{"id":1082,"date":"2016-12-08T22:23:20","date_gmt":"2016-12-08T21:23:20","guid":{"rendered":"http:\/\/www.newslab.sk\/2016\/12\/08\/hormony-v-diagnostike-poruch-reprodukcnych-funkcii\/"},"modified":"2017-10-04T14:38:29","modified_gmt":"2017-10-04T12:38:29","slug":"hormones-in-diagnosis-of-reproductive-function-disorders","status":"publish","type":"post","link":"https:\/\/www.newslab.sk\/en\/hormones-in-diagnosis-of-reproductive-function-disorders\/","title":{"rendered":"Hormones in diagnosis of reproductive function disorders"},"content":{"rendered":"<pre><strong><span style=\"color: #ff0000;\">*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf \r\nattachment at the end of the paper. <\/span><\/strong><\/pre>\n<p>&nbsp;<\/p>\n<p><strong>Kli<\/strong><strong>ni<\/strong><strong>c<\/strong><strong>k<\/strong><strong>\u00fd v\u00fdznam<\/strong><\/p>\n<p>Vy\u0161etrenie hlad\u00edn horm\u00f3nov pri poruch\u00e1ch reproduk\u010dn\u00fdch funkci\u00ed je rutinnou \u00a0s\u00fa\u010das\u0165ou \u00a0ich \u00a0diferenci\u00e1lnej diagnostik y a zah\u0155\u0148a \u0161irok\u00e9 spektrum \u00a0l\u00e1tok. Okrem \u00a0fertilitn\u00fdch \u00a0horm\u00f3nov, teda produktov pohlavn\u00fdch \u00a0\u017eliaz, sa stanovuj\u00fa ich regula\u010dn\u00e9 horm\u00f3ny \u00a0hypofyz\u00e1rneho a hypotalamick\u00e9ho, ako aj androg\u00e9ny \u00a0a ich prekurzory nadobli\u010dkov\u00e9ho p\u00f4vodu. \u00a0Pre \u0161\u00edrku endokrinologickej problematiky v tejto oblasti uv\u00e1dzame preh\u013ead naj\u010dastej\u0161\u00edch horm\u00f3nov a ich vyu\u017eitie v medic\u00ednskej v praxi.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>V<\/strong><strong>y<\/strong><strong>\u0161e<\/strong><strong>t<\/strong><strong>r<\/strong><strong>e<\/strong><strong>ni<\/strong><strong>e ovari\u00e1lnej dysfunkcie<br \/>\n<\/strong>Prim\u00e1rna amenorea (oneskoren\u00e1 puberta)<\/p>\n<p>Nepr\u00edtomnos\u0165 \u00a0v\u00fdvoja sekund\u00e1rnych pohlavn\u00fdch \u00a0znakov u diev\u010dat vo veku 12 \u2013 13 rokov alebo u diev\u010dat nad 16 rokov s inak norm\u00e1lnym pubert\u00e1lnym v\u00fdvojom vy\u017eaduje podrobnej\u0161iu diagnostiku. Naj\u010dastej\u0161\u00edmi pr\u00ed\u010dinami v klesaj\u00facom \u00a0porad\u00ed \u00a0s\u00fa:<br \/>\nchromoz\u00f3mov\u00e9 \u00a0abnormality ved\u00face k dysgen\u00e9ze \u00a0ov\u00e1ri\u00ed, hypotalamick\u00e1 \u00a0dysfunkcia, anatomick\u00e9 anom\u00e1lie vonkaj\u0161\u00edch pohlavn\u00fdch org\u00e1nov, poruchy hypof\u00fdzy.<\/p>\n<p><strong>Odpor\u00fa\u010dan\u00e9 laborat\u00f3rne vy\u0161etrenia:<\/strong> FSH, LH, estradiol, prolakt\u00edn, testoster\u00f3n, TSH a f T4. N\u00edzke hodnoty \u00a0E2 m\u00f4\u017eu potvrdi\u0165 ch\u00fdbanie ovari\u00e1lnej estrog\u00e9novej aktivity. Hodnoty FSH a LH rozl\u00ed\u0161ia hypogonadotropn\u00fd a hypergonadotropn\u00fd hypogonadizmus. Zv\u00fd\u0161en\u00e9 hodnoty prolakt\u00ednu a\/alebo abnormality TSH a f T4 m\u00f4\u017eu poukazova\u0165 na hypofyz\u00e1rnu pr\u00ed\u010dinu. Norm\u00e1lne hladiny horm\u00f3nov \u00a0u \u017eien s prim\u00e1rnou amenoreou, \u00a0ale inak norm\u00e1lnym \u00a0v\u00fdvojom pohlavn\u00fdch\u00a0 znakov m\u00f4\u017eu znamena\u0165 pr\u00edtomnos\u0165 anatomick\u00fdch kongenit\u00e1lnych abnormal\u00edt (tabu\u013eka 1).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Sekund\u00e1rna amenorea a oligoamenorea<\/strong><\/p>\n<p>Sekund\u00e1rna amenorea (vymiznutie predt\u00fdm norm\u00e1lnej men\u0161tru\u00e1cie na viac ako 3 mesiace) a oligoamenorea (MC dlh\u0161\u00ed ako 35 \u2013 40 dn\u00ed) s\u00fa po vyl\u00fa\u010den\u00ed gravidity a lakt\u00e1cie naj\u010dastej\u0161ie hypotalamick\u00e9ho p\u00f4vodu alebo s\u00fa sp\u00f4soben\u00e9 syndr\u00f3mom \u00a0polycystick\u00fdch ov\u00e1ri\u00ed (PCOS) a pred\u010dasn\u00fdm zlyhan\u00edm ov\u00e1ri\u00ed (tabu\u013eka 2).<br \/>\n<strong>Odpor\u00fa\u010dan\u00e9 laborat\u00f3rne vy\u0161etrenia:<\/strong> prolakt\u00edn a TSH na vyl\u00fa\u010denie hyperprolaktin\u00e9mie a hypotyre\u00f3zy; FSH, LH a estradiol; testoster\u00f3n \u00a0pri podozren\u00ed na PCOS, pr\u00edpadne in\u00e9 androg\u00e9ny (vi\u010f ni\u017e\u0161ie).<\/p>\n<p>U \u017eien s nepravideln\u00fdm krv\u00e1can\u00edm je vhodn\u00e9 \u00a0stanovi\u0165 FSH, LH na 4. de\u0148 MC. Pri dlhodobej amenorei nie je pravdepodobn\u00e1 cyklick\u00e1 sekr\u00e9cia gonadotrop\u00ednov, preto \u010dasovanie odberu nie je potrebn\u00e9. Rovnako sa odpor\u00fa\u010da odstup minim\u00e1lne 2 t\u00fd\u017edne od predch\u00e1dzaj\u00facej estrog\u00e9ngestag\u00e9novej medik\u00e1cie.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Hyperandrogenizmy<\/strong><\/p>\n<p>Zv\u00fd\u0161en\u00e1 produkcia androg\u00e9nov u \u017eien b\u00fdva \u010dastou pr\u00ed\u010dinou ovari\u00e1lnej dysfunkcie. Jej prejavmi s\u00fa akn\u00e9, hirzutizmus, viriliz\u00e1cia a poruchy plodnosti. Nadobli\u010dky a ov\u00e1ri\u00e1 produkuj\u00fa slab\u00e9 androg\u00e9ny (DHEAS, DHEA a androstenedi\u00f3n), ktor\u00e9 sa v perif\u00e9rnych tkaniv\u00e1ch (tuk a ko\u017ea) premie\u0148aj\u00fa na silnej\u0161ie androg\u00e9ny. Priamy androg\u00e9nny \u00fa\u010dinok m\u00e1 TEST a jeho biologicky akt\u00edvny metabolit dihydrotestoster\u00f3n (DHT).<br \/>\n<strong>Pr\u00ed\u010diny hypernadrogenizmu \u00a0u \u017eien:<\/strong> syndr\u00f3m polycystick\u00fdch ov\u00e1ri\u00ed (PCOS), kongenit\u00e1lna adren\u00e1lna hyperpl\u00e1zia (KAH \u2013 neskor\u00e1 forma, deficit 21-hydroxyl\u00e1zy), Cushingov syndr\u00f3m, adren\u00e1lne alebo ovari\u00e1lne tumory.<br \/>\nPCOS je naj\u010dastej\u0161ou endokrinnou poruchou u \u017eien vo fertilnom veku a jeho podstatou je porucha selekcie dominantn\u00e9ho \u00a0folikulu \u00fastiaca do anovul\u00e1cie. PCOS je diagnostikovan\u00fd \u00a0na z\u00e1klade pr\u00edtomnosti \u00a0v\u0161etk\u00fdch troch AES krit\u00e9ri\u00ed (2006):<\/p>\n<ul>\n<li>klinick\u00e9 alebo biochemick\u00e9 zn\u00e1mky hyperandrogenizmu<\/li>\n<li>ovari\u00e1lna dysfunkcia (oligoamenorea alebo anovul\u00e1cia) a\/alebo polycystick\u00e9 ov\u00e1ri\u00e1 potvrden\u00e9 USG vy\u0161etren\u00edm<\/li>\n<li>vyl\u00fa\u010denie in\u00fdch pr\u00ed\u010din nadbytku androg\u00e9nov (5)<\/li>\n<\/ul>\n<p>K biochemick\u00fdm \u00a0zn\u00e1mkam PCOS patria zv\u00fd\u0161en\u00e9 hladiny TEST a LH, k\u00fdm FSH b\u00fdva norm\u00e1lny alebo zn\u00ed\u017een\u00fd. Pomer LH\/FSH sa pri PCOS na rozdiel od zdrav\u00fdch jedincov zvy\u0161uje. Okrem \u00a0TEST m\u00f4\u017eu by\u0165 zv\u00fd\u0161en\u00e9 hladiny androstendi\u00f3nu a DHEA, ktor\u00e9 s\u00fa aj ovari\u00e1lneho p\u00f4vodu. Naopak, DHEAS je len nadobli\u010dkov\u00e9ho p\u00f4vodu, pri PCOS b\u00fdva zv\u00fd\u0161en\u00fd len u 20 % \u017eien. TEST nemus\u00ed by\u0165 zv\u00fd\u0161en\u00fd u \u017eien s minim\u00e1lnymi klinick\u00fdmi pr\u00edznakmi. Pr\u00edklad diagnostick\u00e9ho protokolu uv\u00e1dza tabu\u013eka 3.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>V<\/strong><strong>y<\/strong><strong>\u0161e<\/strong><strong>t<\/strong><strong>r<\/strong><strong>e<\/strong><strong>n<\/strong><strong>i<\/strong><strong>a pri poruch\u00e1ch plodnosti<\/strong><\/p>\n<p>Podrobnej\u0161ie vy\u0161etrenie \u017eeny sa spravidla uskuto\u010d\u0148uje, ak k oplodneniu ned\u00f4jde po\u010das 12 mesiacov u \u017eeny mlad\u0161ej ako 35 rokov alebo po\u010das 6 mesiacov u \u017eeny star\u0161ej ako 35 rokov. Po\u010diato\u010dn\u00e9 \u00a0vy\u0161etrenia maj\u00fa za \u00falohu potvrdi\u0165 pr\u00edtomnos\u0165 ovul\u00e1cie.<\/p>\n<p>Stanovenie progester\u00f3nu m\u00e1 by\u0165 vykonan\u00e9 7 dn\u00ed pred o\u010dak\u00e1vanou men\u0161tru\u00e1ciou (napr\u00edklad v 21. de\u0148 pravideln\u00e9ho 28-d\u0148ov\u00e9ho MC) a o ovul\u00e1cii sved\u010dia hodnoty PROG nad 30 nmol\/l \u00a0(tabu\u013eka 4). U \u017eien s pred\u013a\u017een\u00fdmi \u00a0cyklami by mal by \u0165 PROG stanoven\u00fd v 21. de\u0148 cyklu a potom ka\u017ed\u00fdch sedem dn\u00ed a\u017e do objavenia sa men\u0161tru\u00e1cie (alebo sedem dn\u00ed pred o\u010dak\u00e1vanou men\u0161tru\u00e1ciou, ak s\u00fa cykly pred\u013a\u017een\u00e9, ale pravideln\u00e9). FSH, LH a estradiol by mali by\u0165 stanoven\u00e9 na 2. \u2013 6. de\u0148 MC, zv\u00fd\u0161en\u00e9 hodnoty FSH m\u00f4\u017eu poukazova\u0165 na zn\u00ed\u017een\u00fa ovari\u00e1lnu rezervu a mo\u017enos\u0165 pred\u010dasn\u00e9ho ovari\u00e1lneho zlyhania. Ovari\u00e1lna nedostato\u010dnos\u0165 predstavuje kontinuum por\u00fach, ktor\u00e9 mo\u017eno rozdeli\u0165 na \u0161tyri klinick\u00e9 stavy (tabu\u013eka 5).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Pos\u00fadenie ovari\u00e1lnej rezervy<\/strong><\/p>\n<p>Vy\u0161etrenie je ur\u010den\u00e9 pre \u017eeny nad 35 rokov, najm\u00e4 po chirurgick\u00fdch v\u00fdkonoch na vaje\u010dn\u00edkoch, alebo ak neodpovedaj\u00fa na exog\u00e9nnu stimul\u00e1ciu gonadotrop\u00ednmi. Medzi z\u00e1kladn\u00e9 biochemick\u00e9 \u00a0testy, ktor\u00e9 maj\u00fa odhali\u0165 zn\u00e1mky starnutia ov\u00e1ri\u00ed, patr\u00ed vy\u0161etrenie FSH a anti-M\u00fcllerovho horm\u00f3nu (AMH). AMH odr\u00e1\u017ea ve\u013ekos\u0165 a po\u010det primordi\u00e1lnych folikulov a je v\u010dasn\u00fdm\u00a0prediktorom poklesu ovari\u00e1lnej funkcie. V s\u00favislosti s pos\u00favan\u00edm gravidity do vy\u0161\u0161\u00edch vekov\u00fdch skup\u00edn je stanovenie AMH citlivej\u0161\u00edm a v\u010dasnej\u0161\u00edm indik\u00e1torom pred\u010dasn\u00e9ho \u00a0ovari\u00e1lneho \u00fatlmu ako FSH. \u017deny s vy\u0161\u0161ou hladinou AMH a ni\u017e\u0161ou hladinou FSH v krvi maj\u00fa v\u00e4\u010d\u0161iu \u0161ancu na \u00faspe\u0161n\u00fa ovari\u00e1lnu stimul\u00e1ciu pri IVF (tabu\u013eka 6).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>V<\/strong><strong>y<\/strong><strong>\u0161e<\/strong><strong>t<\/strong><strong>r<\/strong><strong>e<\/strong><strong>ni<\/strong><strong>e v perimenopauze a menopauze<\/strong><\/p>\n<p>Pre perimenopauzu \u00a0je typick\u00fd nepravideln\u00fd MC v trvan\u00ed minim\u00e1lne 1 rok. Hladiny \u00a0horm\u00f3nov \u00a0v tomto \u00a0obdob\u00ed v\u00fdrazne \u00a0kol\u00ed\u0161u, preto \u00a0jedin\u00e9 vy\u0161etrenie nesta\u010d\u00ed na jej potvrdenie. Diagn\u00f3za perimenopauzy \u00a0je zvy\u010dajne klinick\u00e1, hladiny FSH (odber na 2. \u2013 6. de\u0148, ak je cyklus zachovan\u00fd) s\u00fa zv\u00fd\u0161en\u00e9 &gt; 30 IU\/l. Vy\u0161etrenie horm\u00f3nov\u00a0 na diagnostiku menopauzy alebo monitorovanie pri substitu\u010dnej hormon\u00e1lnej lie\u010dbe nie je rutinne odpor\u00fa\u010dan\u00e9. V \u0161pecifick\u00fdch \u00a0situ\u00e1ci\u00e1ch, ke\u010f amenorea nie je relevantn\u00fdm sympt\u00f3mom menopauzy, napr\u00edklad u \u017eien, ktor\u00e9 ned\u00e1vno prestali u\u017e\u00edva\u0165 or\u00e1lnu antikoncepciu alebo ktor\u00e9 podst\u00fapili hysterekt\u00f3miu, sa odpor\u00fa\u010da stanovenie FSH.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>V<\/strong><strong>y<\/strong><strong>\u0161e<\/strong><strong>t<\/strong><strong>r<\/strong><strong>ovanie fertilitn\u00fdch horm\u00f3nov u mu\u017ea<\/strong><\/p>\n<p>Medzi naj\u010dastej\u0161ie \u00a0indik\u00e1cie v y\u0161etrenia fertilitn\u00fdch horm\u00f3nov u mu\u017eov patr\u00ed hypogonadizmus, gynekomastia, poruchy plodnosti a erek tiln\u00e1 dysfunkcia. Bez jasn\u00e9ho porozumenia\u00a0 genetiky, fyziol\u00f3gie a komplexnej regul\u00e1cie reproduk\u010dn\u00e9ho \u00a0syst\u00e9mu \u00a0je vy\u0161etrenie \u010dasto neefekt\u00edvne.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Poruchy plodnosti a mu\u017esk\u00fd hypogonadizmus<\/strong><\/p>\n<p>Endokrinn\u00e9 \u00a0pr\u00ed\u010diny zn\u00ed\u017eenej fertility s\u00fa pr\u00edtomn\u00e9 \u00a0asi u 20 % mu\u017eov. U eugonad\u00e1lneho mu\u017ea s norm\u00e1lnym po\u010dtom spermi\u00ed spravidla nie je potrebn\u00e9 vy\u0161etrenie horm\u00f3nov. U mu\u017ea s oligospermiou je potrebn\u00e9 vy\u0161etri\u0165 LH, FSH a testoster\u00f3n na diferenci\u00e1lnu diagnostiku prim\u00e1rneho (hypogonadotropn\u00e9ho) a sekund\u00e1rneho (hypergonadotropn\u00e9ho) hypogonadizmu (tabu\u013eka 7).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Interpret\u00e1cia: \u00a0<\/strong>Odber na stanovenie testoster\u00f3nu by sa mal vykona\u0165 r\u00e1no, ke\u010f\u017ee hodnoty popoludn\u00ed a ve\u010der s\u00fa signifikantne ni\u017e\u0161ie. Koncentr\u00e1cia TEST b\u00fdva ovplyvnen\u00e1 zmenami \u00a0SHBG, preto by sa mal u mu\u017eov s patologick\u00fdmi koncentr\u00e1ciami SHBG alebo n\u00edzkym celkov\u00fdm TEST vypo\u010d\u00edta\u0165 index vo\u013en\u00e9ho testoster\u00f3nu (FAI). Ak je TEST hrani\u010dn\u00fd alebo n\u00edzky, malo by sa vy\u0161etrenie zopakova\u0165 so s\u00fa\u010dasn\u00fdm stanoven\u00edm LH na diferenci\u00e1ciu medzi prim\u00e1rnym a sekund\u00e1rnym hypogonadizmom. Ak je hodnota LH n\u00edzka, mal by sa stanovi\u0165 aj prolakt\u00edn, FSH u mu\u017eov sa vy\u0161etruje len v s\u00favislosti s poruchami plodnosti. Ne\u010dakane vysok\u00e9 koncentr\u00e1cie LH, FSH m\u00f4\u017eu by\u0165 d\u00f4sledkom ich pulzn\u00e9ho uvo\u013e\u0148ovania.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Gynekomastia<\/strong><\/p>\n<p>Asi 75 % pr\u00edpadov gynekomastie sp\u00f4sobuj\u00fa\u00a0 poruchy ved\u00face \u00a0k nerovnov\u00e1he medzi androg\u00e9nmi a estrog\u00e9nmi \u00a0(tabu\u013eka 8). Tieto zah\u0155\u0148aj\u00fa najm\u00e4 zn\u00ed\u017een\u00fa tvorbu androg\u00e9nov \u00a0pri hypogonadizme \u00a0alebo zv\u00fd\u0161en\u00fa tvorbu estrog\u00e9nov \u00a0r\u00f4znymi endokrinne akt\u00edvnymi n\u00e1dormi, ktor\u00e9 bu\u010f priamo syntetizuj\u00fa estrog\u00e9ny, alebo secernuj\u00fa HCG (testikul\u00e1rne tumory), ktor\u00fd stimuluje tvorbu estrog\u00e9nov. Lieky tvoria asi 20 % v\u0161etk\u00fdch pr\u00ed\u010din gynekomastie.<\/p>\n<p><strong><em>L<\/em><\/strong><em><strong>aborat\u00f3rne vy\u0161etrenia:<\/strong> <\/em>testoster\u00f3n, ak je TEST n\u00edzky aj LH, estradiol a HCG.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>P<\/strong><strong>r<\/strong><strong>e<\/strong><strong>d<\/strong><strong>an<\/strong><strong>a<\/strong><strong>l<\/strong><strong>y<\/strong><strong>t<\/strong><strong>i<\/strong><strong>c<\/strong><strong>k<\/strong><strong>\u00e9 podmienky<\/strong><\/p>\n<p><strong>Odber na v\u0161etky horm\u00f3ny:<\/strong> s\u00e9rum v skle alebo plaste, u premonopauz\u00e1lnych \u017eien uvies\u0165 de\u0148 cyklu. Vy\u0161etrenie sa mus\u00ed vykona\u0165 e\u0161te v de\u0148 odberu a materi\u00e1l spracova\u0165 do 8 hod\u00edn. V pr\u00edpade uskladnenia musia by \u0165 splnen\u00e9 podmienky 2 \u2013 8 \u00b0C maxim\u00e1lne 2 dni, \u00a0v pr\u00edpade zmrazenia -20 \u00b0C po obdobie 1 mesiac. <strong>17-hydroxyprogester\u00f3n:<\/strong> odber vykona\u0165 r\u00e1no, u men\u0161truuj\u00facich \u017eien vo folikul\u00e1rnej f\u00e1ze.<br \/>\n<strong>SHBG:<\/strong> odber vykona\u0165 nala\u010dno.<br \/>\n<strong>Prolakt\u00edn:<\/strong> odber \u00a0vykona\u0165 \u00a03 hodiny po prebuden\u00ed (optim\u00e1lne medzi 8.00 \u2013 10.00 hodinou).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>I<\/strong><strong>n<\/strong><strong>t<\/strong><strong>e<\/strong><strong>r<\/strong><strong>f<\/strong><strong>e<\/strong><strong>r<\/strong><strong>e<\/strong><strong>n<\/strong><strong>c<\/strong><strong>ie<br \/>\n<\/strong>Hemol\u00fdza: AMH<br \/>\nLip\u00e9mia: \u00a0\u03b2-HCG<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Z\u00e1ver<\/strong><\/p>\n<p>Laborat\u00f3rne vy\u0161etrenie hormon\u00e1lneho stavu organizmu predstavuje d\u00f4le\u017eit\u00fa s\u00fa\u010das\u0165 vy\u0161etren\u00ed v diferenci\u00e1lnej diagnostike gynekologick\u00fdch a andrologick\u00fdch endokrinopati\u00ed. Porozumenie fyziol\u00f3gie a patofyziol\u00f3gie\u00a0je k\u013e\u00fa\u010dov\u00fdm pri po\u017eadovan\u00ed vy\u0161etrenia pohlavn\u00fdch horm\u00f3nov v prav\u00fd \u010das a na spr\u00e1vnu interpret\u00e1ciu v\u00fdsledkov.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>L<\/strong><strong>it<\/strong><strong>e<\/strong><strong>ra<\/strong><strong>t<\/strong><strong>\u00fa<\/strong><strong>ra<\/strong><\/p>\n<p>1. Walace AM, Sattar N. The changing role of clinical laboratory in the investigation of polycystic ovarian syndrome. Clin. Biochem Rev. 2007;28(8):79\u201392.<br \/>\n2. V\u00e1clavov\u00e1 Z, Borovsk\u00fd M, Payer J. Algoritmus hormon\u00e1lnych vy\u0161etren\u00ed v diferenci\u00e1lnej diagnostike gynekologick\u00fdch endokrinopati\u00ed. Praktick\u00e1 gynekol\u00f3gie. 2002;3:23\u201326.<br \/>\n3. Pinkerton JV. Amenorrhoea. The Merck Manuals [online]. Available from: &lt;www.merckmanuals.com\/professional\/gynecology-and-obstetrics\/menstrual-abnormalities.&gt;.<br \/>\n4. Reproductive hormones: The right test at the right time, for the right patient [online]. Available from: &lt;http:\/\/www.bpac.org.nz\/BT\/2013\/February\/docs\/best_tests_feb2013_reproductive_<br \/>\nhormones_pages_12-22.pdf.&gt;.<br \/>\n5. Azziz R, et al. Position statement: Criteria for Defining Polycystic Ovary Syndromes a Predominantly Hyperandrogenic Syndrome: An Androgen Excess Society Guideline. J Clin. Endocrinol.<br \/>\nMetab. 2006;91(11):4.<br \/>\n6. Rebar RW. Decreased Ovarian Reserve [online]. Available from: &lt;http:\/\/www.merckmanuals.com\/professional\/gynecology-and-obstetrics\/infertility&gt;.<br \/>\n7. Ovarian reserve testing. Committee Opinion No. 618. American College of Obstetricians and Gynecologists. ObstetGynecol. 2015;125:268\u201373.<br \/>\n8. Kreze A, et al. V\u0161eobecn\u00e1 a praktick\u00e1 endokrinol\u00f3gia. Bratislava: Academic Electronic Press, s. r. o.; 2004: 430\u2013441.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf attachment at the end of the paper. &nbsp; Klinick\u00fd v\u00fdznam Vy\u0161etrenie hlad\u00edn horm\u00f3nov pri poruch\u00e1ch reproduk\u010dn\u00fdch funkci\u00ed je rutinnou \u00a0s\u00fa\u010das\u0165ou \u00a0ich \u00a0diferenci\u00e1lnej diagnostik y a zah\u0155\u0148a \u0161irok\u00e9 spektrum \u00a0l\u00e1tok. Okrem \u00a0fertilitn\u00fdch \u00a0horm\u00f3nov, teda produktov pohlavn\u00fdch \u00a0\u017eliaz, sa<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false,"footnotes":""},"categories":[289],"tags":[681,645,680,679],"class_list":["post-1082","post","type-post","status-publish","format-standard","hentry","category-biochemistry","tag-infertility","tag-laboratory-diagnosis","tag-ovarian-dysfunction","tag-reproductive-hormones","typ_clanku-review-article"],"acf":{"abstrakt":"<p>The most frequent indications for measuring of reproductive hormones in females involves investigating primary or secondary amenorrhoea or oligomenorrhoea, testing for causes of infertility or confirming pregnancy. Endocrine causes of infertility in men are rare, but hormonal analysis plays an important role in seeing such patients. Further indications for hormonal testing in men include hypogonadisms, gynaecomastia and erectile dysfunction. Interpretation of hormonal tests requires physiological regulation of reproductive system and how their levels depend on the stage of the menstrual cycle. The topic of hormonal diagnosis in reproductive dysfunctions is very wide therefore the report offers only a brief overview.<\/p>\n<p><strong>Key words: <\/strong>reproductive hormones, ovarian dysfunction, infertility, laboratory diagnosis<\/p>\n","casopis":[{"ID":995,"post_author":"7","post_date":"2016-11-16 12:14:30","post_date_gmt":"2016-11-16 11:14:30","post_content":"<h4><strong>Biochemistry <\/strong><\/h4>\r\n<ul>\r\n \t<li>Biochemical inflammation markers<\/li>\r\n \t<li>Biochemical examinations in liver diseases<\/li>\r\n \t<li>Biochemical diagnosis in diseases of GIT<\/li>\r\n \t<li>Hypoglycemia<\/li>\r\n \t<li>Urolithiasis as a result of metabolic diseases<\/li>\r\n \t<li>Indication and application of tumor markers in clinical practice<\/li>\r\n \t<li>Monoclonal gammopathies \u2013 laboratory examinations in diagnosis and monitoring<\/li>\r\n \t<li>Hormones in diagnosis of reproductive function disorders<\/li>\r\n \t<li>Cerebrospinal fluid diagnosis of diseases affecting the nervous system<\/li>\r\n \t<li>Determining trace elements in blood serum<\/li>\r\n<\/ul>\r\n<h4><strong>Genetics<\/strong><\/h4>\r\n<ul>\r\n \t<li>Assessing the therapeutic response in patients with chronic myelocyte leukemia treated with tyrosine kinase inhibitors<\/li>\r\n \t<li>Hormones in diagnosis of reproductive functions\u2019 disorders<\/li>\r\n<\/ul>\r\n<h4><strong>Hematology <\/strong><\/h4>\r\n<ul>\r\n \t<li>Anemias \u2013 laboratory diagnosis of the most frequently prevalent types of anemia<\/li>\r\n \t<li>Laboratory and hematological technical equipment<\/li>\r\n<\/ul>\r\n<h4><strong>Immunology <\/strong><\/h4>\r\n<ul>\r\n \t<li>Paraneoplastic neurological syndromes and in vitro diagnosis of onconeural antibodies<\/li>\r\n<\/ul>","post_title":"newslab","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"newslab","to_ping":"","pinged":"","post_modified":"2017-08-16 21:40:20","post_modified_gmt":"2017-08-16 19:40:20","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.newslab.sk\/casopis\/newslab\/","menu_order":0,"post_type":"casopis","post_mime_type":"","comment_count":"0","filter":"raw"}],"strana":"17","upload_clanok":{"ID":1083,"id":1083,"title":"durovcova_hormony_v_diagnostike","filename":"\u010eurovcov\u00e1_Hormony_v_diagnostike.pdf","filesize":176890,"url":"https:\/\/www.newslab.sk\/wp-content\/uploads\/2016\/12\/\u010eurovcov\u00e1_Hormony_v_diagnostike.pdf","link":"https:\/\/www.newslab.sk\/en\/hormones-in-diagnosis-of-reproductive-function-disorders\/durovcova_hormony_v_diagnostike\/","alt":"","author":"7","description":"","caption":"","name":"durovcova_hormony_v_diagnostike","status":"inherit","uploaded_to":1082,"date":"2016-12-08 21:10:01","modified":"2016-12-08 21:10:01","menu_order":0,"mime_type":"application\/pdf","type":"application","subtype":"pdf","icon":"https:\/\/www.newslab.sk\/wp-includes\/images\/media\/document.png"}},"_links":{"self":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1082","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/comments?post=1082"}],"version-history":[{"count":0,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1082\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/media?parent=1082"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/categories?post=1082"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/tags?post=1082"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}