産婦人科臨床におけるホルモン測定の意義

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  • Method and Evaluation of Hormone Assays in Practical Obstetrics and Gynecology

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Hormone assays are very important in obstetrics and gynecology. Today, I want to talk about how to measure hormones and how to evaluate the data obtained for therapeutic purposes. In humans, there are two mechanisms of control, neural control and endocrine control. Generally speaking, the neural system controls organs directly via various neurotransmitters, while the endocrine system controls organs by hormones transported in the blood. In fact, recent progress in hormone research has shown that this concept should be modified, because some hormones act as neurotransmitters or regulate other cells or even endocrine cells themselves in the same organ. But I shall not go into this. Today's lecture is focused on hormones that are closely related to clinical obstetrics and gynecology. The hormones that are important are those in females, reproduction, and pregnancy, and tumors. First, and most important, is that patients acquire feminity in the physiological and psychological sense by hormones. The hormones closely related to this are estrogens and pituitary hormones. For reproduction, cyclic hormonal change is important. In the reproductive period, women have menstruation and ovulation along with cyclic changes of ovarian and pituitary hormones. After conception, various kinds of hormones, including hCG, HPL and estriol, are secreted from the feto-placental system. These hormones are used clinically as a markers of placental function. Hormones also have important roles in oncology. hCG is an excellent marker of trophoblastic diseases. Endometrial cancer is expected respond to large doses of progestins if they have progesterone receptors. There are three types of hormone assays, biological assays, immunological assays and chemical assays. Biological assay determine the biological effects of hormones, but these assays are rather complicated, and expensive and give variable results, so they are used only in research. Radioimmunoassays are widely used in the clinical field. This type of assay is sensitive and accurate but a major problem is that it involves radioactive materials. To overcome this problem, enzyme-immunoassays have been developed in which radioactive materials are replaced by enzymes as markers. This type of assay in now getting more popular than radio-immunoassay. The next problem is how to interpret the data. Here two points are important. One is an understanding of the characteristics of the assay method, such as sensitively, specificity and accuracy. The other is accurate information about the normal variation in the data. Hormone levels change depending on age, the day of menstrual cycle, meals, sleep, and pregnancy. Gonadotropin levels change with age and menstrual cycles. PRL levels increase during meals and sleep. HPL and estriol increase during pregnancy, whereas hCG show a peak late in the first trimester. Much progress also achieved recently in measurement of urinary hCG, LH and estrogens. The kits of test for pregnancy increase their sensitivity which made it possible to determine pregnancy in week 4 of gestation. Urinary LH kits are used for detection of the LH surge, which is a good marker of time of ovulation. The kits for urinary estrogens are also useful for detection of follicular development in HMG+hCG therapy. These are the hormones usually measured in obstetrics and gynecology. I want to stress the importance of the assay itself and of interpretation of normal variation. There are discrepancies between the data obtained in immunological assays and biological expression in some cases. The ratio of immunoreactive LH to bioactive LH is known to be higher after menopause. After Buserelin therapy, bioactive LH was found to be low compared with immunoreactive LH. There was a patient with hyperprolactinemia ovulated. Chromatography of her serum on G 100 gel revealed aggregated prolactin with low bioactivity. Thus in evaluation of data, the character of the assay used s hould be taken into consideration. In

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