Applications on

RIA assays1. HCG Hormone2. Estradiol3. prolactin

HCG hormone

(Pregnancy hormone)

Clinical Information Human chorionic gonadotropin (hCG) is a

glycoprotein hormone consisting of 2 noncovalently bound subunits.

with an α (alpha) subunit identical to that of (LH), (FSH), (TSH), and β (beta) subunit that is unique to hCG.

It is early produced by the cells that surround the growing human embryo; these cells will eventually go on to form the placenta and later it is made by the placenta during pregnancy.

HCG Functions

1. HCG hormone is an embryonic hormone helps the embryo implant in the uterus.

2. Maintains the production of progesterone by the corpus luteum

and the ovaries during the first trimester of pregnancy.

3. Causes the blockage of any immune or macrophage action by

the mother , protecting the fetus during the first trimester.

4. Suppresses any myometrial contractions during the course

of pregnancy5. Play a role in the growth and

differentiation of the umbilical cord

Natural Pregnancy The HCG levels starts to

enter the blood stream within 8 to 11 days after conception and continues to increase until the 16th week of last menstrual period .

While the HCG levels keep fluctuating until around the 8th week, by the 9th or 10th week, it tends to double and reaches its peak and then declines for the remainder of the pregnancy  .

The chart illustrates the normal rise and fall of hCG levels throughout pregnancy.

This is why pregnancy test may reveal as negative on the early weeks and become positive a few weeks later.

β -HCG & other hormones

β –HCG Test

Why the test is done?1. Confirming pregnancy.2. To diagnose abnormal conditions, such

as molar pregnancy, ectopic pregnancy, early pregnancy miscarriage, and certain types of ovarian tumors or in men with testicular tumors.

3. To assess the progress of the pregnancy.4. To certify the health of both mom and

the baby.

The test can be either qualitative or quantitative

1st, Qualitative HCG Blood Test A qualitative beta-hCG test confirms the presence or

absence of hCG in the blood . This test only confirms if a woman is pregnant or not.

HCG levels of 25 mIU/mL and more is usually detected by this

method.

HCG urine tests This test may be performed by a laboratory, at a doctor's

office, or at home using a home pregnancy test kit. Methods will vary slightly but for most, a test strip is dipped into a collected cup of urine or exposed to a woman's urine stream. A colored line (or other color change) appears within the time allotted per instructions, usually about 5 minutes

.

Pregnancy strips

2nd, Quantitative HCG Blood Test A quantitative beta-hCG test measures the exact

amount of hCG in the blood,it is a very sensitive test for pregnancy since very small amounts of hCG can be detected even as low as 1 mIU/mL.

This test is not done routinely and is not necessary in all pregnancies.

The test may be offered by the doctor to assess one of these condition :

1. too early in pregnancy when there’s doubt in confirming the result .

2. Implantation cases.3. Severe back pain in a pregnant women4. Abnormal vaginal bleeding

Risk of miscarriage

Facts about β–hCG levels

In 85% of normal pregnancies, the hCG level will double every 48 – 72 hours.

An hCG level of less than 5mIU/ml is considered negative for pregnancy, and anything above 25mIU/ml is considered positive for pregnancy.

The hCG levels should not be used to date a pregnancy, since these numbers can vary so widely

A single hCG reading is not enough in some diagnoses. When there is a question regarding the

health of the pregnancy, multiple testings of hCG done a couple of days apart give a

more accurate assessment of the situation.

High levels of β–hCG

A high level of hCG can also mean a number of things and should be rechecked within 48-72 hours to evaluate changes in the level.

A rise in hCG levels above the reference range can indicate :

1.Miscalculation of pregnancy dating2.Molar pregnancy (Hydatidiform mole)3.Multiple pregnancy4.a tumor of the testicles or ovaries5.Some types of cancer, such as cancer of the

stomach, pancreas , large intestine, liver, or lung.

Molar pregnancy (Hydatidiform mole)

A molar pregnancy is an unsuccessful pregnancy, where the placenta and fetus do not form properly, and a baby does not develop.

In a molar pregnancy, the trophoblastic cells behave abnormally as soon as the egg has been fertilised by the sperm. This results in a mass of abnormal cells that can grow as fluid-filled sacs (cysts) with the appearance of white grapes. These cells grow rapidly within the womb, instead of developing into a baby.

The abnormal cells are referred to as a "mole", which is from the Latin for mass or lump and it is a pre-cancerous form of gestational trophoblastic disease

A molar pregnancy can't continue as a normal viable pregnancy. To prevent complications, the molar tissue must be removed. Treatment usually consists of one or more of the following:

Dilation and curettage (D&C) or Hysterectomy.

Low values of β–HCG

low levels of β-hCG means :1.In an early pregnancy as estimated

by the last menstrual period (LMP).2.An ectopic pregnancy3.Death of the baby4.Miscarriage (spontaneous abortion)

is very likely.

Ectopic pregnancy

An ectopic pregnancy occurs when a fertilized egg implants somewhere other than the main cavity of the uterus.

If this occurs in one of the tubes that carry eggs from the ovaries to the uterus (fallopian tubes). This type of ectopic pregnancy is known as

a tubal pregnancy. In some cases, however, an

ectopic pregnancy occurs in the abdominal cavity, ovary or neck of the uterus (cervix).

An ectopic pregnancy can't proceed normally, also the growing tissue might destroy various maternal structures.

A fertilized egg can't develop normally outside the uterus. To prevent life-threatening complications, the ectopic tissue needs to be removed.

In some cases, medication may be used to stop the growth of pregnancy tissue.

The doctor will monitor HCG levels after surgery to be sure all of the ectopic tissue was removed. If HCG levels don't come down quickly, an injection of methotrexate may be needed.

Estradiol(E2)

Estradiol The term "estrogen" includes a group of

chemically similar hormones: estrone, estradiol (the most abundant in women of reproductive age) and estriol.

Estradiol is the most commonly measured type of estrogen for nonpregnant women.

In women, most estradiol is released from the ovaries and adrenal glands and fat tissues, It is also released by the placenta during pregnancy.

In men, a small amount of estradiol is mainly released by the testis, preventing sperm from dying too early.

Estradiol function

1. Responsible for the growth and development of female sexual characteristics.

2. Supporting the lining of vagina, cervical glands, the endometrium and fallopian tubes.

3. Prepare the endometrium for implantation.4. Regulates a woman’s menstrual cycle5. Regulate the liver’s production of cholesterol6. Also, it helps to preserve bone density

When is the test ordered?1. Help diagnose early-onset puberty or

delayed puberty2. Investigate menstrual abnormalities, such

as amenorrhea, infertility, and abnormal vaginal bleeding

3. Evaluate the function of the ovaries and detect ovarian failure

4. Detect estrogen-producing tumors 5. In males, for Delayed puberty, Tumors of

the testicles (testicular cancer) or adrenal glands, Enlarged breasts (gynecomastia).Note :-

-  The amount of estradiol in a woman's blood varies throughout her menstrual cycle. -  After menopause, estradiol production drops to a very low but constant level.

Estradiol levels that are higher than normal may suggest:

1. Early puberty2. Gynecomastia (development of breasts

in men)3. Hyperthyroidism (overactive thyroid

gland) 4. Cirrhosis, which is scarring of the liver5. In rare cases, high levels of estradiol

could indicate an ovarian tumor or endometrial cancer.

Too high estradiol levels

Too low levels

Lower than normal levels of estradiol may suggest:1. Menopause 2. Polycystic ovarian syndrome (PCOS), which is a

hormone disorder with a wide range of symptoms that’s believed to be a cause of infertility in women

3. Depleted estrogen production, which can be caused by low body fat

4. Hypopituitarism 5. Hypogonadism, which occurs when the ovaries or

testes don’t produce enough hormone

Exogenous estradiol

PRESCRIBED FOR: For symptomatic treatment of the

usual symptoms associated with menopause (hot flashes, vaginal burning or dryness, etc.).

Prevention of bone fractures associated with osteoporosis, and dysfunctional (excessive and painful) uterine bleeding.

Estradiol also is prescribed for breast cancer and, in some cases in prostate cancer.

Prolactin(PRL)

The milk hormone

Prolactin 

Prolactin is a hormone produced by the pituitary gland, its primary role is to stimulate milk production in pregnant women and maintain milk supply during breastfeeding.

Also, Act with estrogen and other hormones for a full development of breast tissue during pregnancy .

However; prolactin is produced in small amounts in both males and non-pregnant females.

Prolactin levels

Prolactin levels are different throughout the day. The highest levels occur during sleep and shortly after you wake up.

The following can temporarily increase prolactin levels:

1. Emotional or physical stress 2. High-protein meals3. Intense breast stimulation4. Recent breast exam5. Recent exercise

Non- pregnantwomen

< 25 ng/mL

Pregnantwomen

34 to 386 ng/mL

Males < 15 ng/mL

Normal ranges of prolactin hormone  in serum

Why is the Test Performed

1. Breast milk production that is not related to childbirth (galactorrhea)

2. Fertility problems3. Irregular or no menstrual

periods (amenorrhea)4. Diagnose tumors that

produce excess prolactin (prolactinomas)

Interpretation of Results

High levels of prolactin are normal during pregnancy and after childbirth while the mother is breastfeeding.

However, the causes of abnormal hyperprolactinemia include liver disease, kidney disease, and hypothyroidism.

High levels of Prolactin can also be caused by pituitary tumors, which can be treated medically or surgically.

Low levels of prolactin are usually of no concern in women and men.

Some drugs as dopamine may cause low levels of prolactin

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