3ng/mL

Questions:

1.Is there any abnormal results obtained in the Laboratory results?
If there is, give the normal values.

ANSWER:

Definitely the obtained results are abnormal,

Laboratory results: Interpretations: Normal Values:

TOTAL testosterone: 105 ng/dL ABNORMAL 15-70 ng/dL
FREE Testosterone: 12.5pg/m ABNORMAL 1.0-8.5pg/mL
LH:11mU/mL ABNORMAL
Prolcatin: 3ng/mL ABNORMAL


2.What is the diagnosis of the doctor based on the laboratory findings?
ANSWER:
Based on the results, The woman has an abnormally increased of testosterone level in her body that's make her showed excessive growth of axillary and pubic hair than her peers; enlargement of external genitalia and deepening of voice. The levels of Testosterone should be lesser in amount for woman as compared to the males because it is the primarily responsible for the male characteristics.

3.What are the possible treatment may given to the patient?
ANSWER:
ESTROGEN REPLACEMENT
Low estrogens allow the circulating androgens and testosterone to be more freely available and thus stimulate cells more. Increasing the circulating estrogen in the blood by taking estrogens will increase the proteins that bind the androgens and help decrease the effects of all androgens, whether the levels are normal or excessive.



Case analysis
2.A 26 year old male happened to visit a doctor and complaining of erectile dysfunction, fatigue, hot flashes, polyuria,night sweats and anxiety. The doctor had requested him to undergone several Clinical chemistry test:
Laboratory findings:


Free Testosterones: 200ng/dL
Total Testosterones:25pg/ml
Glucose: 250mg/dl
Urinalysis: Normal results
Sperm count: Decreased level

Questions:

1. Is there any abnormal results obtained in the Laboratory results?
If there is, give the normal values.

Laboratory results: Interpretations: Normal Values:

TOTAL Testosterone: 200ng/dL ABNORMAL 270-1070 ng/dL
FREE Testosterone:25pg/ml ABNORMAL 50-210 pg/mL
Glucose: 250mg/dl ABNORMAL 60-120mg/dL
Urinalysis: Normal results
Sperm count: Decreased level ABNORMAL

2. What is the diagnosis of the doctor based on the laboratory findings?

ANSWER:

Based on the laboratory findings, The Physician diagnosed hypogonadism because all the symptoms manifested by the man are all due to low testosterone level in the body. Hypoganadism is a disease may acquired due to low testosterone level.

3. What are the possible treatments that may be given to the patient?

ANSWER:

Hypogonadism is most often treated by replacement of the appropriate hormones.

For men, this is testosterone. Commonly-used testosterone formulations include transdermal testosterone, injectable testosterone, and buccal testosterone.

Oral testosterone is no longer used in the U.S. because it is broken down in the liver and rendered inactive.

REFERENCES:

Wikipedia.com
http://www.diagnose-me.com/cond/C621300.html
http://images.google.com.ph/imgres?imgurl=http://www.newbeacon.org.uk/images/exam_boy_icon.jpg&imgrefurl=http://www.newbeacon.org.uk/boys-exam_results.htm&usg=__sfG0bcYYuq7zZa1aQcrNR0gDhMo=&h=90&w=92&sz=10&hl=tl&start=15&um=1&tbnid=6Iwym6u8vfTNXM:&tbnh=77&tbnw=79&prev=/images%3Fq%3Dexam%2Bicon%26ndsp%3D20%26hl%3Dtl%26sa%3DN%26um%3D1

Tuesday, June 16, 2009









Questions:

1.What is the primary sex hormones produced in male's body which is responsible for the development of penis and testes, growth of facial hair and deepining of
voice?

2.Where is the site of pordution for the testosterone hormone?

3. What is the normal value of testosterone in adult male and in adult female?

4.What are the diseases or condition associated with the person that has high level of testosterones? Give atleast three?


5.What are the diseases or condition associated with the person that has low level of testosterones? Give atleast three?

6.How is the testosterone measured in the body?

7.What are the treatment given to the person that has deficient in testosterones?

8.What are the causes of testosterone defficiency?

9.What are the differences of testosterones and Bio available testosterones?

10.Is Testosterone replacement safe to treat testosterone difficiency?




Case analysis:

1.A 16 year old woman presented. A school Physical examination showed excessive growth of axillary and pubic hair than her peers; enlargement of external genitalia and deepening of voice. The patient was subjected to undergone clinical test:
Laboratory results:

TOTAL testosterone: 105 ng/dL
FREE Testosterone: 12.5pg/m
LH:11mU/mL
Prolcatin: 3ng/mL

Questions:
1.Is there any abnormal results obtained in the Laboratory results?
If there is, give the normal values.

2.What is the diagnosis of the doctor based on the laboratory findings?

3.What are the possible treatment may given to the patient?



Case analysis
2.A 26 year old male happened to visit a doctor and complaining of erectile dysfunction, fatigue, hot flashes, polyuria,night sweats and anxiety. The doctor had requested him to undergone several Clinical chemistry test:
Laboratory findings:

TOTAL Testosterones: 200ng/dL
FREE Testosterones:25pg/ml
Glucose: 250mg/dl
Urinalysis: Normal results
Sperm count: Decreased level

Questions:
1. Is there any abnormal results obtained in the Laboratory results?
If there is, give the normal values.

2. What is the diagnosis of the doctor based on the laboratory findings?

3. What are the possible treatment may given to the patient?

REFERENCES:

http://images.google.com.ph/imgres?imgurl=http://www.newbeacon.org.uk/images/exam_boy_icon.jpg&imgrefurl=http://www.newbeacon.org.uk/boys-exam_results.htm&usg=__sfG0bcYYuq7zZa1aQcrNR0gDhMo=&h=90&w=92&sz=10&hl=tl&start=15&um=1&tbnid=6Iwym6u8vfTNXM:&tbnh=77&tbnw=79&prev=/images%3Fq%3Dexam%2Bicon%26ndsp%3D20%26hl%3Dtl%26sa%3DN%26um%3D1

Monday, June 1, 2009

Testosterones



It is the primary androgen secreted by interstitial cells of the testes (leydig cell) in men and by adrenal glands and ovaries in women. This is also responsible for the male secondary sex characteristics. The excessive production of this hormone may lead to premature puberty in young males and for women, it may cause excessive facial and body masculinity. It also contributes to the enlargement of external genitalia, accessory organs such as the prostate gland, Voluntary muscle and to the growth of facial, pubic and axillary hair.


The testosterone synthesis begins to increase at onset of puberty and continues to progress during adulthood. And production began to decline at about age of 4o and then totally stop at the peak level of 80.

It is always present is serum as both unbound or free form and bound fractions to albumin. The level of testosterone in the body helps to asses if the patient has hypogonadism, pituitary gonadotropin function, impotency and cryptochidism.
For women it helps to diagnose ovarian tumors, hirsuitism and even irregularities in menstrual periods.


The following guidelines observed during the patient preparation:
The health care provider should able to explain the objectives in performing this Laboratory examination to the patient. They should know well the basic principles of the test and most importantly is to perform the procedure accurately and safely for the benefit of the patient.



Procedure:
Perform a venipucture and collect a serum sample in a 7ml clot-activator tube, If plasma is to be collected use a heparinized tube. Indiacte the patient' age, sex, and history of hormone.


Refence values:

NORMAL
Total Testosterone
Men: 270-1070 ng/dL or 9-38nmol/L (values in elderly men diminish moderately)
Women: 15-70 ng/dL or 0.52-2.4 nmol/L
Pregnant women:3-4 times normal
Postmenopausal women: 8-35 ng/dL or 0.3-1.2nmol/L
Children:2-20 ng/dL or 0.07-0.79nmol/L (depends on age, sex, onset of puberty)
Free testosterone
Men:50-210 pg/mL or 174-729 pmol/L
Women: 1.0-8.5pg/mL or 3.5-29.5 pmol/L
Childern:
Boys: 0.1-3.2 pg/mL or 0.3-11.1pmol/L
Girls:0.1-0.9pg/mL or 0.3-3.1pmol/L
Puberty:
Boys:1.4-156pg/mL or 4.9-541pmol/L
Girls:1.0-5.2pg/mL or 3.5-18.0 pmol/L


Clinical implications:
In males having a decreased total testosterone levels occur in the following condition:
In males have a deceased free testosterone levels occur in hypogonadism and elderly in men.
In males have a increased testosterone levels occur in the following conditions:
Hyperthyrodism, Snydromes of androgen resistance, Adrenal tumors, Precocious puberty and adrenal hyperplasi in boys.
In females have a increased toatl testosterone levels are associated with the following diseases:
Adrenal neoplasms, Ovarian tumor, trophoblastic disease during pregnancy, Idiopathic hirsuitism, Hilar cell tumor.
In females have a increased free testosterone levels are associated with the following conditions:
Female hirsuitism, polycystics ovaries, virilization


Interfering factors:
Avoid hemolysis specimen
Alcoholism in males, drugs such as androgens, steroids may decreases the testosterone levels.
Estrogen theraphy increase testosterone.


References:
Fischbach, Frances, A manual of Laboratory And diagnostic test, 7th edition
Professional gude to Diagnostic tests.