Download Hormone Profile

Hormone Testing in
Clinical Practice: Part 2
Meridian Valley Laboratory
24-hour Urine Tests
Urinary Hormones

Part 1: Sex Hormones




Estrogen
Progesterone
Testosterone
Part 2:





Adrenal Hormones
Growth Hormone
Thyroid
Sodium/Potassium Ratio
Enzyme Activity
© 2010 Meridian Valley Laboratory
2
Metabolism of
Selected Steroids
5
© 2010 Meridian Valley Laboratory
3
Pregnenolone
The “mother” hormone
 Synthesized from cholesterol
 Involved in the steroidogenesis of:

Progesterone
 Estrogens
 Androgens
 Glucocorticoids
 Mineralocorticoids

© 2010 Meridian Valley Laboratory
4
ADRENAL HORMONES
© 2010 Meridian Valley Laboratory
5
Adrenal Hormones
Cholesterol
Pregnenolone
Progesterone
DHEA
Mineralocorticoids
Glucocorticoids
(Cortisol, et.al.)
© 2010 Meridian Valley Laboratory
Testosterone
Estrogens
6
DHEA
© 2010 Meridian Valley Laboratory
7
DHEA
Cholesterol
Pregnenolone
17-OH Pregnenolone
Androsterone
DHEA
Androstenedione
Etiocholanolone
Testosterone
© 2010 Meridian Valley Laboratory
Estrone
8
DHEA

Produced in:
Adrenal Glands
 Gonads
 Brain

DHEA  Androsterone  Testosterone &
Estrone
 Peaks around 30 years of age
 Most abundant steroid hormone

© 2010 Meridian Valley Laboratory
DHEA

Low levels associated with
Immune dysfunction
 Autoimmune disease
 Type II Diabetes
 Cancer
 Hypertension
 Cardiovascular disease
 Depression
 Cognitive dysfunction

© 2010 Meridian Valley Laboratory
DHEA

Low levels associated with
Low libido
 Osteoporosis


Suppressed by
Stress
 Excess cortisol

© 2010 Meridian Valley Laboratory
DHEA

Therapeutic Uses
 pro-inflammatory cytokines
 Anti-glucocorticoid effects
 Increases effectiveness of vaccination
 Decreases body fat
 Increases lean body mass
 Increases insulin sensitivity
 May increase activity of exogenous
thyroid hormone

© 2010 Meridian Valley Laboratory
DHEA
Cholesterol
Pregnenolone
+Rhodiola rosea
-Prednisone
-Stress
+Tribulus terrestris
+Meditation
DHEA
© 2010 Meridian Valley Laboratory
13
DHEA
© 2010 Meridian Valley Laboratory
14
PREGNANETRIOL
© 2010 Meridian Valley Laboratory
15
Pregnanetriol
Cholesterol
Pregnenolone
17-OH Pregnenolone
Progesterone
17-OH Progesterone
Pregnandiol
Pregnanetriol
Glucocorticoids
(Cortisol, et.al.)
© 2010 Meridian Valley Laboratory
16
Pregnanetriol
Byproduct of cortisol biosynthesis
 Useful in assessment of adrenal health


Increased:
 Congenital Adrenal Hyperplasia
 Adult onset Adrenal Hyperplasia
 Progesterone Supplementation
© 2010 Meridian Valley Laboratory
17
Pregnanetriol
© 2010 Meridian Valley Laboratory
18
GLUCOCORTICOIDS
© 2010 Meridian Valley Laboratory
19
Glucocorticoids
Cholesterol
Pregnenolone
Pregnanetriol
Progesterone
17-OH Progesterone
11β-OH Androsterone
Cortisol
Cortisone
Tetrahydrocortisone
11β-OH Etiocholanolone
Allo-Tetrahydrocortisol
Tetrahydrocortisol
© 2010 Meridian Valley Laboratory
20
Cortisol
Produced in the adrenal glands
 Primary stress hormone
 Weak mineralcorticoid activity
 Urinary reflects circulating
 Primary functions:

Gluconeogenesis
 Suppression of inflammation
 Fat, protein and carbohydrate
metabolism

© 2010 Meridian Valley Laboratory
21
Cortisone
“Storage” form of cortisol
 Cortisone  Cortisol via 11β-HSD
 A normal ratio with Cortisol = 0.7

© 2010 Meridian Valley Laboratory
22
Cortisol & Cortisone
+Insulin Resistance
+Human Growth Hormone
+Testosterone
+Obesity
Cortisol
11β-HSD I +Licorice
11β-HSD II
Cortisone
-Hyperthyroidism
© 2010 Meridian Valley Laboratory
23
Cortisol & Cortisone
Elevated Cortisol or Cortisone








Cushing's syndrome / Cushing's disease
Ectopic ACTH Production
Unipolar Depression
Sleep deprivation
Generalized Anxiety Disorder
PTSD
Panic Disorder, early stage
Exogenous Cortisol supplementation
© 2010 Meridian Valley Laboratory
24
Cortisol & Cortisone
Elevated Cortisol or Cortisone



Licorice root supplementation
Intensive physical exercise
Acute ingestion of Alcohol (Cortisol)
© 2010 Meridian Valley Laboratory
25
Cortisol & Cortisone
Decreased Cortisol or Cortisone





Adrenal Insufficiency
Chronic Fatigue Syndrome
Fibromyalgia
Rheumatoid Arthritis
Panic Disorder, late stage
© 2010 Meridian Valley Laboratory
26
Cortisone & Cortisol
© 2010 Meridian Valley Laboratory
27
Adrenal Insufficiency
Clinical Manifestations









Fatigue
Exercise intolerance
Hypoglycemia
Salt craving
Depression
Insomnia
Irritability
Positive Hippus test
Low blood pressure
© 2010 Meridian Valley Laboratory
28
Adrenal Excess
Clincal Manifestations




Insomnia
Anxiety
Insulin resistance
Obesity
© 2010 Meridian Valley Laboratory
29
Cortisol & Cortisone
Metabolites
Cholesterol
Pregnenolone
Pregnanetriol
Progesterone
17-OH Progesterone
11β-OH Androsterone
Cortisol
Cortisone
Tetrahydrocortisone
11β-OH Etiocholanolone
Allo-Tetrahydrocortisol
Tetrahydrocortisol
© 2010 Meridian Valley Laboratory
30
Cortisol Metabolites
© 2010 Meridian Valley Laboratory
31
ALDOSTERONE
© 2010 Meridian Valley Laboratory
32
Aldosterone
Cholesterol
Pregnenolone
Progesterone
Deoxycortisone
Corticosterone
Aldosterone
© 2010 Meridian Valley Laboratory
33
Aldosterone
Major mineralocorticoid
 Acts to increase the reabsorption of
sodium and water and to secrete
potassium
 Receptor blocked by Spironolactone
 Age related hearing loss

© 2010 Meridian Valley Laboratory
34
Aldosterone
© 2010 Meridian Valley Laboratory
35
OTHER
MINERALOCORTICOIDS
© 2010 Meridian Valley Laboratory
36
Mineralocorticoids
Cholesterol
Pregnenolone
Progesterone
Deoxycortisone
Corticosterone
Aldosterone
5α-THB
(Allo-Tetrahydrocorticosterone)
THA
(11-Dehydrotetrahydrocorticosterone)
THB
(Tetrahydrocorticosterone)
© 2010 Meridian Valley Laboratory
37
Mineralocorticoids
© 2010 Meridian Valley Laboratory
38
Mineralocorticoids
Cholesterol
Pregnenolone
Progesterone
Deoxycortisone
Corticosterone
+ ↑↑Acute Stress
-↑Salt
+ ↑↑Acute Stress
-↑Chronic Stress
-↑Chronic Stress
(11-Dehydrotetrahydrocorticosterone)
+ Pregnenolone
THA
-↑Stress
-Dehydration
-Spironolactone
Aldosterone
5α-THB
(Allo-Tetrahydrocorticosterone)
+ ↑↑Acute Stress
-↑Chronic Stress
THB
(Tetrahydrocorticosterone)
© 2010 Meridian Valley Laboratory
39
HUMAN GROWTH
HORMONE
© 2010 Meridian Valley Laboratory
40
Growth Hormone
Hypothalamus
GHRH
GHIH
– Somatostatin
+
Anterior Pituitary
Growth Factors
Adipose Tissue
Muscle
Cellular Repair and Regeneration
Bone
Cartilage
Skin
Kidney
© 2010 Meridian Valley Laboratory
Growth Hormone
Deficiency Symptoms:








Short Stature (in children)
Exercise intolerance
Strength
 Body fat
Glucose intolerance
Dyslipidemia
Fragility of skin and blood vessels
 Immune function
© 2010 Meridian Valley Laboratory
42
Growth Hormone
Excess:





Pituitary Adenoma most common cause
Thickening of bones
Sweating
Muscle weakness
 SHBG
© 2010 Meridian Valley Laboratory
43
Human Growth Hormone
© 2010 Meridian Valley Laboratory
44
Growth Hormone
+ Secretagogues
+ Glutamine (Older people)
+ Arginine (Younger people)
+ hCG
+ Melatonin
+ Resistance Training
+ Vigorous Exercise
+ Thyroid
+ Progesterone
+ Adequate Protein
+ Deep Sleep
+ Estrogen
+ Testosterone
– Sedentary Lifestyle
– Inadequate Protein
– Poor Sleep
– Insufficient endogenous hormones
© 2010 Meridian Valley Laboratory
THYROID
HORMONES
© 2010 Meridian Valley Laboratory
46
Thyroid Hormones

Thyroid Hormones Control
Speed of Protein synthesis
 Energy use
 Sensitivity to other hormones


T3 and T4
Tyrosine
 Iodine
 T4 more stable
 T3 active
 T4  T3 happens within cells

© 2010 Meridian Valley Laboratory
47
Thyroid
© 2010 Meridian Valley Laboratory
48
SODIUM / POTASSIUM
RATIO
© 2010 Meridian Valley Laboratory
49
Sodium/Potassium Ratio
Reflection of Dietary intake
 Important in prevention of

Hypertension
 Heart Attack
 Stroke


Ideal ratio = 1.5
© 2010 Meridian Valley Laboratory
50
Sodium/Potassium Ratio
© 2010 Meridian Valley Laboratory
51
ENZYME ACTIVITY
© 2010 Meridian Valley Laboratory
52
5a-Reductase
© 2010 Meridian Valley Laboratory
53
5α-Reductase
– Dutasteride
– Finasteride
– Green Tea Extract
– Progesterone
– Saw Palmetto
– Zinc
– GLA
5α-Reductase
© 2010 Meridian Valley Laboratory
11-B Hydroxysteroid
Dehydrogenase
© 2010 Meridian Valley Laboratory
55
Urine Hormone Profiles
24-Hour Urine Hormone Profiles:







DHEA
Assess adrenal health
Tailor adrenal supportive therapies
Assess Growth Hormone
Assess Thyroid
Identify risk factors for CVD
Identify enzyme imbalances
© 2010 Meridian Valley Laboratory
56
Next Webinar...
Monday, September 27th
1pm PDT
Hormone Testing in Clinical Practice: Part 3
Cases: Interpreting 24-Hour Urine Hormone Profiles