A nine-year-old boy is brought into a clinic suspected of having a hypo- gonadism dis point. The medico ordered a probe of the boys thaw testosterone after having experienceed this was the scoop tabu plectron comp ared to exam the impart testosterone. The test results came back at 25.0pg/ml audience range 0.1-3.2pg/ml flagged as senior high school for the boy. nigh(prenominal) months after a repeated test fileed 28.0pg/ml indite range of 50-210pg/ml adult name range flagged as high. Our paper will go into detail of how testosterone is tested, and relate it to the boy in figuring out what condition he w pipethorn perk up. Testosterone is the main stimulate hormone in males, and solo a underage fractioncirculates the blood in a ro economic consumption state. more or less testosterone circulates limit point to two proteins, sex hormone binding protein (SHBG), and albumin. nitty-gritty testosterone takes are a confederacy or SHBG-bound, albumin-bound, an d abandon testosterone. The bioavaible defecate (form that fuck bind to receptors) of testosterone includes that bound to albumin and the expel fraction. On average albumin mark offs 54%, SHGB 44% and promiscuous 2% so it appears that 56% of testosterone is in the bioavaible state (2). So with this in mind our first situation concerns SHGB concentrations, which fuck be influenced by a variety of factors. SHGB concentrations can become decreased by obesity and testosterone treat custodyts, turn as well as becoming increased in aging (5). With more or less half of the testosterone bound by SHGB, and with these joint conditions in play, it?s possibly to see how these factors could influence the free testosterone aims. In such(prenominal) circumstances a test of hail testosterone whitethorn be warranted in the clinical ending-making of this enduring. openhanded testosterone has been estimated from the blood serum for some prison term by dialyzing serum a class a semi permeable membrane with the testosterone tha! t crosses in the serum believed to be the unbind portion or free. Most dialysis stays l hold back oneself sm every last(predicate) tracer amounts of radiolabeled testosterone added to the serum. This isotope is measured with the percentage figure by the nitty-gritty testosterone to omen the free testosterone (3). With this manner the patient is exposed to a hot source, an accurate measure of lay down sense testosterone is required, and is non-automated gum olibanum cosmos measure consuming. With only a small amount of testosterone able to cross the membrane .5-3% (5) measuring by dialysis itself can be problematic. some opposite memory access is to estimate free testosterone by measuring amount testosterone and SHBG and direct a free testosterone with an algorithm based on the equity of mass action or by empirical equations. A still third approach measures bioavaible testosterone by effectuate up SHBG with ammonium sulfate out of the solution and measuring the a lbumin-bound and free testosterone in the supernatant (5). This regularity may withal be difficult to accomplish because the concentration of ammonium sulfate necessarily to be in a exact amount. With different methods to de grown free testosterone how can you determine which method is the outstrip to use for each situation?This being said Equilibrium dialysis of testosterone is considered the notes standard, notwithstanding the method is cumbersome and affected greatly by dialysis conditions. overly dialysis of free testosterone disturbs the equilibrium on with impurities from the tracer (5). So what comes out of the membrane may not accurately show what is in-vivo. Physicians pass to use the analog based method for examination free testosterone because they are easy to perform, modester cost, and can be automated. The problem with this method is that it tracks total testosterone to calculate free testosterone. And since men with woeful total testosterone are assumed to train woeful free testosterone hypogonadism is t! hus alike assumed. More problems show up with how well this method can be trusted when shrewd free testosterone, when also needing an accurate total testosterone to go along with it. The patient should also be tested with the total testosterone test to help become a better clinical diagnosis on his condition. ground upon the manner testosterone circulates the bloodstream bound to proteins, or being free, and multiplex slipway of testing each that are not fail-proof. It appears as if testing for testosterone is not the easiest substrate in the body to go after. To help rule out hypogonadism, which may occur at whatsoever age in males, an examination of the testes would be the best option. Before puberty testes usually are 1-3cm^3 in volume. During puberty, testes can grow up to 25cm^3 in coat. The scrotum can be examined to see if it?s entirely fused. And using the tanner method for genitalia, public haircloth, and axillary hair, puberty can be staged to see where the pat ient should be (3). With this physical being conducted along with a measure of total testosterone a physician should catch a better feeling on whether or not this patient has hypogonadism or low testosterone levels. Normal name ranges are also crucially historic in find if a patient is honorable or diseased. The testosterone prescript reference ranges are based on small samples of convenience, so not surprisingly normal reference ranges qualify considerably from wisdom lab to laboratory. beginning ranges on average in healthy junior men hunt down to be from 275-1000ng/dl with separate ranges for subgroups (1). Reference ranges in children are particularly abstruse in that populations of children have different growth velocities, bone age, hair growth, and other factors to consider (1). Therefore it?s not out-of-doors what puberty attribute to link high or low testosterone to. Testosterone varying so much in a normal population also transfers down to when trying to de termine a normal testosterone level for a child. With! children being able to hit puberty at different ages it is hard to accurately set up any kind of reference range for children that is trustworthy.
It is sort of possible that the boy may be just fine at his true testosterone level, for a couple years later puberty may start to take wrap up and end with him in the reference range. In a study with 55 boys all of them displayed diurnal rhythm of serum testosterone before and during pubertal development. In pre-pubertal boys the testosterone concentrations at 0600-1000 hours showed the highest values. During puberty the concentration at 0600h was importantly high t han that at 1000, 1400, 1800, 2200, and 0200h. The lowest concentrations were observed from 1800-2200h (4). These diurnal rhythms are parkland and more severe in puberty, but they do tend to flatten out the older the child gets. testing for testosterone in may cases may not take into flier diurnal rhythms and the effect they may have on testosterone levels. If a novel patient is tested early in the sunrise he will have a higher testosterone level and so if he was tested for testosterone later in the evening. A misadventure comes up as to if the boy was tested in the dawning for his first test, and at night for his second test. This time sort in testing may be square along with other possible factors to have him appear to have a lower testosterone level. To answer the question if the patient?s results are low are high first off requires an brain of the reference range for the patients age group. With no trunk of the onset of puberty, and taking diurnal cycles of testoster one into account, it may be hard to have an accurate ! reference range to compare a healthy or diseased child to. Multiple ways of testing each with positive or negatives add no trunk to a testing for testosterone. Without evaluation of the total testosterone along with other hormones it becomes hard to narrow down a solution. 1. Bhasin, Shalender, Anqi Zhang, and Andrea Coviello. July 2008. The tinge of assay quality and reference ranges in clinical decision making in the diagnosis of androgen disorders. Steroids. 2008: 1311-13172. Kaplan, Lawrence A. clinical chemical science: Theory, Analysis, Correlation. Mosby, Inc. 2003: 864-868 . 3. Kemp, Stephen MD PhD. Hypogonadism. Updated November 16, 2007. http://emedicine.medscape.com/article/922038-overview4. Norjavaara, Ensio and Carina Lindgren. ?Changes of diurnal rhythm and levels of total and free testosterone secretion from pre to late puberty in boys: crackpot size of 3ml is a transition stage to puberty.? European journal of Endocrinology. (2004) 747-7575. Ronald S. Swerdloff and Christina Wang. ?Free Testosterone Measurement by Analog Displacement channel halt: Old Concerns and New Evidence.? American Association of Clinical Chemistry, Inc (2008): 54:458-460 If you want to get a full essay, order it on our website:
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