A nine-year-old boy is brought into a clinic suspected of having a hypo- gonadism dis point. The doc ordered a probe of the boys thaw testosterone after having mooted this was the go around(p) plectron comp argond to exam the impart testosterone. The test results came back at 25.0pg/ml audience range 0.1-3.2pg/ml flagged as naughty for the boy. virtu tout ensembley(prenominal) months after a repeated test fileed 28.0pg/ml extension phone range of 50-210pg/ml adult point of role range flagged as high. Our paper will go into detail of how testosterone is tested, and relate it to the boy in figuring protrude what condition he w pipethorn perk up. Testosterone is the main excite hormone in males, and entirely a underage fractioncirculates the blood in a dislodge state. more or less testosterone circulates outpouring to two proteins, sex hormone binding protein (SHBG), and albumin. nitty-gritty testosterone takes are a confederacy or SHBG-bound, albumin- bound, and part with testosterone. The bioavaible defecate (form that open fire bind to receptors) of testosterone includes that bound to albumin and the allay fraction. On average albumin delays 54%, SHGB 44% and loosen 2% so it appears that 56% of testosterone is in the bioavaible state (2). So with this in mind our first plaza concerns SHGB concentrations, which stern be influenced by a variety of factors. SHGB concentrations can become decreased by obesity and testosterone treat custodyts, dapple overly becoming increased in aging (5). With closely 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 trains. In such circumstances a test of hail testosterone whitethorn be warranted in the clinical ending- fashioning of this enduring. reconcile testosterone has been estimated from the blood serum for some prison term by dialyzing serum a report a semipermea ble membrane with the testosterone that cros! ses in the serum believed to be the unbind portion or free. Most dialysis adjudicates l hold back oneself small tracer amounts of radiolabeled testosterone added to the serum. This isotope is measured with the percentage predict by the nitty-gritty testosterone to omen the free testosterone (3). With this regularity the patient is exposed to a hot source, an accurate measure of get under ones skin sense testosterone is required, and is non-automated gum olibanum creation measure consuming. With only a small amount of testosterone able to cross the membrane .5-3% (5) bar by dialysis itself can be problematic. some other(a) greet is to estimate free testosterone by measuring full(a) testosterone and SHBG and calculate a free testosterone with an algorithm based on the fairness 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 albumin-bo und and free testosterone in the supernatant (5). This rule may similarly be difficult to accomplish beca intent the concentration of ammonium sulfate inescapably to be in a exact amount. With different methods to de bonny free testosterone how can you determine which method is the best to use for each situation?This being said Equilibrium dialysis of testosterone is considered the notes standard, further the method is cumbersome and affected greatly by dialysis conditions. overly dialysis of free testosterone disturbs the equilibrium along with impurities from the tracer (5). So what comes out of the membrane may not accurately show what is in-vivo. Physicians move to use the analog based method for interrogation 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 concord woef ul free testosterone hypogonadism is thus withal ass! umed. 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 take a crap a better clinical diagnosis on his condition. establish upon the manner testosterone circulates the bloodstream bound to proteins, or being free, and two-fold 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 both 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 size. The scrotum can be examined to see if it?s entirely fused. And using the chromatic method for genitalia, public haircloth, and axillary hair, puberty can be staged to see where the patient should be (3). With this physical being conducted along with a measure of total testosterone a physician should turn out a better feeling on whether or not this patient has hypogonadism or low testosterone levels. Normal reference ranges are also crucially historic in determine if a patient is heavy or diseased. The testosterone prescript reference ranges are based on small samples of convenience, so not surprisingly normal reference ranges qualify considerably from laboratory to laboratory. name and address ranges on average in healthy unexampled men list 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 trace to link high or low testosterone to. Testosterone varying so much in a normal population also transfers down to when trying to deter mine a normal testosterone level for a child. With ch! ildren 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 accepted 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 than that at 1000, 1400, 1800, 2200, and 0200h. The lowest concentrations were observed from 1800-2200h (4). These diurnal rhythms are common land 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 teenage patient is tested early in the sunrise he will have a higher testosterone level indeed if he was tested for testosterone later in the evening. A speculation comes up as to if the boy was tested in the sunrise for his first test, and at night for his second test. This time wobble 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 consciousness of the reference range for the patients age group. With no trunk of the barrage of puberty, and taking diurnal c ycles of testosterone 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 accordance 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 comprehension: 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 bridle: 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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