Learning Unit 4 OS 215 Hormonal Regulation module topic presentation 23 Jan 2020, UP College of Medicine.

1. PRINCIPLES OF HORMONE TESTING
Iris Thiele Isip Tan MD, MSc
Professor, UP College of Medicine
Chief, UP Medical Informatics Unit
Director, UP Manila Interactive Learning Center

2. 1
2
3
The endocrine system is evaluated primarily
by measuring hormone concentrations.
Only order tests that will influence patient
management and outcome.
An understanding of hormone secretion,
hormone action and feedback control is
essential when doing hormone testing.

3. 1 The endocrine system is evaluated primarily
by measuring hormone concentrations.

4. HORMONE
EXCESS DEFICIENCY RESISTANCE

7. 2 Only order tests that will influence patient
management and outcome.

9. DIAGNOSIS MONITORING SCREENING RESEARCH
WHY ORDER A TEST?

10. Hypothesis Deduction & Pattern Recognition
Sabatine MD. Pocket Medicine. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2011

11. Medical Algorithm
Mind the arrows

12. FeanDoe. Modified version from Walber's Precision and Recall
https://commons.wikimedia.org/wiki/File:Precisionrecall.svg
SENSITIVITY: percentage of individuals
with disease who have a positive test result
SPECIFICITY: percentage of individuals
without disease who have a negative test
result
PREVALENCE: ratio of number of
individuals with disease to number of
individuals in population to be tested

13. 50-50
RULE OF THUMB
Useful test
Sensi + Speci > 170

14. FeanDoe. Modified version from Walber's Precision and Recall
https://commons.wikimedia.org/wiki/File:Precisionrecall.svg

15. FeanDoe. Modified version from Walber's Precision and Recall
https://commons.wikimedia.org/wiki/File:Precisionrecall.svg

16. Which test will
you choose?

17. 77
23
700
9300
1% prevalence of pheochromocytoma
in secondary hypertension
= 77%
= 93%
= 9.9%
= 99%
100 10000
http://sphweb.bumc.bu.edu/otlt/MPH-Modules/EP/EP713_Screening/
EP713_Screening5.html

18. 3
An understanding of hormone secretion,
hormone action and feedback control is
essential when doing hormone testing.

19. All I really needed
to know I learned
in LU 3 Physiology :)
Baby steps by Kristina Alexanderson,
https://flic.kr/p/att5j5

20. FSH REFERENCE INTERVALS
Before puberty: 0 to 4.0 mIU/ml
During puberty: 0.3 to 10.0 mIU/ml.
Women who are still menstruating: 4.7 to 21.5 mIU/ml
After menopause: 25.8 to 134.8 mIU/ml.

21. Polesel et al 2017; https://doi.org/10.1089/gyn.2017.0040

22. 17/F never had menses
Normal birth and development; good scholastic performance
Tanner stage III breast development & Tanner stage III pubic hair
LH 16.9 mIU/ml (NV 1.1 to 11.6 mIU/ml)
FSH 84.2 mIU/ml (NV 2.8 to 11.3 mIU/ml)
Estradiol 0.281 pg/mL
(NV premenopausal 15-350 pg/mL; postmenopausal <10 pg/mL)

24. https://www.cambridge.org/core
https://doi.org/10.1017/9781108149938.006

25. Adrenal fatigue???

26. Adrenal fatigue???

30. Development and Validation of In Vitro Bioassays for Thyroid Hormone Receptor Mediated Endocrine Disruption - Scientific Figure on ResearchGate. Available from:
https://www.researchgate.net/figure/The-Hypothalamic-Pituitary-Thyroid-axis-including-the-roles-of-thyrotropin-releasing_fig2_257006752 [accessed 22 Jan, 2020]
49/F brought to ER for
generalized weakness
Previously well until 6 months ago, she
began experiencing easy fatigability,
weight gain, frequent nausea,
constipation and cold intolerance.
Difficult delivery at home of last child 15
years ago. She was transfused 4 packs
of rbc.

31. Development and Validation of In Vitro Bioassays for Thyroid Hormone Receptor Mediated Endocrine Disruption - Scientific Figure on ResearchGate. Available from:
https://www.researchgate.net/figure/The-Hypothalamic-Pituitary-Thyroid-axis-including-the-roles-of-thyrotropin-releasing_fig2_257006752 [accessed 22 Jan, 2020]
Klee G. Clinical Chemistry 1999;45(8B):1323-1330

32. 23/F pregnant (13 wks AOG)
with frequent vomiting for
past two weeks
Has nausea, dizziness, headache and
loss of appetite.
No fever, palpitations, agitation, diarrhea
and heat intolerance
No eye signs. No goiter. HR 89 bpm
No tremors

33. Juan C. Galofre, Terry F. Davies. Autoimmune Thyroid Disease in Pregnancy: A
Review. Journal of women’s health 2009;18(11):1847-1856 http://
www.ncbi.nlm.nih.gov/pmc/articles/PMC2828163/pdf/jwh.2008.1234.pdf

34. Juan C. Galofre, Terry F. Davies. Autoimmune Thyroid Disease in Pregnancy: A
Review. Journal of women’s health 2009;18(11):1847-1856 http://
www.ncbi.nlm.nih.gov/pmc/articles/PMC2828163/pdf/jwh.2008.1234.pdf
28/F pregnant (20 wks AOG)
Complains of palpitation
Has a palpable goiter

35. Juan C. Galofre, Terry F. Davies. Autoimmune Thyroid Disease in Pregnancy: A
Review. Journal of women’s health 2009;18(11):1847-1856 http://
www.ncbi.nlm.nih.gov/pmc/articles/PMC2828163/pdf/jwh.2008.1234.pdf

36. 65/M in the ICU for stroke
Referred for low T3, low TSH and
low normal T4
On dopamine and steroids

38. 1
2
3
The endocrine system is evaluated primarily
by measuring hormone concentrations.
Only order tests that will influence patient
management and outcome.
An understanding of hormone secretion,
hormone action and feedback control is
essential when doing hormone testing.