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Hormone Testing in Clinical Practice: Part 3

Hormone Testing in Clinical Practice: Part 3

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Hormone Testing in Clinical Practice: Part 3

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  1. Hormone Testing in Clinical Practice: Part 3 Interpreting Your Patients’ 24-Hour Hormone Profile Results

  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. Urinary Hormones Part 3: Case Studies Menopause, without HRT Menopause, with BHRT © 2010 Meridian Valley Laboratory 3

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

  5. Case One Janet, a 67 year old Post-Menopausal Woman © 2010 Meridian Valley Laboratory

  6. Hormone Questionnaire

  7. Case History • Height: 5’4” Weight: 155lbs • BP: 105/70 LMP: 2005 • Menopausal sx have worsened in past 6 months • Family hx of osteoporosis • Family hx of CVD © 2010 Meridian Valley Laboratory

  8. Medications and Supplements Levothyroxine 25mcg qd Probiotics Fish oil Multivitamin Ginko Calcium Magnesium © 2010 Meridian Valley Laboratory 8

  9. Signs and Symptoms • Symptoms • Hot flashes • Vaginal Dryness • Night sweats • Foggy thinking • Memory lapse • Bone loss • Anxiety • Stress © 2010 Meridian Valley Laboratory

  10. Signs and Symptoms • Symptoms • Increased facial hair • Fatigue • Insomnia • Stress Incontinence • Decreased libido • Acne • Mood swings © 2010 Meridian Valley Laboratory

  11. 24-Hour Urine Hormone Profile Report Doe, Jane Doe, Jane Doe, Jane 0001 Dr. Jonathan Wright, MD The Tahoma Clinic 801 SW 16th Street Renton, WA 98057 FAX: (425) 264-0071 Phone: (425) 264-0059 © 2010 Meridian Valley Laboratory 11

  12. Total Volume & Creatinine 0.9 gm/24hr 2700 mL © 2010 Meridian Valley Laboratory 12

  13. Estrogens • Estrone (E1) • Estradiol (E2) • Estriol (E3) • 2-Hydroxyestrone • 16α-Hydroxyestrone • 4-Hydroxyestrone • 2-Methoxyestrone • 2-Methoxyestradiol Phase 1 Metabolites Phase 2 Metabolites

  14. Estrogens Testosterone Androstenedione Estradiol (E2) Estrone (E1) 4-OH Estrone 2-OH Estradiol 16α-OH Estrone 2-OH Estrone 2-CH3O Estradiol Estriol (E3) 2-CH3O Estrone

  15. Estrogens: E1, E2, E3 Luteal 17-26 10.8-89.2 Follicular 27-11 7.0-110 Mid-Cycle 12-16 38-221 Post Menopausal 0-41 7.3 © 2010 Meridian Valley Laboratory 15

  16. Estrogen Quotient • Estrogen Quotient • Originated by Henry Lemon, MD • Women with EQ>1 have  survival rate after BrCA • Estriol (E3) divided by the sum of Estrone (E1) + Estradiol (E2) EQ = E3 / (E1 + E2)

  17. Estrogens: EQ 3.0 + 1.1 4.1 3.2 ÷ 0.8 >1.0 EQ = E3 ÷ (E1 + E2) © 2010 Meridian Valley Laboratory 17

  18. Promotion of Estriol (E3) Estrone (E1) 16-OH Estrone +Iodine (↑ E1→E3) Estriol (E3)

  19. 2/16α Ratio Testosterone Androstenedione Estradiol (E2) Estrone (E1) +Obesity +DIM +Hypothyroidism +Indol-3 Carbonyl +Pesticides 4-OH Estrone +Cimetidine +Exercise +Flax 16α-OH Estrone +Soy – Pesticides +Ω-3 Fatty acids – Alcohol +Progesterone – High Fat Diet Estriol (E3) + Promotes this enzyme ― Inhibits this enzyme 2-OH Estrone

  20. Estrogens: 2/16 Ratio 1.4 ÷ 0.7 = 2.0-4.0 1.9 ÷ 2-OH E1 16-OH E1 © 2010 Meridian Valley Laboratory 20

  21. 4-OH Estrone Testosterone Androstenedione Estradiol (E2) Estrone (E1) 4-OH Estrone 16α-OH Estrone Estriol (E3) 2-OH Estrone

  22. Estrogens: 4-OH E1 <0.25 © 2010 Meridian Valley Laboratory 22

  23. Estrogen Methylation Estradiol (E2) Estrone (E1) 2-OH Estradiol 2-OH Estrone +Vitamin B12 +Methionine +Magnesium Methylation +Folate +Betaine +SAMe +Zinc 2-CH3O Estradiol 2-CH3O Estrone

  24. Estrogens: Methylation 0.9 <0.1 © 2010 Meridian Valley Laboratory 24

  25. Treatment Recommendations Biest 1.25mg qd applied to vaginal labia Recommendations © 2010 Meridian Valley Laboratory 25

  26. Progesterone Cholesterol Pregnenalone Progesterone 17-OH Pregnenolone Mineralocorticoids Pregnandiol 17-OH Progesterone Androstenedione Glucocorticoids(Cortisol, et.al.) Testosterone Estrogens

  27. Progesterone 95 © 2010 Meridian Valley Laboratory 27

  28. Treatment Recommendations Progesterone 25-50 mg qd applied to vaginal labia Recommendations © 2010 Meridian Valley Laboratory 28

  29. Androgens Cholesterol Pregnenolone 17-OH Pregnenolone Androsterone DHEA Androstenedione Etiocholanolone Testosterone Estradiol Estrone © 2010 Meridian Valley Laboratory 29

  30. Testosterone Testosterone 5β Reductase Aromatase 5α Reductase 5β-DHT Estradiol 5α-DHT 5β- Androstanediol 5α-Androstanediol

  31. Androgens 25 Low 0.6 Low 6.4 9.8 Low 552 474 Low © 2010 Meridian Valley Laboratory 31

  32. Testosterone Testosterone –Myomin* –Chrysin +Cortisol – GLA 5β Reductase Aromatase –Progesterone +Vit C deficiency – Zinc –Aromatase Inhibitors 5α Reductase +Low T3 – Saw Palmetto –Grape Seed Extract +Insulin – Progesterone – Quercitin +Growth Hormone –Spironolactone 5β-DHT Estradiol 5α-DHT 5β- Androstanediol 5α-Androstanediol * Myomin is a product consisting of 4 herbs: Aralia dasyphylla, Curcuma zedoria, Cyperus rotundus, and Smilax glabra

  33. Treatment Recommendations DHEA 10mg SL spray Recommendations © 2010 Meridian Valley Laboratory 33

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

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

  36. Glucocorticoids 182 83 45 © 2010 Meridian Valley Laboratory 36

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

  38. Glucocorticoids 2094 1061 1055 4210 646 239 © 2010 Meridian Valley Laboratory 38

  39. Treatment Recommendations Adrenal Support: Sodium Ascorbate 2g BID Pantothenic Acid 250 mg BID Vitamin A 40,000 IU QD B6 50mg QD Chromium 6000 mcg daily for 30 days then taper to 2000 mcg Adrenal cortical extract Adaptogenic herbs Recommendations © 2010 Meridian Valley Laboratory 39

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

  41. Mineralocorticoids Normal Diet: 6.0-25.0 Low Salt: 17.0-44.0 High Salt: 0.0-6.0 3.8 234 64 65 130-600 30-240 62-293 © 2010 Meridian Valley Laboratory 41

  42. 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

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

  44. Human Growth Hormone 1065-4722 638 Low © 2010 Meridian Valley Laboratory 44

  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. Treatment Recommendations Growth Hormone Support: Get adequate sleep Aerobic and resistance exercise Paleolithic diet Secretogogue- Glutamine 2g QD Recommendations © 2010 Meridian Valley Laboratory 46

  47. Thyroid Hormones 768 871 470-1750 430-3200 © 2010 Meridian Valley Laboratory 47

  48. Urine Minerals 40-220 26-150 62-293 155 48 3.2 © 2010 Meridian Valley Laboratory 48

  49. Treatment Recommendations Increase dietary potassium: avocados bananas leafy green veggies Recommendations © 2010 Meridian Valley Laboratory 49

  50. 5-Reductase Activity © 2010 Meridian Valley Laboratory 50