The clinical significance of measuring six items of sex hormones is to understand female endocrine function and diagnose diseases related to endocrine disorders by measuring sex hormone levels. The six commonly used sex hormones are follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), progesterone (P), testosterone (T), and prolactin (PRL), which basically meet the needs of clinicians. Screening for endocrine disorders and general understanding of physiological functions.
1. Follicle-stimulating hormone (FSH): It is a glycoprotein hormone secreted by basophilic cells of the anterior lobe of the pituitary gland. Its main function is the development and maturation of follicles in the ovary. The concentration of blood FSH is 1.5-10U/L in the pre-ovulation period, 8-20U/L during ovulation, and 2-10U/L in the late ovulation period. Low FSH values ??are seen during estrogen and progesterone treatment, Sheehan syndrome, etc. High FSH levels are common in premature ovarian failure, ovarian insensitivity syndrome, primary amenorrhea, etc.
2. Luteinizing hormone (LH): It is also a glycogen protein hormone secreted by the basophil cells of the anterior lobe of the pituitary gland. The main function is to promote ovulation and form luteal hormone secretion. Blood LH concentration is 2-15U/L in the pre-ovulation period, 20-100U/L in the ovulation period, and 4-10U/L in the late ovulation period. Less than 5U/L is a more reliable indicator of hypogonadotropin function, which is seen in Sheehan syndrome. If high FSH is combined with high LH, ovarian failure is certain. LH/FSHgt;=3, is one of the basis for diagnosis of polycystic ovary syndrome.
3. Prolactin (PR1): secreted by lactation trophoblast, one of the eosinophilic cells in the anterior lobe of the pituitary gland. It is a simple protein hormone whose main function is to promote the proliferation of the mammary gland and the production and excretion of milk. milk. During the non-lactation period, the normal value of blood PR1 is 0.08-0.92nmol/L. Higher than 1.0nmol/L is hyperglycemia.
4. Estradiol (E2) is secreted by the ovarian follicles. The main function is to make the intrauterine glands grow into the proliferative phase and promote the development of female secondary sexual characteristics. The concentration of blood E2 is 48-52lpmol/L during ovulation, 370-1835pmol/L during ovulation, and 272-793pmol/L in the late ovulation period. Low values ??are seen in low ovarian function, premature ovarian failure, and Sheehan syndrome.
5. Progesterone (P): secreted by the corpus luteum of the ovary. The main function is to promote the transition of the endometrium from the proliferative phase to the secretory phase. The blood P concentration is 0-4.8mnol/L in the pre-ovulation period and 7.6-97.6nmol/L in the late ovulation period. The blood P value is low in the late ovulation period, which is seen in luteal insufficiency and ovulatory uterine dysfunction bleeding.
6. Testosterone (T): 50% of the testosterone in women is converted from peripheral androstenedione, 25% is secreted by the adrenal cortex, and only 25% comes from the ovary. Its main function is to promote the development of the clitoris, labia and mons pubis, has an antagonistic effect on androgens, and has a certain impact on systemic metabolism. The plasma testosterone level in women is 0.7-2.1nmol/L, and the T value is high, which is called hypertestosteronemia, which can cause female infertility.
Clinical significance of six sex hormones
Testosterone
1. Increased testosterone concentration: common in testicular benign Leydig cell tumors, congenital adrenal hyperplasia, True precocious puberty, male pseudohermaphroditism, female virilizing tumors, polycystic ovary syndrome, hypercortisolism and the use of gonadotropins, obesity and late-term pregnant women can all increase the concentration of testosterone in the blood.
2. Reduced testosterone concentration: male sexual dysfunction, primary testicular hypoplasia, hyperprolactinemia, hypopituitarism, systemic lupus erythematosus, hypothyroidism, osteoporosis, cryptozoosclerosis Decreased testosterone levels can be seen in orchitis and gynecomastia.
Estradiol
1. Estradiol increases slightly during normal pregnancy and decreases sharply after delivery of the placenta.
2. Abnormal twin or multiple pregnancies and pregnant women with diabetes usually have elevated estradiol; patients with severe pregnancy-induced hypertension syndrome have lower estradiol. If the estradiol is particularly low, it indicates that the fetus The possibility of intrauterine death should be determined in combination with other examinations for prompt treatment; estradiol is reduced in anencephaly infants; in molar pregnancy, estradiol is low, and the urinary estradiol content is only 1-12 times that of a normal pregnancy. .
3. Pathological causes of increased estradiol value 1) Ovarian diseases: ovarian granulosa cell tumors, ovarian blastomas, ovarian lipoid cell tumors, sex hormone producing tumors, etc., all show hyperovarian function and estrogen production. Increased glycol secretion. 2) Heart disease: myocardial infarction, angina pectoris, coronary artery stenosis. 3) Others: systemic lupus erythematosus, liver cirrhosis, male obesity.
4. Pathological causes of decreased estradiol 1) Ovarian diseases: Absence or low development of ovaries, primary ovarian failure, ovarian cysts. 2) Pituitary amenorrhea or infertility. 3) Others: hypothyroidism or hyperthyroidism, Cushing's syndrome, Addison's disease, malignant tumors, large-scale infections, renal insufficiency, focal lesions of the brain and pituitary gland, etc., can all cause plasma estrogen levels. Decreased alcohol
Estriol
1. Monitor placental function: placental dysfunction, placental sulfatase deficiency and pregnancy-induced hypertension syndrome affecting uteroplacental blood circulation can all be used Resulting in a decrease in estriol levels. Generally speaking, for pregnant women with a gestational age of >42 weeks, their placental function gradually decreases. Testing the estrogen concentration 2-3 times a week will help clinical problems be found at any time. If the estriol level continues to be high, you can wait for natural delivery; when the estriol value decreases, it reflects that the fetus-placental function has tended to be poor, and the fetus may have an intrauterine accident at any time, and clinical labor should be induced promptly or a caesarean section should be performed.
2. Monitor high-risk pregnancy: Regular dynamic detection of estriol content in pregnant women’s blood or urine can help estimate the pregnancy period; estriol continues to rise, indicating that the pregnancy is not full term; if several tests are performed at the same time, The level indicates a full-term pregnancy; if the measured value gradually decreases, it is often an expired pregnancy; a significant decrease indicates fetal intrauterine distress, and clinical indicators such as fetal movement and fetal heart rate should be closely monitored, and corresponding measures should be actively taken according to the actual situation; plasma estrogen If the triol content is less than 2mg/L, the possibility of intrauterine fetal death is very high
3. Assist in diagnosing fetal diseases: intrauterine growth retardation, excessive smoking or malnutrition in pregnant women affecting the fetus In those who are developing, estriol will decrease; in those whose fetuses have congenital adrenal agenesis or malformations such as anencephaly that affect adrenal function, estriol will decrease; but it is only about 10 of the normal value.
4. Other diseases: In cases of coronary heart disease, liver cirrhosis and other diseases, the estriol content increases.
Progesterone
1. In a normal woman’s menstrual cycle, the blood progesterone content is the highest in the luteal phase and the lowest in the follicular phase. The use of dynamic detection can help determine the ovulation period, understand the function of the corpus luteum, and study the mechanism of action of various steroid contraceptives and anti-early pregnancy drugs.
2. In normal pregnancy, the progesterone content in the blood increases starting from the 11th week and reaches a peak at 35 weeks, reaching 80-320ug/L. In threatened miscarriage, progesterone is still at a high value; if there is a downward trend, miscarriage is possible. In multiple pregnancies, progesterone increases.
3. Pathological increase of progesterone is seen in diabetic pregnant women, molar pregnancy, ovarian granulosa cell tumor, ovarian lipoid tumor, congenital adrenal hyperplasia, congenital 17a-hydroxylase deficiency, primary Diseases such as episodic hypertension.
4. Pathological reduction of progesterone is mainly seen in lutein production disorders and dysfunction, polycystic ovary syndrome, anovulatory dysfunctional uterine bleeding, severe pregnancy-induced hypertension syndrome, and gestational placental dysfunction. , fetal growth retardation and stillbirth.
Follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
1. Increased FSH and LH are common in primary gonadal lesions, such as premature ovarian failure and gonadal agenesis. , primary amenorrhea, primary sexual hypofunction, seminiferous tubule development disorder, complete (true) precocious puberty.
2. Decreased FSH and LH are mainly seen in pituitary or hypothalamic amenorrhea and incomplete (pseudo) precocious puberty.
3. Patients with pituitary FSH tumors or LH tumors and FSH/LH tumors have different types of changes in serum FSH and LH concentrations due to different adenoma types: FSH tumors mainly show increased FSH, and LH can be normal. ; In patients with LH tumors, LH is significantly increased and FSH is decreased; in patients with FSH/LH tumors, both FSH and LH are increased.
4. Detection of FSH and LH concentrations in amenorrheic women can effectively differentiate between ovarian amenorrhea and pituitary or hypothalamic amenorrhea. It is generally believed that low LH (<51U/L=more reliably indicates insufficient GTH secretion function of the adenohypophysis, while high FSH (>40IU/L) more reliably indicates ovarian failure. If high FSH is accompanied by high LH, it can be reliably determined. It is ovarian failure. If serum FSH and LH are both abnormally low or FSH is at the lower limit of normal and LH is abnormally low, pituitary or hypothalamic amenorrhea can be diagnosed, and luteinizing-releasing hormone (LRH) is used for pituitary stimulation. Test can further distinguish pituitary and hypothalamic amenorrhea: the stimulation test shows that LH and FSH are increased and the peak time is delayed, indicating that the pituitary reserve function is good, and hypothalamic amenorrhea should be considered; if LH and FSH respond weakly, it indicates that the pituitary reserve is If the function is low, pituitary amenorrhea should be considered. In summary, multiple indicators can be combined to identify the location of amenorrhea.
Please note that the reference values ??of the six sex hormones are not unified standards. Different testing methods and reagents may have different values, which are for reference only. If the test value is within the normal range, it does not mean that there is nothing wrong or there is no abnormality. If you have clinical symptoms, it is best to come to the hospital to consult a doctor in person.