Author: Wang Jingjing, Shuang Xiaojing
Unit: Xi'an Regional Medical Laboratory Center
A sex hormone test specimen from a male patient was received today.
male? Make a mistake, you check the patient information again.
Check it out, it's really the patient himself.
Ah, men also check sex hormones?
When we see a sex hormone checklist for men, we often wonder why men also have to check six sex hormones, is this not a special examination for women?
In fact, the six sex hormones are not specific to women, for example, follicle-producing hormone (FSH) was first found to have a stimulating effect on the maturation of female follicles and got its name, but in fact, it is an important hormone in both sexes.
Six items of sex hormones
The six items of sex hormones refer to follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), prolactin (PRL), progesterone (P), and testosterone (T).
Sex hormone testing is recommended in men during unprovoked breast enlargement, reproductive system dysplasia, abnormal male features, male infertility, and hormonal drug therapy.
1
Case studies
On February 16, 2022, Xi'an Regional Medical Laboratory Center received a sample from the regional outlet, the testing room of Yongle Center Health Center, the patient was male, 53 years old, the test items were PSA and sex hormones, and the test results were as follows:
The first reaction after seeing the report form is to wonder, why is it a male patient? Was it a gender input error or a sample that was not my own?
After checking with the blood collection staff of the laboratory of the outlet, it is determined that the patient himself is determined.
Why do the results show that FSH and LH are more than twice as high, testosterone is lower, while PSA is within the normal range?
After communicating with clinicians, it was learned that this patient was indeed male, and in June 2021, he was pathologically diagnosed with prostate cancer with bone metastasis, and the Gleason classification value was 4-5.
After prostate cancer castration surgery and adjuvant androgen-suppressing drugs, postoperative oral androgen-suppressing drugs were taken, and this examination was routine postoperative treatment monitoring.
LH is elevated because the pituitary gland secretes FSH and LH act on the testicles, producing male hormones that keep them at high concentrations of androgen levels. However, in this case, the patient underwent prostate cancer castration surgery and androgen-suppressing adjuvant drug therapy, so that the pituitary gland secreted FSH and LH could not act on the testicles, and the concentrations of FSH and LH increased.
Testosterone is mainly produced by LH-stimulating interstitial cells of the testicles, so testosterone levels decrease rapidly after castration surgery. The decrease in testosterone concentration directly promotes the secretion of GnRH in the hypothalamus through negative feedback mechanisms, and indirectly promotes the secretion of FSH and LH in the pituitary gland. Therefore, the indicators of FSH and LH hormones detected in the blood are increased, and the concentration of testosterone is reduced.
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Bone metastases from prostate cancer
Why do patients get prostate cancer bone metastasis at just 53 years old?
According to data released by the World Health Organization's International Agency for Research on Cancer in 2020, prostate cancer occurs per 100,000 people in all age groups.
The data showed that men under the age group of 40 had a lower incidence of prostate cancer (
We can't help but think deeply, prostate cancer patients are mostly elderly men, the age of onset is mostly over 60 years old, but the patients in the case are only 53 years old, which is unexpected. With the aging of the mainland population, dietary structure, lifestyle changes and other factors, the incidence of prostate cancer is increasing year by year. In order to have a healthy body, it is necessary to screen as early as possible.
The PSA in the report sheet is a prostate-specific antigen secreted by prostate acinar and ductal epithelial cells, is prostate tissue-specific, and can be used for individualized screening for prostate cancer.
In 2020, the Chinese Society of Clinical Oncology recommended screening populations
Category 1 recommendations: > 50 years; > 45 years old with a family history of prostate cancer; > 40 years old with BRCA2 gene mutations; category 2 recommendations: life expectancy of at least 10-15 years.
Recommended screening frequency: Category II recommendation: follow-up of PSA every two years.
The 2022 edition of the "Guidelines for Prostate Cancer Screening and Early Diagnosis and Early Treatment in China" gives recommendations on prostate cancer screening technology
1. PSA is recommended as the preferred method for prostate cancer screening, and the critical value of PSA is 4.0ng/ml (strong recommendation, evidence classification: medium);
2. It is not recommended to use positron emission computed tomography, ultrasound or magnetic resonance imaging alone for prostate cancer screening (strong recommendation, evidence grading: medium);
3. It is not recommended to use digital rectal examination alone for prostate cancer screening, and it is recommended that the digital rectal examination be used as an auxiliary examination when the initial examination of PSA is positive (strong recommendation, evidence grading: Medium).
The 2022 edition of the "Guidelines for Prostate Cancer Screening and Early Diagnosis and Early Treatment in China" gives recommendations for the management of prostate cancer screening results
1. Twice serum PSA > 4.0ng/ml, after excluding the interference of other factors affecting the PSA detection level, it is recommended that the urologist guide further clinical examination and intervention;
2. When serum PSA ≤ 4.0ng/ml, it is recommended to monitor it regularly (every two years).
The 2017 edition of NCCN Guidelines Version 2.2017 Prostate Cancer Early Detection states
Phi is committed to the diagnosis of PSA gray area, PSA at 4-10ng /ml, can be applied phi index to assist in the diagnosis of prostate cancer, reduce unnecessary trouble.
Prostate cancer is a common urinary tract tumor in men, in recent years, the incidence of prostate cancer has gradually become younger, as early as possible, regular detection of PSA, can be early prevention, early detection, early treatment of urinary diseases.
For primary health centers, unconventional testing requires going to higher-level hospitals. However, the Laboratory Department of Yongle Central Health Center is a community network laboratory established by Xi'an Regional Medical Inspection Center, and the testing projects of Xi'an Regional Medical Inspection Center can reach more than 1500, and the joint construction of grass-roots health centers allows patients to enjoy the convenience of medical treatment at their doorstep.
Xi'an Regional Medical Laboratory Center
Xi'an Regional Medical Laboratory Center is a large-scale public service people's livelihood project approved by the Xi'an Municipal Government, registered in the Ministry of Finance of the People's Republic of China, and invested and constructed by the Xi'an Municipal Health Commission as the project implementation unit, using the PPP model.
According to international standards, the center has built a core laboratory in Xixian New Area that can carry out more than 3,000 medical testing projects, upgraded the laboratory departments of 15 hospitals to 15 secondary central laboratories, and improved 450 community health service centers or the laboratory departments of township health centers into community network laboratories.
After the completion of the center, it will significantly improve the diagnosis and treatment service capacity of medical institutions in the region; effectively reduce the repeated financial investment in the construction of hospital laboratory departments; promote mutual recognition of inspection reports through the construction of a unified quality management system, so that the broad masses of people can enjoy a better medical experience while reducing medical insurance expenditures.
Edited by: Yeah Reviewer: Xiao Ran