GONADAL FUNCTION

TEST
3 Major estrogens are estrone(E1),estradiol(E2),
estriol(E3)
Their biosynthesis from androstenedioen&
testosterone.
Major site of estrogen production is the ovary but
adrenal cortex & sertolic cells of the testis also produce
small quantities of estrogen.
The site of production in the ovary in the non pregnant
state are the Graffian follicle
E2 is biologically the most potent & account most of the
estrogenic activity in the non pregnant women of
reproductive age.
The plasma estrogens are mainly protein bound
Normal plasma contains all 3 estrogens & E1 also
present as its sulphate.
Estriol sulphate present during pregnancy.
E1 & estrone sulphate bound to albumin where as
E2 bind to globulin.
PROGESTRONE
Progesterone is a precursor of cortisol , androgens &
estrogens.
Major site of secretion are the corpus luteum of the
ovary & in pregnancy , the placenta.
A small amount produced by adrenal cortex
Progesterone occurs in plasma mainly bound to
proteins.
ANDROGENS
The major androgens are
Testosterone
Dihydro testosterone
Andro stenedione
Dehydroepiandrosterone
Dehydroepiandrosterone sulphate
In women , quantitatively the most imp androgens are
Androstenidione & Dehydroepiandrosterone. In men , it
is Testosterone.
OTHER HORMONES CONCERNED WITH GONADAL
FUNCTION
FSH,LH,HCG
Anterior pituitary hormones(LH , FSH )
Gonadotropin releasing hormones also known as
LH/FSH
Prolactin(Anterior pituitary hormones)
 Principles in gonadal function tests
1.measurement of individual plasma hormone
concentration by immunoassay technique
The pituitary & gonadal hormones may show diurnal
variation , monthly variation with age related change in
plasma concentration & be secreted episodically
2. Group steroid assays & the assays of specific
hormones or their metabolites in 24 hr. urine.
3.Stimulation tests
Stimulation of gonads & determination of their
secretions
GnRH test
Clomiphene stimulation tests
Estradiol benzoate stimulation test
The ovaries may also be directly stimulated in the
treatment of infertility where there is potential for
normal ovarian function.
11. Analytical methods for basal secretion studies
1. Determination of oestradiol in plasma
RIA ,Refer feto placental function tests
2. Determination of progesterone in plasma : RIA
methods
Non extraction methods by using aniline naphthalene
sulphonic acid or danzol ( a synthetic steroid) to strip
[Progesterone from binding proteins.
Flourimetric assays & ELISA are now available
N.V:male 12-30 microgram/dl
Female 0.6-3 microgm/dl
DETERMINATION OF TESTESTERONE IN PLASMA
RIA methods
Normal value : males – 300-1000ng/l
Females- 25-45 ng/l
4. DETERMINATION OF GONADOTROPINS
RIA methods
LH males 1.5-7 Iu/L
Females 20-50 Iu/l
FSH Males 4-10 Iu/l
Females 10-20 IU/L
5. Determination of Protein
Prolactin assay
Males 10-15 micro gm/l
Females 10-20 micro gm/l
Pregnancy 90-400 microgram/l
6. Determination of Sex hormone binding globulin
Methods Binding capacity assay
Immunological technique RIA ,Radial immune
diffusion.
GnRH Test
A 100 microgm dose of GnRH is administrated IV.
Blood samples are taken before & 20,60 min after
wards for LH & FSH assays.
In adult males the LH concentration rises 7-8 folds
& FSH 2 fold above basal levels. The peak
concentration usually occur at 20 min. If the 60 min
value > than 20 min value, the response is said to
be delayed.
CLOMIPHENE STIMULATION TEST
Clomiphene citrate initiates the hypothalamic
release of GnRH by modifying the feed back control
of circulating estrogen or testosterone. It act as
estrogen antagonist at E2 receptor sites in the
hypothalamus.
The usual dose for dynamic studies is 50
mg taken orally & twice daily for 5-7 days. Plasma
samples are collected at intervals which vary with
different workers.
The response of LH is more marked than that of
FSH. So it is the more marker of useful investigation
Alternatively plasmaE2 or progesterone
concentration can be determined and response to
clomiphene is suggestive of hypothalamic lesion.
Clomiphene citrate used in assessment & Rx of
infertility
Estrogen provocation test
For ovulation to occur , the hypothalamus must respond
to the rapidly rising plasma E2 concentration in the late
follicular phase by provoking the release of GnRH
resulting in the pre ovulatory surface of LH.
The estrogen provocation test is used to test the
integrity of this mechanism
After collecting a basal blood sample, estradiol
benzoate (1mg) is given intramuscular injection & further
samples are collected at 8, 24, 32, 48, 56, 72 hr. The
plasma E2 concentration is max at 8 hr & in normal
female subjects the plasma LH concentration is max at
48-72 hrs.
4. HCG STIMULATION TEST
In males, it has been used to demonstrate the
presence of testicular tissue.HCG stimulate
testicular tissue & produce testosterone.
In males, the dose used varies considerably.
1000-5000 IU daily for 1-4 days intramuscularly.
Collect plasma for testosterone measurement on
days 0,3 &5.The normal response is a rise to
150-300% of the basal level on either day 3 or day 5.
The peak value is usually >35 nmol/l.
PROLACTIN
SERUM PROLACTIN DETERMINATION
It is important in diagnosis & management of
patients with tumors of hypothalamus or pituitary &
in the case of women with amenorrhea &
galactorrhea.
2. GONADOTROPINS
They are glycoproteins. They influence the
functions of maturation of testes & ovary. The
secretion of LH/FSH is regulated by a single
hypothalamic releasing factor , LH/FSH-RH(GnRH) i.e
luteinizing hormone/follicle stimulating hormone
releasing hormone.
Serum FSH Determination
Increased values of FSH are found in menopause, In
male , seminiferous tubule failure
Decreased levels of FSH may be found in
hypogonadism,& neoplasm of testes.
Serum LH Determination
Human placental lactogen