1. Applications on RIA assays
HCG Hormone
Estradiol
prolactin

2. HCG
hormone
(Pregnancy hormone)

3. Clinical Information
Human chorionic gonadotropin (hCG) is a glycoprotein hormone consisting of 2 noncovalently bound subunits.
with an α (alpha) subunit identical to that of (LH), (FSH), (TSH), and β (beta) subunit that is unique to hCG.
It is early produced by the cells that surround the growing human embryo; these cells will eventually go on to form the placenta and later it is made by the placenta during pregnancy.
نفحص B-HCG لتخطي مشكلة False +ve في حال كان لدى المريضة خلل في thyroid gland

4. HCG Functions
1. HCG hormone is an embryonic hormone helps the embryo implant in the uterus. 2. Maintains the production of progesterone by the corpus luteum and the ovaries during the first trimester of pregnancy. 3. Causes the blockage of any immune or macrophage action by the mother , protecting the fetus during the first trimester 4. Suppresses any myometrial contractions during the course of pregnancy. 5. Play a role in the growth and differentiation of the umbilical cord
in the event that the ovulated egg is fertilised by sperm and an embryo is conceived, it is vital that the corpus luteum continues to produce progesterone until the placenta is established (the placenta then takes over progesterone production). It is important that the corpus luteum keeps producing progesterone because loss of progesterone leads to shedding of the womb lining (menstruation), which would prevent an embryo from implanting.
Myometrium smooth muscle of uterus
HCG hormone repel the immune cells of the mother due to its highly negative charge
umbilical cord (also called thenavel string,[1] birth cord orfuniculus umbilicalis) is a conduit between the developingembryo or fetus and theplacenta. During prenatal development, the umbilical cord is physiologically and genetically part of the fetus and, (in humans), normally contains twoarteries (the umbilical arteries) and one vein (the umbilical vein), buried within Wharton's jelly. The umbilical vein supplies the fetus with oxygenated, nutrient-richblood from the placenta. Conversely, the fetal heart pumps deoxygenated, nutrient-depleted blood through the umbilical arteries back to the placenta.
veins

5. Natural Pregnancy
The HCG levels starts to enter the blood stream within 8 to 11 days after conception and continues to increase until the 16th week of last menstrual period .
While the HCG levels keep fluctuating until around the 8th week, by the 9th or 10th week, it tends to double and reaches its peak and then declines for the remainder of the pregnancy  .
Beta hCG can be detected in maternal plasma or urine by 8 to 9 days after ovulation.
The chart illustrates the normal rise and fall of hCG levels throughout pregnancy.
This is why pregnancy test may reveal as negative on the early weeks
and become positive a few weeks later.

6. β -HCG & other hormones

7. Why the test is done? β –HCG Test Confirming pregnancy.
To diagnose abnormal conditions, such as molar pregnancy, ectopic pregnancy, early pregnancy miscarriage, and certain types of ovarian tumors or in men with testicular tumors.
To assess the progress of the pregnancy.
To certify the health of both mom and the baby.
molar pregnancy, ectopic pregnancy, early pregnancy miscarriage, and multiple pregnancy. These cases usually displayed by the lack of HCG development and thus, it can be treated as early as possible to ensure a healthy pregnancy.
Molar الحمل العنقودي
Ectopic hgplg الحمل الأنبوبي td rkhm thg,f

8. 1st, Qualitative HCG Blood Test
The test can be either qualitative or quantitative
1st, Qualitative HCG Blood Test
A qualitative beta-hCG test screen the presence or absence
of hCG in the blood .
This test only a screen if a woman is pregnant or not. HCG levels
of mIU/mL and more is usually detected by this method.
HCG urine tests
This test may be performed by a laboratory, at a doctor's office, or at home using a home pregnancy test kit. Methods will vary slightly but for most, a test strip is dipped into a collected cup of urine or exposed to a woman's urine stream. A colored line (or other color change) appears within the time allotted per instructions, usually about 5 minutes .
If the test is negative, it is often repeated several days later. Since hCG rises rapidly, an initial negative test can turn positive within this time period.
The hCG test can give both false-negative results and false-positive results for pregnancy. the doctor will help to figure out the results or to do follow-up testing if there’s any doubt.
Pregnancy strips

9. 2nd, Quantitative HCG Blood Test
A quantitative beta-hCG test measures the exact amount of hCG in the blood,it is a very sensitive test for pregnancy since very small amounts of hCG can be detected even as low as 1 mIU/mL.
This test is not done routinely and is not necessary in all pregnancies.
The test may be offered by the doctor to assess one of these condition :
too early in pregnancy when there’s doubt in confirming the result .
Implantation cases.
Severe back pain in a pregnant women
Abnormal vaginal bleeding
Abnormal pregnancy and cancer
Risk of miscarriage

10. Facts about β–hCG levels
In 85% of normal pregnancies, the hCG level will double every 48 – 72 hours.
An hCG level of less than 5mIU/ml is considered negative for pregnancy, and anything above 25mIU/ml is considered positive for pregnancy.
The hCG levels should not be used to date a pregnancy, since these numbers can vary so widely
A single hCG reading is not enough in some diagnoses.
When there is a question regarding the health of the pregnancy, multiple testing
of hCG done a couple of days apart give a more accurate assessment of the situation.
every woman’s level of hCG can rise differently. It is not necessarily the level that matters, but rather the  change in the level

11. High levels of β–hCG
A high level of hCG can also mean a number of things and should be rechecked within hours to evaluate changes in the level.
A rise in hCG levels above the reference range can indicate :
Miscalculation of pregnancy dating
Molar pregnancy (Hydatidiform mole)=vesicular pregnancy
Multiple pregnancy
A tumor of the testicles or ovaries
Some types of cancer, such as cancer of the stomach, pancreas , large intestine, liver, or lung.
hCG levels in weeks from LMP (gestational age)* :
3 weeks LMP: 5 – 50 mIU/ml
4 weeks LMP: 5 – 426 mIU/ml
5 weeks LMP: 18 – 7,340 mIU/ml
6 weeks LMP: 1,080 – 56,500 mIU/ml
7 – 8 weeks LMP: 7, 650 – 229,000 mIU/ml
9 – 12 weeks LMP: 25,700 – 288,000 mIU/ml
13 – 16 weeks LMP: 13,300 – 254,000 mIU/ml
17 – 24 weeks LMP: 4,060 – 165,400 mIU/ml
25 – 40 weeks LMP: 3,640 – 117,000 mIU/ml
The normal values listed here-called a reference range-are just a guide. These ranges vary from lab to lab
The values that falls outside the normal values listed here may still be normal for some pregnant or other lab.

12. Molar pregnancy (Hydatidiform mole)
Also called vesicular pregnancy in which an unsuccessful pregnancy, where the placenta and fetus do not form properly, and a baby does not develop.
In a molar pregnancy, the trophoblastic cells behave abnormally as soon as the egg has been fertilised by the sperm. This results in a mass of abnormal cells that can grow as fluid-filled sacs (cysts) with the appearance of white grapes. These cells grow rapidly within the womb, instead of developing into a baby.
The abnormal cells are referred to as a "mole", which is from the Latin for mass or lump and it is a pre-cancerous form of gestational trophoblastic disease
Molar pregnancy = الحمل العنقودي
The placenta is made up of millions of cells known as trophoblastic cells.
Womb رحم
Lumb kotla

13. Dilation and curettage (D&C) or Hysterectomy.
A molar pregnancy can't continue as a normal viable pregnancy. To prevent complications, the molar tissue must be removed. Treatment usually consists of one or more of the following:
Dilation and curettage (D&C) or Hysterectomy.
Measure HCG to monitor treatment

14. low levels of β-hCG means :
Low values of β–HCG
low levels of β-hCG means :
In an early pregnancy as estimated by the last menstrual period (LMP).
An ectopic pregnancy
Death of the baby
Miscarriage (spontaneous abortion) is very likely.

15. Ectopic pregnancy
An ectopic pregnancy occurs when a fertilized egg implants somewhere other than the main cavity of the uterus.
If this occurs in one of the tubes that carry eggs from the ovaries to the uterus (fallopian tubes). This type of ectopic pregnancy is known as a tubal pregnancy.
In some cases, however, an ectopic pregnancy occurs in the abdominal cavity, ovary or neck of the uterus (cervix).
pregnancy\Ectopic Pregnancy.mp4

16. An ectopic pregnancy can't proceed normally, also the growing tissue might destroy various maternal structures.
A fertilized egg can't develop normally outside the uterus. To prevent life-threatening complications, the ectopic tissue needs to be removed.
In some cases, medication may be used to stop the growth of pregnancy tissue.
The doctor will monitor HCG levels after surgery to be sure all of the ectopic tissue was removed. If HCG levels don't come down quickly, an injection of methotrexate may be needed.

17. Estradiol
(E2)

18. Estradiol
The term "estrogen" includes a group of chemically similar hormones: estrone, estradiol (the most abundant in women of reproductive age) and estriol.
Estradiol is the most commonly measured type of estrogen for nonpregnant women.
In women, most estradiol is released from the ovaries and adrenal glands and fat tissues, It is also released by the placenta during pregnancy.
In men, a small amount of estradiol is mainly released by the testis, preventing sperm from dying too early.
Estrogen is partly responsible for creating healthy sperm. When estrogen levels are high, sperm levels in semen may fall. This can lead to fertility issue
estrone (E1)
Estriol (E3)

19. Estradiol function
1. Responsible for the growth and development of female sexual characteristics.
2. Supporting the lining of vagina, cervical glands, the endometrium and fallopian tubes.
3. Prepare the endometrium for implantation.
4. Regulates a woman’s menstrual cycle
5. Regulate the liver’s production of cholesterol
6. Also, it helps to preserve bone density
During the menstrual cycle, leutinizing hormone surge, inducing ovulation
يتدفق
بطانة الرحم endometrium

20. When is the test ordered?
Help diagnose early-onset puberty or delayed puberty
Investigate menstrual abnormalities, such as amenorrhea, infertility, and abnormal vaginal bleeding
Evaluate the function of the ovaries and detect ovarian failure
Detect estrogen-producing tumors
In males, for Delayed puberty, Tumors of the testicles (testicular cancer) or adrenal glands, Enlarged breasts (gynecomastia).
lack of menstrual periods (amenorrhea)
Male: 10 to 50 picograms per milliliter (pg/mL)
Female (premenopausal): 30 to 400 pg/mL
Female (postmenopausal): 0 to 30 pg/mL
Note :-
- The amount of estradiol in a woman's blood varies throughout her menstrual cycle.
- After menopause, estradiol production drops to a very low but constant level.

21. Too high estradiol levels
Estradiol levels that are higher than normal may suggest:
Early puberty
Gynecomastia (development of breasts in men)
Hyperthyroidism (overactive thyroid gland)
Cirrhosis, which is scarring of the liver
In rare cases, high levels of estradiol could indicate an ovarian tumor or endometrial cancer.
Symptoms of High Estrogen
bloating
swelling and tenderness in the breasts
irregular menstrual periods
headaches
mood swings
fibrocystic developments in the breast
weight gain
hair loss
cold hands or feet
feeling tired or lacking energy
difficulty with memory
trouble sleeping
increased symptoms of premenstrual syndrome or PMS

22. Too low levels Lower than normal levels of estradiol may suggest:
Menopause
Polycystic ovarian syndrome (PCOS), which is a hormone disorder with a wide range of symptoms that’s believed to be a cause of infertility in women
Depleted estrogen production, which can be caused by low body fat
Hypopituitarism
Hypogonadism, which occurs when the ovaries or testes don’t produce enough hormone
قصور النخامية
قصور الغدد التناسلية

23. Exogenous estradiol PRESCRIBED FOR:
For symptomatic treatment of the usual symptoms associated with menopause (hot flashes, vaginal burning or dryness, etc.).
Prevention of bone fractures associated with osteoporosis, and dysfunctional (excessive and painful) uterine bleeding.
Estradiol also is prescribed for breast cancer and, in some cases in prostate cancer.
هشاشة العظام

24. Prolactin
(PRL)
The milk hormone

25. Prolactin
Prolactin is a hormone produced by the pituitary gland, its primary role is to stimulate milk production in pregnant women and maintain milk supply during breastfeeding.
Also, Act with estrogen and other hormones for a full development of breast tissue during pregnancy .
However; prolactin is produced in small amounts in both males and non-pregnant females.
الغدة النخامية

26. Normal ranges of prolactin hormone in serum
Prolactin levels
Prolactin levels are different throughout the day. The highest levels occur during sleep and shortly after you wake up.
The following can temporarily increase prolactin levels:
Emotional or physical stress
High-protein meals
Intense breast stimulation
Recent breast exam
Recent exercise
Non- pregnant
women
< 25 ng/mL
Pregnant
34 to 386 ng/mL
Males
< 15 ng/mL
Breast stimulation = sucking by a baby
Normal ranges of prolactin hormone in serum

27. Why is the Test Performed
Breast milk production that is not related to childbirth (galactorrhea)
Fertility problems
Irregular or no menstrual periods (amenorrhea)
Diagnose tumors that produce excess prolactin (prolactinomas)
Fertility problems : ازا البرولاكتين عالي كتير بيمنع حدوث الحمل .. عشان هيك بعض النساء و هما برضعوا ما بحملو

28. Interpretation of Results
High levels of prolactin are normal during pregnancy and after childbirth while the mother is breastfeeding.
However, the causes of abnormal hyperprolactinemia include liver disease, kidney disease, and hypothyroidism.
High levels of Prolactin can also be caused by pituitary tumors, which can be treated medically or surgically.
Low levels of prolactin are usually of no concern in women and men.
Some drugs as dopamine may cause low levels of prolactin
Many conditions can affect prolactin levels. The doctor will talk with the patient about any abnormal results in relation to the symptoms and past health.

29. رَزَقهُم اللّه لِكلِّ مُشتهِي