I'd like to see the calcium, PTH and vit D repeated with a phosphate -
?Primary hyperpara with vit D deficiency.
Men (average age 63) with vit D deficiency tended to higher SHBG and
lower testo than men who were sufficient - Wehr et al Clin Endoc
2010;73:243-8.
best wishes
Anne
Dr Anne Dawnay PhD FRCPath
Consultant Biochemist, UCLH
08451555000 ext 2954
Date: Thu, 17 Feb 2011 12:37:48 +0000
From: Stuart Jones <[log in to unmask]>
Subject: SHBG puzzle
Some unusual hormone results for you to puzzle over:
35yo man presented in 2005 with testicular pain and ED, result from
urology referral (all immulite):
FSH 26.2 (0.7 - 11.1)
LH 12.4 (0.8 - 7.6)
Testo 19.0 (8.4 - 28.7)
SHBG - 78 (13 - 71)
Hormone results repeated at various times by primary care and
consistently showed the similar pattern but with LH/FSH apparently
increasing. Referred to endocrinology in Aug 2010; results (centaur
unless specified):
FSH - 43.3 (1.4 - 18.1)
LH - 38.6 (1.5 - 9.3)
TESTO - 23.2 ( 8.4-28.7)
SHBG (immulite) - 119 (13 - 71)
E2 - 145 ( <155)
Prolactin - 137 (45 - 375)
9am Cortisol - 569
TSH - 2.6
All results (except SHBG) confirmed by alternative methods at Birmingham
SAS lab (Testo by MS/MS - 28.4 (7 - 27).
Alpha subunits also measured and were negative
Free testo calculates at 0.80%, which I believe is slightly low (1.0-2.7
from Tietz)
Additional results from Jan endocrine OPD app:
ACa - 2.9
PTH - 7.9pmol/L (1.3 - 6.8)
ACE - 86 (15 - 70)
24 Ca excretion - 5.9 (2.5 - 7.5)
Total Vit D - 15nmol/l
Slight macrocytosis with low/normal folate
History shows high calcium (2.8-3.0) since at least 2008.
Other details:
Hypertensive - on ACEi
Mildly elevated cholesterol (5-6mmol/L) - Not currently on statin No
other meds Normal liver function Normal thyroid function Normal renal
function No evidence of pituitary disease/adenoma Denies exogenous
hormone ingestion and is not a frequent gym attender
It appears that the high SHBG is driving gonadotrophin production and
high testosterone but what could be the cause of this? Genetic variant
perhaps? Could the calcium be related or is this a red herring?
Thoughts/opinions greatly appreciated
Stuart Jones
Senior Clinical Scientist
Queen's Hosp
Romford
------------------------------------------------------------------------
This email is confidential and is intended solely for the person or
Entity to whom it is addressed. If this is not you, please forward the
Message to [log in to unmask] We have scanned this email
before sending it, but cannot guarantee that malicious software is
absent and we shall carry no liability in this regard.
We advise that information intended to be kept confidential should not
Be sent by email. We also advise that health concerns should be
Discussed with a medical professional in person or by telephone.
NHS Direct can also provide advice. We shall not be liable for any
failure to follow this advice. University College London Hospitals NHS
Foundation Trust (UCLH).
------ACB discussion List Information--------
This is an open discussion list for the academic and clinical community working in clinical biochemistry.
Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content.
ACB Web Site
http://www.acb.org.uk
Green Laboratories Work
http://www.laboratorymedicine.nhs.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/
|