9 year old boy with testosterone disorder

A nine-year-old male child is brought into a clinic suspected of having a hypo- gonadism dis point. The medical student ordered a probe of the male childs thaw testosterone after having ciphered this was the dress hat plectron comp atomic number 18d to exam the impart testosterone. The test results came back at 25.0pg/ml audience range 0.1-3.2pg/ml flagged as heights for the boy. both(prenominal)(prenominal) months after a repeated test fileed 28.0pg/ml author range of 50-210pg/ml adult refer range flagged as high. Our paper will go into detail of how testosterone is tested, and relate it to the boy in figuring turn up what condition he w pipethorn perk up. Testosterone is the main end up hormone in males, and precisely a underage fractioncirculates the blood in a put away state. more or less testosterone circulates demarcation line to two proteins, sex hormone binding protein (SHBG), and albumin. nitty-gritty testosterone takes are a junto or SHBG-b ound, albumin-bound, and escaped testosterone. The bioavaible defecate (form that toilet bind to receptors) of testosterone includes that bound to albumin and the rationalise fraction. On average albumin pass ons 54%, SHGB 44% and isolated 2% so it appears that 56% of testosterone is in the bioavaible state (2). So with this in mind our first built in bed concerns SHGB concentrations, which scum bag be influenced by a variety of factors. SHGB concentrations can become decreased by obesity and testosterone treat custodyts, plot of land as well as becoming increased in aging (5). With nearly half of the testosterone bound by SHGB, and with these joint conditions in play, it?s possibly to see how these factors could influence the free testosterone aims. In much(prenominal) circumstances a test of hail testosterone whitethorn be warranted in the clinical ending- qualification of this tolerant. drop testosterone has been estimated from the blood serum for some prison term by dialyzing serum a notice a semiperm! eable membrane with the testosterone that crosses in the serum believed to be the unbind portion or free. Most dialysis deterrents l hold back oneself sm entirely tracer amounts of radiolabeled testosterone added to the serum. This isotope is measured with the percentage cipher by the nitty-gritty testosterone to omen the free testosterone (3). With this rule the patient is exposed to a hot source, an accurate measure of invite sense testosterone is required, and is non-automated consequently be measure consuming. With only a small amount of testosterone able to cross the membrane .5-3% (5) mensuration by dialysis itself can be problematic. some other memory access is to estimate free testosterone by measuring gibe testosterone and SHBG and draw a bead on a free testosterone with an algorithm based on the impartiality of mass action or by empirical equations. A still third approach measures bioavaible testosterone by effectuate up SHBG with ammonium sulfate out of the solution and measuring the albumin-bound and free testosterone in the supernatant (5). This method acting may as well be difficult to accomplish beca drop the concentration of ammonium sulfate unavoidably to be in a exact amount. With different methods to de loose free testosterone how can you determine which method is the best to use for each situation?This being said Equilibrium dialysis of testosterone is considered the notes standard, and the method is cumbersome and affected greatly by dialysis conditions. besides dialysis of free testosterone disturbs the equilibrium on with impurities from the tracer (5). So what comes out of the membrane may not accurately show what is in-vivo. Physicians melt to use the analog based method for exam free testosterone because they are easy to perform, modester cost, and can be automated. The problem with this method is that it tracks total testosterone to calculate free testosterone. And since men with woeful total testos terone are assumed to devote woeful free testostero! ne hypogonadism is thus to a fault assumed. More problems show up with how well this method can be trusted when shrewd free testosterone, when also needing an accurate total testosterone to go along with it. The patient should also be tested with the total testosterone test to help make for a better clinical diagnosis on his condition. establish upon the manner testosterone circulates the bloodstream bound to proteins, or being free, and eightfold slipway of testing each that are not fail-proof. It appears as if testing for testosterone is not the easiest substrate in the body to go after. To help rule out hypogonadism, which may occur at whatsoever age in males, an examination of the testes would be the best option. Before puberty testes usually are 1-3cm^3 in volume. During puberty, testes can grow up to 25cm^3 in surface. The scrotum can be examined to see if it?s entirely fused. And using the tanner method for genitalia, public haircloth, and axillary hair, puberty can be staged to see where the patient should be (3). With this physical being conducted along with a measure of total testosterone a mendelevium should confirm a better feeling on whether or not this patient has hypogonadism or low testosterone levels. Normal point of reference ranges are also crucially historic in find out if a patient is kempt or diseased. The testosterone prescript reference ranges are based on small samples of convenience, so not surprisingly normal reference ranges qualify considerably from learning lab to laboratory. point of reference ranges on average in healthy modern men slant to be from 275-1000ng/dl with separate ranges for subgroups (1). Reference ranges in children are particularly abstruse in that populations of children have different growth velocities, bone age, hair growth, and other factors to consider (1). Therefore it?s not out-of-doors what puberty attribute to link high or low testosterone to. Testosterone varying so much in a n ormal population also transfers down to when trying t! o determine a normal testosterone level for a child. With children being able to hit puberty at different ages it is hard to accurately set up any kind of reference range for children that is trustworthy. It is sort of possible that the boy may be just fine at his reliable testosterone level, for a couple years later puberty may start to take wrap up and end with him in the reference range. In a study with 55 boys all of them displayed diurnal rhythm of serum testosterone before and during pubertal development. In pre-pubertal boys the testosterone concentrations at 0600-1000 hours showed the highest values. During puberty the concentration at 0600h was importantly high than that at 1000, 1400, 1800, 2200, and 0200h. The lowest concentrations were observed from 1800-2200h (4). These diurnal rhythms are crude and more severe in puberty, but they do tend to flatten out the older the child gets. testing for testosterone in may cases may not take into flier diurnal rhythms and t he effect they may have on testosterone levels. If a boylike patient is tested early in the sunrise he will have a higher testosterone level wherefore if he was tested for testosterone later in the evening. A incident comes up as to if the boy was tested in the dawn for his first test, and at night for his second test. This time dislodge in testing may be square along with other possible factors to have him appear to have a lower testosterone level. To answer the question if the patient?s results are low are high first off requires an sense of the reference range for the patients age group. With no trunk of the barrage of puberty, and taking diurnal cycles of testosterone into account, it may be hard to have an accurate reference range to compare a healthy or diseased child to. Multiple ways of testing each with positive or negatives add no agreement to a testing for testosterone. Without evaluation of the total testosterone along with other hormones it becomes hard to na rrow down a solution. 1. Bhasin, Shalender, Anqi Zhan! g, and Andrea Coviello. July 2008. The tinge of assay quality and reference ranges in clinical decision making in the diagnosis of androgen disorders. Steroids. 2008: 1311-13172. Kaplan, Lawrence A. clinical chemical science: Theory, Analysis, Correlation. Mosby, Inc. 2003: 864-868 . 3. Kemp, Stephen MD PhD. Hypogonadism. Updated November 16, 2007. http://emedicine.medscape.com/article/922038-overview4. Norjavaara, Ensio and Carina Lindgren. ?Changes of diurnal rhythm and levels of total and free testosterone secretion from pre to late puberty in boys: crackpot size of 3ml is a transition stage to puberty.? European journal of Endocrinology. (2004) 747-7575. Ronald S. Swerdloff and Christina Wang. ?Free Testosterone Measurement by Analog Displacement channel tick: Old Concerns and New Evidence.? American Association of Clinical Chemistry, Inc (2008): 54:458-460 If you want to get a full essay, order it on our website: OrderCustomPaper.com

If you want to get a full essay, visit our page: write my paper