![]() ![]() Artificially low LH and FSH results may occur in patients taking oral contraceptives and hormone treatments. Drugs, such as anticonvulsants, clomiphene, and naloxone, may falsely elevated LH, whereas smoking, cimetidine, clomiphene, digitalis, and levodopa cause elevated FSH. Evaluate results in the context of age and Tanner stage specific reference intervals. It is recommended to measure LH and FSH early in the follicular phase of the cycle if possible.Ĭoncentrations of LH and FSH change dramatically during puberty. LH and FSH concentrations change throughout the menstrual cycle, even in amenorrheic patients. LH and FSH are episodically released from the pituitary, and concentrations may vary, depending on when they are measured during the day. Any of these may lead to dysregulation of gonadotropins, amenorrhea, and infertility. Prolactin is mildly elevated by stress, herpes simplex virus (HSV) infections in the chest wall, and numerous drugs, including dopamine agonists, proton pump inhibitors, antipsychotics (risperidone, phenothiazines, haloperidol), antihypertensives (methyldopa, reserpine, verapamil), estrogens, and illicit drugs (amphetamines, cannabinoids, opiates, etc). One can test for the variant effect by diluting the urine sample and repeating the testing. Instead, they interfere with one antibody and cause a false-negative result. This phenomenon occurs when high concentrations of hCG isoforms in urine (hCG beta core fragment) are not recognized by both antibodies in the assay. False-negative results can also occur due to the variant effect. To ensure an appropriate urine specimen, perform urine pregnancy testing on first morning voids and check the protein concentration by measuring the urine specific gravity and/or urine creatinine. False-negative results can occur if urine is too dilute. Are There Any Factors That Might Affect the Lab Results? In particular, does your patient take any medications – OTC drugs or Herbals – that might affect the lab results?įalse-negative results can occur with urine pregnancy tests and may result in a misdiagnosis. However, karyotyping confirms the diagnosis of TS in patients with primary amenorrhea, ovarian failure, and/or an absent uterus. High concentrations of FSH and/or LH in multiple specimens are suggestive of primary ovarian failure and consistent with TS. Patients with normal TSH and prolactin should be evaluated for TS by measuring luteinizing hormone (LH) and follicle stimulating hormone (FSH) to assess gonadotropic function. Prolactin inhibits gonadotropin function, thus, causing amenorrhea in nursing mothers and patients with prolactinomas. An elevated prolactin result should prompt a physician to perform an MRI in search of a pituitary adenoma. A high thyroid stimulating hormone (TSH) result suggests the primary amenorrhea is due to primary hypothyroidism and should be followed with fT4 analysis. In patients with a detectable uterus, hypothyroidism and prolactinemia should be ruled out. Because of the varying degrees of developmental defects in TS due to mosaicism of the second X chromosome, patients may or may not develop a uterus. ![]() Patients without secondary sex characteristics and/or a negative pregnancy test should have a pelvic exam or ultrasonography to determine if a uterus is present. Amenorrhea occurs in patients with TS because of absent or limited ovarian function due to inappropriate development (gonadal dysgenesis) or premature ovarian failure. Further, TS patients may also present with a webbed neck, edema of the hands and feet, congenital heart disease, hypothyroidism, and/or a shield shaped chest. TS patients are phenotypic females with short stature, gonadal dysgenesis, and little or no development of secondary sex characteristics. Turner Syndrome (TS) due to the complete deletion of all or part of the X chromosome results in primary amenorrhea. Patients who have not developed secondary sex characteristics, especially the absence of breast development, and have not established periodic menstruation by age 13 should also be worked up for primary amenorrhea. Primary amenorrhea should be considered in a patient with secondary sex characteristics who has not experienced periodic menstruation by 16 years of age or 5 years after breast development. Amenorrhea is the absence of menstrual blood flow.
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