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Hormon Reproduksi
Reproductive hormon dr. Zulfikar Lubis, SpPK-K dr. Ida Adhayanti, SpPK
1. GnRH ( Gonadotropin-releasing hormon ) 2. FSH ( Follicle-stimulating hormon ) 3. LH (Luteinizing hormon ) 4. Testosteron 5. Estradiol 6. Progesteron
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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
UMUR
1. Age 2. Sex 3. Time 4. Season 5. Altitude 6. Condition - menstruation - pregnancy 7. Lifestyle
Hasil laboratorium dikelompokan berdasarkan : 1. Pediatric 2. Adolescent 3. Adult 4. Geriatric
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WAKTU Perbedaan Jenis Kelamin Terjadi oleh karena perbedaan besarnya massa otot , endokrin dan perbedaan organ yang spesific.
Perubahan Musim
Hormon Tiroid 20% rendah pd musim semi dibanding musim dingin
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.
KETINGGIAN
Konsentrasi estriol berkurang dengan peningkatan ketinggian.
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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.
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
Kadar Progesteron pada awal menstruasi rendah,kadarnya mulai meningkat setelah ovulasi dan mencapai puncaknya pada pertengahn fase luteal.
Jadi ada pengaruh kadar hormon LH,FSH, estradiol dan progesteron pada siklus menstruasi fase folikular, midcycle, dan fase luteal.
meningkat lalu menurun bersamaan dgn menurunnya kadar estrogen hingga terjadi siklus menstruasi berikutnya.
KEHAMILAN Pada kehamilan trisemester 2, Plasenta mengeluarkan hormon antagonis insulin. Efeknya hormon estrogen,progesteron, Human Placenta Lactogen meningkat yg dapat menyebabkan terjadinya Diabetes Gestasional.
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GAYA HIDUP 1. Diet 2. Caffein 3. Alkohol 4. Merokok
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
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 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
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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.
Analytic 1. • • • • •
Kalibrasi : Panjang Gelombang pH Reagen Waktu Inkubasi Washing
Transport specimen by car or plane must be use ice box.
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Analytic 2. Standarisasi • Single Standart • Multiple Standart
Analytic 3. Quality Control • Pooled Sera • Normal Sera atau Patologis Sera • Reference WHO Sera
• Reference Standart
Metode Pemeriksaan 1. Radio immuno assay ( RIA ) • Gold Standart • ß 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
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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 )
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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
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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 )
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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
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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
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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
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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
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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
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