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Bilan Hormonal Question posée 1 2 3 Ovulation? Qualité de l ovulation? Vieillissement ovarien? Fonction thyroïdienne Fonction surrénalienne Bilan androgénique chez la femme
Bilan Hormonal Question posée 1 2 3 Ovulation? Qualité de l ovulation? Vieillissement ovarien? Fonction thyroïdienne Fonction surrénalienne Bilan androgénique chez la femme
Bilan Hormonal 1 2 3 Le cycle menstruel: L unité de compte fondamentale. La phase folliculaire: Le recrutement des follicules stimulables. La phase lutéale: L aboutissement du recrutement folliculaire.
Menstrual cycle synchronization The dogma says: Normal 1 3 5 7 9 11 13 15 Menses Cycle 1 Cycle 2 P4 / E2 25 26 27 28 1 3 5 7 9 11 13 15 LH FSH
Menstrual cycle synchronization The dogma says: Foll. phase Normal 1 3 5 7 9 11 13 15 Menses Cycle 1 Cycle 2 P4 / E2 25 26 27 28 1 3 5 7 9 11 13 15 LH FSH
Menstrual cycle synchronization The dogma says: Foll. phase Normal 1 3 5 7 9 11 13 15 Menses Cycle 1 Cycle 2 P4 / E2 25 26 27 28 1 3 5 7 9 11 13 15 LH FSH
Menstrual cycle synchronization Normal 1 3 5 7 9 11 13 15 Menses Cycle 1 Cycle 2 Inter-cycle FSH elevation: P4 / amplitude E2 of 2.5mIU/mL 25 26 27 28 1 3 5 7 9 11 13 15 LH FSH
Menstrual cycle synchronization Long Normal Menses Cycle 1 Cycle 2 P4 / E2 25 26 27 28 1 3 5 7 9 11 13 15 LH FSH
Menstrual cycle synchronization Long Normal Short Menses Cycle 1 Cycle 2 P4 / E2 25 26 27 28 1 3 5 7 9 11 13 15 LH FSH
Menstrual cycle synchronization Long Normal Short Menses Cycle 1 Cycle 2 P4 Progesterone / E2 What can be done practically? 25 26 27 28 1 3 5 7 9 11 13 15 LH FSH
Menstrual cycle synchronization 1 Time end of cycle I Inter-cycle 2 Time onset of cycle II Normal Follicular phase 1 3 5 7 9 11 13 15 P4/E2 Menses Cycle 1 Cycle 2 25 26 27 28 1 3 5 7 9 11 13 15 LH FSH
Menstrual cycle synchronization 1 Time end of cycle I Inter-cycle 2 Time onset of cycle II Normal Follicular phase 1 3 5 7 9 11 13 15 P4/E2 Menses 2 hormones: E2,& P4 2 events: menses, FSH Cycle 1 Cycle 2 25 26 27 28 1 3 5 7 9 11 13 15 LH FSH
Taming the inter-cycle FSH Control cycle Inhibin U/L 1200 FSH IU/L Inhibin FSH 6 900 600 4 300 2 0-5 -4-3 -2-1 1 2 3 4 5 6 7 8 9 10 11 0 E2 pmol/l 1000 800 E2 P nmol/l Progesterone 120 100 600 80 400 200 60 40 20 0-5 -4-3 -2-1 1 2 3 4 5 6 7 8 9 10 11 Cycle days 0 From: Le Nestour et al., JCEM, 1993; 77: 439-42
Taming the inter-cycle FSH Control cycle E2 day 25 - day 3 Inhibin U/L 1200 900 FSH IU/L Inhibin FSH 6 Inhibin U/L 1800 1500 1200 FSH IU/L Inhibin FSH 6 4 600 4 900 600 2 300 2 300 0-5 -4-3 -2-1 1 2 3 4 5 6 7 8 9 10 11 0-5 -4-3 -2-1 1 2 3 4 5 6 7 8 9 10 11 0 0 E2 pmol/l 1000 E2 P nmol/l Progesterone 120 E2 pmol/l 600 E2 Progesterone P nmol/l 120 800 100 500 100 600 80 400 80 400 60 40 300 60 40 200 20 200 20 0-5 -4-3 -2-1 1 2 3 4 5 6 7 8 9 10 11 Cycle days 0 0-5 -4-3 -2-1 1 2 3 4 5 6 7 8 9 10 11 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: 439-42
Bilan Hormonal FSH / E2 / LH a J3 AMH Reserve ovarienne Profil OPK (PCOS) Evaluation des amenorrhees Reserve ovarienne Exclure PCOS et multi cystic ovaries
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
Bilan Hormonal
Bilan Hormonal
Bilan Hormonal
Bilan Hormonal Question posée 1 2 3 Ovulation? Qualité de l ovulation? Vieillissement ovarien? Fonction thyroïdienne Fonction surrénalienne Bilan androgénique chez la femme
Fonction thyroïdienne Bilan Hormonal
Bilan Hormonal Fonction thyroïdienne Screening TSH in all infertile women Supplement thyroid hormone if TSH 2.5 Initial dose 75-100 mcg Adjust during pregnancy according to TSH
Bilan Hormonal
Bilan Hormonal Bilan surrenalien Urinary free cortisol Late night salivary cortisol Overnight dexamethasone suppression test Cortisol <50 nmol/l
Bilan Hormonal Question posée 1 2 3 Ovulation? Qualité de l ovulation? Vieillissement ovarien? Fonction thyroïdienne Fonction surrénalienne Bilan androgénique chez la femme
Production of androgens in women 1. Production of androgens in women
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
2. Peripheral action of androgens in women androstenedione testosterone 5a - RA DHT
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
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
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
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
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
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)
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)
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
Little big horn Sitting bull
Little big horn Sitting bull Talibans
Warriors with similar testosterone levels Little big horn Sitting bull Talibans
Warriors with similar testosterone levels Little big horn Sitting bull Talibans
Warriors with similar testosterone levels Little big horn Les généraux imberbes Sitting bull Talibans
Warriors with similar testosterone levels Little big horn Les généraux imberbes Sitting bull Talibans age 15 25 35 45 55 time-related
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