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Reproductive hormon

dr. Zulfikar Lubis, SpPK-K

dr. Ida Adhayanti, SpPK

Hormon Reproduksi

1. GnRH ( Gonadotropin-releasing hormon )

2. FSH ( Follicle-stimulating hormon )

3. LH (Luteinizing hormon )

4. Testosteron

5. Estradiol

6. Progesteron

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Hasil tes Laboratorium

tergantung pada :

1. Pre-analytic

2. Analytic

3. Post-analytic

- Result

- Interpretation

Hal-hal yg dpt mempengaruhi

Pre analytic

1. Variabel Physiologic

2. Specimen collection

3. Interference factors

Physiologic Variables

1. Age

2. Sex

3. Time

4. Season

5. Altitude

6. Condition - menstruation

- pregnancy

7. Lifestyle

UMUR

Hasil laboratorium dikelompokan

berdasarkan :

1. Pediatric

2. Adolescent

3. Adult

4. Geriatric

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Perbedaan Jenis Kelamin

Terjadi oleh karena perbedaan besarnya

massa otot , endokrin dan perbedaan organ

yang spesific.

WAKTUAda hubungan fluktuasi waktu pada kadar

beberapa analyt.

Ritme Circadian berpengaruh pd sirkulasi

beberapa analyt seperti :

Hormon Kortisol punck jam 6 pagi,turun wkt

malam dan tengah malam

Hormon Pertumbuhan meningkat pada saat

tidur dan minimal pd saat bangun.

Perubahan Musim

Hormon Tiroid 20% rendah pd musim

semi dibanding musim dingin

KETINGGIAN

Konsentrasi estriol berkurang dengan

peningkatan ketinggian.

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Menstruasi

Pada awal menstruasi kadar estrogen rendah dan kadarnya meningkat pada hari 6 atau 7 hari setelah menstruasi memuncak pada beberapa hari sebelum ovulasi,kemudian menurun.

Kadar Progesteron pada awal menstruasi rendah,kadarnya mulai meningkat setelah ovulasi dan mencapai puncaknya pada pertengahn fase luteal.

Pada pertengahan siklus menstruasi terjadi

letupan sekresi LH yg memicu ovulasi dan

pembebasan ovum shg bermigrasi ke tuba

falopii lalu ke uterus.

Pada saat ovulasi kadar progesteron mulai

meningkat lalu menurun bersamaan dgn

menurunnya kadar estrogen hingga terjadi

siklus menstruasi berikutnya.

Jadi ada pengaruh kadar hormon

LH,FSH, estradiol dan progesteron

pada siklus menstruasi fase folikular,

midcycle, dan fase luteal.

KEHAMILAN

Pada kehamilan trisemester 2, Plasenta mengeluarkan hormon antagonis insulin.

Efeknya hormon estrogen,progesteron,

Human Placenta Lactogen meningkat yg dapat menyebabkan terjadinya Diabetes Gestasional.

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GAYA HIDUP

1. Diet

2. Caffein

3. Alkohol

4. Merokok

Pengumpulan Specimen

� Vena punksi pada areal cubical tanpa

torniquit

� Penekanan jari pada bagian proximal

dari tempat punksi diperbolehkan

� Bila tjd kesulitan boleh pindah ke

lengan sebelah,setelah istirahat 15

menit.

Collection in the morning from

hospitality patient

The day before specimen collectionThe day before specimen collectionThe day before specimen collectionThe day before specimen collection

• Food ordinary intake; last meal before

22.00

• Alcohol max. of small bottle beer ~

beverage, taken with a meal

• Abstinence no solid food or tobacco

and max. of one glass of water after

22.00

Collection in the morningCollection in the morningCollection in the morningCollection in the morning

Subjects lying in bed

Bed rest from 22.00 untillcollection; a

short visit to the toilet allowed, but

min. of 1 hour before collection

Collection between 07.00 – 09.00 supine

position with the arm approximately in

the horizontal plane

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Ambulatory subjects collection

in the morning

- Rest 1-3 hour before collection

- Public transport or car transport for max.45 min, walking a max. of 500 m at moderate speed

- Rest sitting for at least 15 min; arm muscle work not allowed

- Collection between 08.00 – 10.00, sitting position with the arm approximately 45o below the horizontal position

Ambulatory Subject collection in

the afternoon

• Breakfast a light meal in the morning ( 310 kcal ) composed of milk, coffee or tea ( max. 2 cup ); two open sandwiches with butter, slice of lunch meat/cheese.

• Activity : No exercise or heavy work

• Rest sitting at least 15 min. arm muscle work not allowed.

• Collection between 13.00 and 15.00; min. 4 hours after breakfast; otherwise as above.

Handling and transportation

specimen

If the hormon assay not available, serum

can stored in :

refrigerator for one day,

freezer > 6 month and

deep freezer > 1 year.

Transport specimen by car or plane

must be use ice box.

Analytic

1. Kalibrasi :

• Panjang Gelombang

• pH

• Reagen

• Waktu Inkubasi

• Washing

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Analytic

2. Standarisasi

• Single Standart

• Multiple Standart

• Reference Standart

Analytic

3. Quality Control

• Pooled Sera

• Normal Sera atau Patologis Sera

• Reference WHO Sera

Metode Pemeriksaan

1. Radio immuno assay ( RIA )

• Gold Standart

• ß dan Gamma Counter

• Ada 7 standart, biasanya 3

• Kompetisi antara Ab berlabel dgn

Ab thd Hormon

2. IRMA (Immuno Radio Measure Assay)

• Ab berlabel terhadap hormon

3. ELISA / EIA

• Metode Direct atau Indirect

• Sandwich

• Enzyme : peroksidase

• Substrat : kromogen

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4. Ilumination

• Generasi ke-3

• Metode ELISA

5. Chromatography

• Hormon Peptida

• Biaya sangat mahal.

Disorder of the Female Reproductive

System

• Hypothalamic anovulation

• Hyperprolactinemia

• Androgen excess

• Premature ovarian failure

• Chronic illness ( e,g. hepatic or renal failure,

acquired immunodeficiency syndrome )

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Disorder of the Female Reproductive

System

• Hypothalamic anovulation*

• Hyperprolactinemia

• Androgen excess

• Premature ovarian failure

• Chronic illness ( e,g. hepatic

or renal failure, acquired

immunodeficiency

syndrome )

• LHRH� FSH, LH

• CRH � ACTH

• And exercise

• And associated with eating

disorders

Disorder of the Female Reproductive

System

• Hypothalamic anovulation

• Hyperprolactinemia

• Androgen excess

• Premature ovarian failure

• Chronic illness ( e,g. hepatic

or renal failure, acquired

immunodeficiency

syndrome )

• TRH, Dopamine and

estradiol � transcription of

the prolactin gene

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Disorder of the Female Reproductive

System

• Hypothalamic anovulation

• Hyperprolactinemia

• Androgen excess

• Premature ovarian failure

• Chronic illness ( e,g. hepatic or renal failure,

acquired immunodeficiency syndrome )

•

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Disorder of the Female Reproductive

System

• Hypothalamic anovulation

• Hyperprolactinemia

• Androgen excess

• Premature ovarian failure

• Chronic illness ( e,g. hepatic

or renal failure, acquired

immunodeficiency

syndrome )

• FSH

• Karyotype

• Cortisol after ACTH

• TSH

• Glucose fasting and 2 hr

• Ca and Phosphate (

hypoparathyrodism )

• dll

Causes of Irregular uterine bleeding

• Complication of Pregnancy

• Anovulation

• Anatomic Defect Affecting the Uterus

• Coagulation defects

• Extrauterine genital bleeding

Causes of Irregular uterine bleeding

• Complication of Pregnancy

• Anovulation

• Anatomic Defect Affecting the Uterus

• Coagulation defects

• Extrauterine genital bleeding

• Threatened miscarriage

• Incomplete miscarriage

• Ectopic pregnancy

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Causes of Irregular uterine bleeding

• Complication of Pregnancy

• Anovulation

• Anatomic Defect Affecting the Uterus

• Coagulation defects

• Extrauterine genital bleeding

• Threatened miscarriage

• Incomplete miscarriage

• Ectopic pregnancy

Causes of Irregular uterine bleeding

• Complication of Pregnancy

• Anovulation

• Anatomic Defect Affecting

the Uterus

• Coagulation defects

• Extrauterine genital

bleeding

• Uterus leiomyomas

• Endometrial polyps

• Adenomyosis

• Intrauterine adhesions

• Endometritis

• Endrometrial hyperplasia,

cancer, PCOS, medicamen,

liver failure

• other

Causes of Irregular uterine bleeding

• Complication of Pregnancy

• Anovulation

• Anatomic Defect Affecting

the Uterus

• Coagulation defects

• Extrauterine genital

bleeding

• Uterus leiomyomas

• Endometrial polyps

• Adenomyosis

• Intrauterine adhesions

• Endometritis

• Endrometrial hyperplasia,

cancer, PCOS, medicamen,

liver failure

• other

Causes of Irregular uterine bleeding

• Complication of Pregnancy

• Anovulation

• Anatomic Defect Affecting the Uterus

• Coagulation defects

• Extrauterine genital bleeding

• Von Willebrand,s disease

• Factor XI deficiebcy

• other

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Causes of Irregular uterine bleeding

• Complication of Pregnancy

• Anovulation

• Anatomic Defect Affecting the Uterus

• Coagulation defects

• Extrauterine genital bleeding

• May mimic uterine bleeding.

• Vaginitis, genital trauma, foreing bodies, vaginal neoplasma,

• Vulval neoplasma other

Disorders of the testis and the male

reproductive tract

Physiology of testicular function

Abnormalities of androgen metabolism and

testicular function

• Abnormalities of estrogen metabolism

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Disorders of the testis and the male

reproductive tract

• Physiology of testicular

function

• Abnormalities of

androgen metabolism

and testicular function

• Abnormalities of

estrogen metabolism

• Fetal life

• Neonatal life

• Puberty

• Adulthood

• Old age

• Disorders of all age

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Disorders of the testis and the male

reproductive tract

• Abnormalities of

androgen metabolism

and testicular function

• Abnormalities of

estrogen metabolism

• Gynecomastia

• Impairment of estrogen

formation of action

GYNECOMASTIA

• Gynecomastia in the newborn

in the adolescent of aging

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