Bilan Hormonal. Question posée. Ovulation? Qualité de l ovulation? Vieillissement ovarien? Fonction thyroïdienne Fonction surrénalienne
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2 Bilan Hormonal Question posée Ovulation? Qualité de l ovulation? Vieillissement ovarien? Fonction thyroïdienne Fonction surrénalienne Bilan androgénique chez la femme
3 Bilan Hormonal Question posée Ovulation? Qualité de l ovulation? Vieillissement ovarien? Fonction thyroïdienne Fonction surrénalienne Bilan androgénique chez la femme
4 Bilan Hormonal Le cycle menstruel: L unité de compte fondamentale. La phase folliculaire: Le recrutement des follicules stimulables. La phase lutéale: L aboutissement du recrutement folliculaire.
5 Menstrual cycle synchronization The dogma says: Normal Menses Cycle 1 Cycle 2 P4 / E LH FSH
6 Menstrual cycle synchronization The dogma says: Foll. phase Normal Menses Cycle 1 Cycle 2 P4 / E LH FSH
7 Menstrual cycle synchronization The dogma says: Foll. phase Normal Menses Cycle 1 Cycle 2 P4 / E LH FSH
8 Menstrual cycle synchronization Normal Menses Cycle 1 Cycle 2 Inter-cycle FSH elevation: P4 / amplitude E2 of 2.5mIU/mL LH FSH
9 Menstrual cycle synchronization Long Normal Menses Cycle 1 Cycle 2 P4 / E LH FSH
10 Menstrual cycle synchronization Long Normal Short Menses Cycle 1 Cycle 2 P4 / E LH FSH
11 Menstrual cycle synchronization Long Normal Short Menses Cycle 1 Cycle 2 P4 Progesterone / E2 What can be done practically? LH FSH
12 Menstrual cycle synchronization 1 Time end of cycle I Inter-cycle 2 Time onset of cycle II Normal Follicular phase P4/E2 Menses Cycle 1 Cycle LH FSH
13 Menstrual cycle synchronization 1 Time end of cycle I Inter-cycle 2 Time onset of cycle II Normal Follicular phase P4/E2 Menses 2 hormones: E2,& P4 2 events: menses, FSH Cycle 1 Cycle LH FSH
14 Taming the inter-cycle FSH Control cycle Inhibin U/L 1200 FSH IU/L Inhibin FSH E2 pmol/l E2 P nmol/l Progesterone Cycle days 0 From: Le Nestour et al., JCEM, 1993; 77:
15 Taming the inter-cycle FSH Control cycle E2 day 25 - day 3 Inhibin U/L FSH IU/L Inhibin FSH 6 Inhibin U/L FSH IU/L Inhibin FSH E2 pmol/l 1000 E2 P nmol/l Progesterone 120 E2 pmol/l 600 E2 Progesterone P nmol/l Cycle days E 2 T r e a t m e n t C y c l e d a y s 0 From: Le Nestour et al., JCEM, 1993; 77:
16 Bilan Hormonal FSH / E2 / LH a J3 AMH Reserve ovarienne Profil OPK (PCOS) Evaluation des amenorrhees Reserve ovarienne Exclure PCOS et multi cystic ovaries
17 Bilan Hormonal At Foch, we measure FSH/E2, AFC and AMH in all infertility patients. FSH/E2 AFC AMH <8mIU/mL 8-12mIU/mL >12mIU/mL >8 total 5-7 total <5 total >1ng/mL O.5-1 ng/ml <O.5 ng/ml We believe that making 3 measurements is cost effective. Interpret according to circumstances
18 Bilan Hormonal
19 Bilan Hormonal
20 Bilan Hormonal
21 Bilan Hormonal Question posée Ovulation? Qualité de l ovulation? Vieillissement ovarien? Fonction thyroïdienne Fonction surrénalienne Bilan androgénique chez la femme
22 Fonction thyroïdienne Bilan Hormonal
23 Bilan Hormonal Fonction thyroïdienne Screening TSH in all infertile women Supplement thyroid hormone if TSH 2.5 Initial dose mcg Adjust during pregnancy according to TSH
24 Bilan Hormonal
25 Bilan Hormonal Bilan surrenalien Urinary free cortisol Late night salivary cortisol Overnight dexamethasone suppression test Cortisol <50 nmol/l
26 Bilan Hormonal Question posée Ovulation? Qualité de l ovulation? Vieillissement ovarien? Fonction thyroïdienne Fonction surrénalienne Bilan androgénique chez la femme
27 Production of androgens in women 1. Production of androgens in women
28 Production of androgens in women DHEA D4 PCOS 1 0,75 0,5 0,25 0 DHEA - S Testosterone PCOS 1 0,75 0,5 0,25 0 S controls PCOS controls ovx
29 2. Peripheral action of androgens in women androstenedione testosterone 5a - RA DHT
30 2. Peripheral action of androgens in women androstenedione testosterone 5a - RA DHT 1. Increases sebum 2. Diff of hair follicle 3. Anagen phase of hair cell
31 2. Peripheral action of androgens in women androgens + androstenedione testosterone 5a - RA DHT 1. Increases sebum 2. Diff of hair follicle 3. Anagen phase of hair cell
32 2. Peripheral action of androgens in women androgens + - E2, P4 androstenedione testosterone 5a - RA DHT 1. Increases sebum 2. Diff of hair follicle 3. Anagen phase of hair cell
33 2. Peripheral action of androgens in women Local factor?? + androgens + - E2, P4 idiopathic hirsutism??? no evidence androstenedione testosterone 5a - RA DHT 1. Increases sebum 2. Diff of hair follicle 3. Anagen phase of hair cell
34 2. Peripheral action of androgens in women Local factor?? + androgens + - E2, P4 idiopathic hirsutism??? no evidence androstenedione testosterone 5a - RA DHT A-diol G 1. Increases sebum 2. Diff of hair follicle 3. Anagen phase of hair cell
35 1 2 Time course Patho-physiology of hyperandrogenism 3 Clinical consequence Symptoms Masculinization Increased hair growth: hirsutism Acne and oily skin Hair loss (female-pattern androgenic alopecia)? Vrilization Major androgen elevation Lowering of voice Bi temporal baldness (male-pattern hair loss) Clitoromegaly (>1cm shaft)
36 1 2 Time course Patho-physiology of hyperandrogenism 3 Clinical consequence Symptoms Masculinization Increased hair growth: hirsutism Acne and oily skin Hair loss (female-pattern androgenic alopecia)? Vrilization Major androgen elevation Lowering of voice Bi temporal baldness (male-pattern hair loss) Clitoromegaly (>1cm shaft)
37 1 2 Time course Patho-physiology of hyperandrogenism 3 Clinical consequence Symptoms Masculinization Increased hair growth: hirsutism In men and women, hair growth: Does not reflect testosterone levels Is affected by ethnical differences In women, idiopathic hirsutism seriously challenged
38 Little big horn Sitting bull
39 Little big horn Sitting bull Talibans
40 Warriors with similar testosterone levels Little big horn Sitting bull Talibans
41 Warriors with similar testosterone levels Little big horn Sitting bull Talibans
42 Warriors with similar testosterone levels Little big horn Les généraux imberbes Sitting bull Talibans
43 Warriors with similar testosterone levels Little big horn Les généraux imberbes Sitting bull Talibans age time-related
44 Bilan Hormonal Conclusion 1 Ovarian function J 3 FSH/LH/E2 (Avec AFC score) 2 3 Fonction thyroïdienne: TSH 2.5 Fonction surrénalienne Dexamethasonesupprerssiontest Bilan androgénique chez la femme en cas de masculinisation pour exclure une tumeur secrétante
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