• Estradiol is the most abundant and active female hormone. It plays a major role in being a female, order of menstrual cycle, maintenance of bone density, prevention of cardiovascular disease, and feminine aggression. A postmenopausal level is not considered to be acceptable for most women's optimal health.

• Estradiol's presence may play a major role in the development of prostatic cancer. Therefore, it is essential to measure its level especially in men over 40 years of age. If there is too much of it in the blood it not only could contribute to the development of prostate cancer but it will also contribute to demasculanization and a diminished libido.

• Progesterone is the second most important female hormone with numerous metabolic functions. One of these is increasing cerebral sugar metabolism. This hormone is not only important for the female but also for men. Actually, its presence contributes to the prevention of prostate cancer by modulating estrogen's carcinogenic effects. In a sense it balances out possible estrogen over-production by the male.

• Use Traditionally, progesterone establishes the presence of a functioning corpus luteum or luteal cell function; confirm basal body temperature measurements for the occurrence of ovulation; obtain an indication of the day of ovulation; evaluate the functional state of the corpus luteum in infertility patients; assess placental function during pregnancy; ovarian function test.

• Progesterone and 17--hydroxyprogesterone are weak androgens. Increased in congenital adrenal hyperplasia due to 21-hydroxylase, 17-hydroxylase, and 11--hydroxylase deficiency. It is decreased in threatened abortion, primary or secondary hypogonadism, and short luteal phase syndrome.

• Free Testosterone - Testosterone exists in serum both free and bound to albumin and to sex hormone binding globulin (SHBG) (testosterone binding globulin). Unbound (free) testosterone is the active moiety. Free as well as total testosterone can be measured. Usual testosterone assays measure both bound and unbound levels. In certain settings, total testosterone can be normal but free testosterone increased, or the reverse; then the total testosterone result is misleading.

• IGF-1 is a more precise indicator of human growth hormone (GH). IGF-1, also called Somatomedin-C (Sm-C) measurements reflect availability of the number one human "youth and longevity hormone" the growth hormone. Clinical studies have shown that GH administration to the elderly has significant rejuvenating effects. Some of these are improved cognesence, muscle and bone strength, libido, generally longevity. IGF-1 also enhances athletic performance.

• Use Traditionally IGF-1 is used to diagnose acromegaly, in which Sm-C and GH are increased; evaluate hypopituitarism and hypothalamic lesions in children (diagnosis of dwarfism and response to therapy). Low levels occur in Laron dwarfism, an entity in which GH is increased.

• Malnutrition will cause low somatomedin-C levels in spite of normal amounts of circulating growth hormone. The Sm-C level does not distinguish pituitary dwarfism from constitutional delay of growth and development.

• IGF-1 (Somatomedin-C) is a polypeptide hormone produced by the liver and other tissues, with effect on growth promoting activity and glucose metabolism (insulin-like activity). Somatomedin-C is carried in blood bound to a carrier protein which prolongs its half-life. Its level is therefore more constant than that of growth hormone.

• Low values are described with the extremes of age (first 5-6 years and advanced age), hypopituitarism, malnutrition, diabetes mellitus, Laron dwarfism, hypothyroidism, maternal deprivation syndrome, pubertal delay, cirrhosis, hepatoma, and some cases of short stature and normal GH response to pharmacologic tests. Low values may be found with nonfunctioning pituitary tumors, with constitutional delay of growth and development and with anorexia nervosa.

• High values occur with adolescence, true precocious puberty, pregnancy, obesity, pituitary gigantism, acromegaly and diabetic retinopathy.

• Since Sm-C is decreased with malnutrition, its concentration provides an index with which to monitor therapy for food deprivation.

• DHEA-S is the adrenal anti-stress, immunity, and longevity hormone. The production level will decrease with stress and age, and it is required for proper immune function, especially as it is related to the thymus gland. The level is low or zero in most cancer patients, and declines with aging. The DHEA-S form of the hormone is a better analyte to test than DHEA itself because of its longer half-life (presence in the blood) and more abundance. However, the two are readily inter converted. DHEA (DHEA-S) is exerting its affect through the blood therefore other specimens, e.g. saliva may not give proper results.

• BR-MR (CA 15-3) Special Instructions: Values obtained with different assay methods should not be used interchangeably. The same specimen, serum or plasma, should be used consistently when monitoring a patient.

• The CA 15-3 assay value, regardless of level, should not be interpreted as absolute evidence for the presence or absence of malignant disease. The CA 15-3 assay value should be used in conjunction with information available from clinical evaluation and diagnostic procedure.

• Methodology: immunochemiluminometric assay (ICMA) References Hayes DF, Zurawski VR Jr, and Kufe DW, "Comparison of Circulating CA 15-3 and Carcinoembryonic Antigen Levels in Patients With Breast Cancer, J Clin Oncol, 1986, 4(10):1542-50.

• CA 125 is not entirely specific for tumors of the ovary. In some cases it will be moderately elevated in benign ovarian tumors as well.

• Use Tumor marker for monitoring disease progression in nonmucinous epithelial neoplasms of the ovary. Currently some physicians are recommending this cancer marker for screening of ovarian cancers.

• CA 125 is a 220 kD glycoprotein expressed by >80% of nonmucinous ovarian epithelial neoplasms. It is also expressed by other coelomic epithelial derivatives and other gynecologic neoplasms, and those of the pancreas, liver, colon, breast, and lung (in smaller percentages). It can also be detected in pregnancy, tubo-ovarian abscess, endometriosis, and benign teratomas (dermoids). Levels >65 IU/mL are associated with malignancy in >90% of cases with pelvic masses. CA 125 is most useful in monitoring progression or recurrence in cases of known ovarian carcinoma. For this purpose, levels >35 IU/mL may be significant; although a lower level does not replace a second-look operation. About 25% of patients have CA 125 level <35 IU/mL before a second look laparotomy despite the presence of residual tumor. However, some patients with negative second-look procedure reverted to a positive CA 125 within 1 month. Therefore, CA 125 remains a useful tool to follow these patients.

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