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Hormone Testing in Clinical Practice: Part 2
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  1. Hormone Testing in Clinical Practice: Part 2 Meridian Valley Laboratory 24-hour Urine Tests

  2. Urinary Hormones • Part 1: Sex Hormones • Estrogen • Progesterone • Testosterone • Part 2: • Adrenal Hormones • Growth Hormone • Thyroid • Sodium/Potassium Ratio • Enzyme Activity © 2010 Meridian Valley Laboratory

  3. Metabolism of Selected Steroids 5 5 © 2010 Meridian Valley Laboratory

  4. Pregnenolone • The “mother” hormone • Synthesized from cholesterol • Involved in the steroidogenesis of: • Progesterone • Estrogens • Androgens • Glucocorticoids • Mineralocorticoids © 2010 Meridian Valley Laboratory

  5. ADRENAL HORMONES © 2010 Meridian Valley Laboratory

  6. Adrenal Hormones Cholesterol Pregnenolone Progesterone DHEA Mineralocorticoids Glucocorticoids(Cortisol, et.al.) TestosteroneEstrogens © 2010 Meridian Valley Laboratory

  7. DHEA © 2010 Meridian Valley Laboratory

  8. DHEA Cholesterol Pregnenolone 17-OH Pregnenolone Androsterone DHEA Androstenedione Etiocholanolone Testosterone Estrone © 2010 Meridian Valley Laboratory

  9. DHEA • Produced in: • Adrenal Glands • Gonads • Brain • DHEA  Androsterone  Testosterone & Estrone • Peaks around 30 years of age • Most abundant steroid hormone © 2010 Meridian Valley Laboratory

  10. DHEA • Low levels associated with • Immune dysfunction • Autoimmune disease • Type II Diabetes • Cancer • Hypertension • Cardiovascular disease • Depression • Cognitive dysfunction © 2010 Meridian Valley Laboratory

  11. DHEA • Low levels associated with • Low libido • Osteoporosis • Suppressed by • Stress • Excess cortisol © 2010 Meridian Valley Laboratory

  12. DHEA • Therapeutic Uses •  pro-inflammatory cytokines • Anti-glucocorticoid effects • Increases effectiveness of vaccination • Decreases body fat • Increases lean body mass • Increases insulin sensitivity • May increase activity of exogenous thyroid hormone © 2010 Meridian Valley Laboratory

  13. DHEA Cholesterol Pregnenolone +Rhodiola rosea +Tribulus terrestris -Prednisone +Meditation -Stress DHEA © 2010 Meridian Valley Laboratory

  14. DHEA © 2010 Meridian Valley Laboratory

  15. PREGNANETRIOL © 2010 Meridian Valley Laboratory

  16. Pregnanetriol Cholesterol Pregnenolone 17-OH Pregnenolone Progesterone Pregnandiol Pregnanetriol 17-OH Progesterone Glucocorticoids(Cortisol, et.al.) © 2010 Meridian Valley Laboratory

  17. Pregnanetriol • Byproduct of cortisol biosynthesis • Useful in assessment of adrenal health • Increased: • Congenital Adrenal Hyperplasia • Adult onset Adrenal Hyperplasia • Progesterone Supplementation © 2010 Meridian Valley Laboratory

  18. Pregnanetriol © 2010 Meridian Valley Laboratory

  19. GLUCOCORTICOIDS © 2010 Meridian Valley Laboratory

  20. Glucocorticoids Cholesterol Pregnenolone Pregnanetriol Progesterone 17-OH Progesterone 11β-OH Androsterone Cortisol 11β-OH Etiocholanolone Cortisone Allo-Tetrahydrocortisol Tetrahydrocortisol Tetrahydrocortisone © 2010 Meridian Valley Laboratory

  21. Cortisol • Produced in the adrenal glands • Primary stress hormone • Weak mineralcorticoid activity • Urinary reflects circulating • Primary functions: • Gluconeogenesis • Suppression of inflammation • Fat, protein and carbohydrate metabolism © 2010 Meridian Valley Laboratory

  22. Cortisone • “Storage” form of cortisol • Cortisone  Cortisol via 11β-HSD • A normal ratio with Cortisol = 0.7 © 2010 Meridian Valley Laboratory

  23. Cortisol & Cortisone +Insulin Resistance +Human Growth Hormone +Testosterone +Obesity Cortisol +Licorice Cortisone 11β-HSD I 11β-HSD II -Hyperthyroidism © 2010 Meridian Valley Laboratory

  24. Elevated Cortisol or Cortisone Cushing's syndrome / Cushing's disease Ectopic ACTH Production Unipolar Depression Sleep deprivation Generalized Anxiety Disorder PTSD Panic Disorder, early stage Exogenous Cortisol supplementation Cortisol & Cortisone © 2010 Meridian Valley Laboratory

  25. Elevated Cortisol or Cortisone Licorice root supplementation Intensive physical exercise Acute ingestion of Alcohol (Cortisol) Cortisol & Cortisone © 2010 Meridian Valley Laboratory

  26. Decreased Cortisol or Cortisone Adrenal Insufficiency Chronic Fatigue Syndrome Fibromyalgia Rheumatoid Arthritis Panic Disorder, late stage Cortisol & Cortisone © 2010 Meridian Valley Laboratory

  27. Cortisone & Cortisol © 2010 Meridian Valley Laboratory

  28. Adrenal Insufficiency Clinical Manifestations Fatigue Exercise intolerance Hypoglycemia Salt craving Depression Insomnia Irritability Positive Hippus test Low blood pressure © 2010 Meridian Valley Laboratory 28

  29. Adrenal Excess Clincal Manifestations Insomnia Anxiety Insulin resistance Obesity © 2010 Meridian Valley Laboratory 29

  30. Cortisol & Cortisone Metabolites Cholesterol Pregnenolone Pregnanetriol Progesterone 17-OH Progesterone 11β-OH Androsterone Cortisol 11β-OH Etiocholanolone Cortisone Allo-Tetrahydrocortisol Tetrahydrocortisol Tetrahydrocortisone © 2010 Meridian Valley Laboratory

  31. Cortisol Metabolites 1763 © 2010 Meridian Valley Laboratory

  32. ALDOSTERONE © 2010 Meridian Valley Laboratory

  33. Aldosterone Cholesterol Pregnenolone Progesterone Deoxycortisone Corticosterone Aldosterone © 2010 Meridian Valley Laboratory

  34. Aldosterone • Major mineralocorticoid • Acts to increase the reabsorption of sodium and water and to secrete potassium • Receptor blocked by Spironolactone • Age related hearing loss © 2010 Meridian Valley Laboratory

  35. Aldosterone © 2010 Meridian Valley Laboratory

  36. OTHER MINERALOCORTICOIDS © 2010 Meridian Valley Laboratory

  37. Mineralocorticoids Cholesterol Pregnenolone Progesterone Deoxycortisone Corticosterone Aldosterone 5α-THB (Allo-Tetrahydrocorticosterone) THA (11-Dehydrotetrahydrocorticosterone) THB (Tetrahydrocorticosterone) © 2010 Meridian Valley Laboratory

  38. Mineralocorticoids © 2010 Meridian Valley Laboratory

  39. Mineralocorticoids Cholesterol Pregnenolone Progesterone Deoxycortisone Corticosterone + ↑↑Acute Stress -↑Salt + ↑↑Acute Stress THA (11-Dehydrotetrahydrocorticosterone) -↑Stress -↑Chronic Stress -↑Chronic Stress -Dehydration + Pregnenolone -Spironolactone 5α-THB (Allo-Tetrahydrocorticosterone) Aldosterone + ↑↑Acute Stress THB (Tetrahydrocorticosterone) -↑Chronic Stress © 2010 Meridian Valley Laboratory

  40. HUMAN GROWTH HORMONE © 2010 Meridian Valley Laboratory

  41. Growth Hormone Hypothalamus GHIH Somatostatin – GHRH + GH Somatotropin Anterior Pituitary Growth Factors Adipose Tissue Muscle Cellular Repair and Regeneration Skin Cartilage Bone Kidney © 2010 Meridian Valley Laboratory

  42. Growth Hormone Deficiency Symptoms: Short Stature (in children) Exercise intolerance Strength  Body fat Glucose intolerance Dyslipidemia Fragility of skin and blood vessels  Immune function © 2010 Meridian Valley Laboratory 42

  43. Growth Hormone Excess: Pituitary Adenoma most common cause Thickening of bones Sweating Muscle weakness  SHBG © 2010 Meridian Valley Laboratory 43

  44. Human Growth Hormone © 2010 Meridian Valley Laboratory

  45. Growth Hormone + Secretagogues + Glutamine (Older people) + hCG + Arginine (Younger people) + Melatonin + Resistance Training + Thyroid + Vigorous Exercise + Progesterone + Adequate Protein + Estrogen + Deep Sleep + Testosterone – Sedentary Lifestyle – Inadequate Protein – Poor Sleep – Insufficient endogenous hormones © 2010 Meridian Valley Laboratory

  46. THYROID HORMONES © 2010 Meridian Valley Laboratory

  47. Thyroid Hormones • Thyroid Hormones Control • Speed of Protein synthesis • Energy use • Sensitivity to other hormones • T3 and T4 • Tyrosine • Iodine • T4 more stable • T3 active • T4  T3 happens within cells © 2010 Meridian Valley Laboratory 47

  48. Thyroid © 2010 Meridian Valley Laboratory

  49. SODIUM / POTASSIUMRATIO © 2010 Meridian Valley Laboratory

  50. Sodium/Potassium Ratio • Reflection of Dietary intake • Important in prevention of • Hypertension • Heart Attack • Stroke • Ideal ratio = 1.5 © 2010 Meridian Valley Laboratory 50