Anda di halaman 1dari 65

Reproductive hormon

dr. Zulfikar Lubis, SpPK-K


dr. Ida Adhayanti, SpPK

Hormon Reproduksi
1.
)
2.
3.
4.
5.
6.

GnRH ( Gonadotropin-releasing hormon


FSH ( Follicle-stimulating hormon )
LH (Luteinizing hormon )
Testosteron
Estradiol
Progesteron

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.
2.
3.
4.
5.
6.

Age
Sex
Time
Season
Altitude
Condition - menstruation
- pregnancy
7. Lifestyle

UMUR
Hasil laboratorium dikelompokan
berdasarkan :
1. Pediatric
2. Adolescent
3. Adult
4. Geriatric

Perbedaan Jenis Kelamin


Terjadi oleh karena perbedaan besarnya
massa otot , endokrin dan perbedaan
organ yang spesific.

WAKTU
Ada 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.

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 pertenghan 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.

GAYA HIDUP
1.
2.
3.
4.

Diet
Caffein
Alkohol
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 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 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

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

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
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

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 )

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

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 )

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

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

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

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

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