Endocrinology in Relation to Reproduction

Ans. is d i.e. 0.001 1U/m1

Pregnancy tests

All the pregnancy tests used now days are immunological, which function on the principle of detecting HCG quantitatively or qualitatively, either in the urine or blood :

hCG is composed of  and  subunits and can be produced as intact hormone, which is biologically active, or as uncombined biologically inert subunits. Ectopic production of intact hCG occurs most often in association with testicular embryonal tumors, germ cell tumors, extragonadal germinomas, lung cancer, hepatoma, and pancreatic islet tumors. 

In Downs syndrome the level of AFP is low, PAAP-A is low, and B hCG is high.

• Upslanting palpebral fissures, epicanthal folds, midface hypoplasia, and small, dysplastic pinnae.
• Generalized hypotonia.
• Cognitive disabilities
• Congenital heart disease, most oftenly endocardial cushion defects or other septal defectsGastrointestinal tract anomalies including esophageal and duodenal atresias
• The affected newborn may have prolonged physiologic jaundice, polycythemia, and a transient leukemoid reaction. 
• Leukemia is 12–20 times more common in Down syndrome patients.

The HCG secreted by the syncytiotrophoblast of the placenta is released into both the fetal and maternal circulation.

Hydatidiform mole can be diagnosed using HCG titer and transvaginal ultrasound.

Chest Xray is usually done in these patients to rule out pulmonary metastasis of the trophoblast. 

Hydatidiform moles are characterised by high serum beta hCG levels more than 40,000mU/ml.

Levels are higher with complete moles than with partial moles.

Transvaginal ultrasound shows heterogeneous echogenic image and no fetus or placenta.

Urine pregnancy test can detect hCG in serum upto 1-2 mIU/ml and as early as 5 days before the first missed period.

It is based on one monoclonal antibody that binds the hCG and a second antibody that is linked with enzyme alkaline phosphatase to ‘sandwich’ the hCG.

This is more specific and sensitive.

Therefore the most appropriate answer given here is 5mIU/ml.

The corpus luteum secretes estrogens, progesterone, and relaxin. hCG, secreted by the syncytiotrophoblast lining the placental villi, maintains the corpus luteum during the first trimester of pregnancy.

Ans. is ‘d’ i.e., Endodermal sinus tumor

Testicular tumors                      Tumors markers

Human chorionic gonadotropin (HCG) o Embryonal carcinoma

a-Fetoprotein (AFP)

o Yolk sac tumor                               AFP

(Endodermal sinus tumor)                -antitrypsin

o Choriocarcinoma                           HOG

o Polyembryoma is a malignant tumor of ovary which contains embryoid bodies and secrete both HCG and AFP.

Ans. is a i.e., Seminoma

INCIDENTCE OF ELEVATED TUMOUR MARKES BY HISTOLOGIC TYPE IN

Ans. is ‘c’ i.e., Placental HCG

During embryogenesis, In male embryo, at 6-7 week of gestatin, secretion of first anti-mullerian hormone (also k/o mullerian inhibiting substance) causes regression of mullerian duct.

Then at 8-12 week, under influence of Placental HCG, testes started producing testosterone.

Ans is ‘a’ ie Beta HCG 

• Tumor markers of Germ cell tumors of the testis

I) Beta HCG 2) Alpha feto protein (AFP) 3) LDH

• Beta HCG – concentration is increased in both seminoma & non seminoma
• AFP – concentration is increased in only non-seminoma
• LDH – is increased in both, it is not as specific as either of AFP or Beta HCG.
• So both 13 hCG and AFP are markers for testicular Ca, but if we have to choose one option, we would go for 13 hCG as its seen in both seminomas as well as non-seminoma
• Some other tumor markers for testicular Ca (but not imp.) are

– Placental alkaline phosphatase (PLAP)

Gamma-glutamyl transpeptidase (GGT)

Answer is C (Serum HPL levels)

Serum HPL is not included as a parameter within the ‘triple test’ fir downs syndrome

Triple Test :

• It is used in the detection of Downs syndrome. Q
• In an affected pregnancy : – level of MSAFP is decreased Q

– level of oestriol is decreased Q

– levels of hCG is High (increased) Q

• This test only gives a risk ratio and result is considered positive if risk ratio is 1 : 2 For confirmation Amniocentesis has to be done^Q
• It is performed between 16 to 18 weeks.Q

Ans. C: 70 days

Human chorionic gonadotropin (hCG) is made by the embryo soon after conception and later by the syncytiotrophoblast.

It can be detected as early as 8-9 days following ovulation, doubles every 2 days in pregnancy and maximum levels are reached between 60-70 days of pregnancy (100-200 IU/ ml)

Its role is to prevent the disintegration of the corpus luteum of the ovary and thereby maintain progesterone production that is critical for a pregnancy in humans.

Early pregnancy testing, in general, is based on the detection or measurement of hCG. It is an important tumor marker. The beta subunit of human chorionic gonadotropin is secreted also by choriocarcinoma, germ cell tumors, teratoma and islet cell tumor.

The lack of a visible fetus on vaginal ultrasound after the beta hCG levels have reached 1500 IU/ ml is strongly indicative of an ectopic pregnancy.

Gestational trophoblastic disease like Hydatidiform moles (“molar pregnancy”) or Chroiocarcinoma may produce high levels of beta hCG (due to the presence of syncytialtrophoblasts- part of the villi that make up the placenta) despite the absence of an embryo.

Ans. B: 2 days

• With a sensitive test, the hormone hCG can be detected in maternal serum or urine by 8 to 9 days after ovulation.
• The doubling time of serum hCG concentration is 1.4 to 2.0 days.
• Serum hCG levels increase from the day of implantation and reach peak levels at 60 to 70 days.
• Thereafter, the concentration declines slowly until a plateau is reached at approximately 16 weeks.

Ans. C: Syncytiotrophoblast

Ans. 8 to 10 weeks

Ans. is ‘d’ i.e., Placenta

Ans. is ‘d’ i.e., ACTH

Human chorionic gonadotropin (HCG)

• HCG is a placental hormone.
• It is synthesized by the syncytiotrophoblasitc cells of the placental villi
• It is a glycoprotein
• It is a dimer and has two dissimilar subunits

1. α Subunits
2. β Subunits

• But only the β subunit of HCG is typically measured as a tumour marker because of specificity of the β subunit
• The β subunit of HCG has unique sequences that are not shared with other human glycoprotein hormones.
• It is detected by radioimmunoassay using antibodies to the β chain.
• HCG is not used as tumour marker because a unit of the FSH, LH and TSH are identical
• So there can be cross reactivity between a subunits of these hormone.
• That is why in case of testicular tumours the patients also undergo simultaneous assay of LH to be certain that the marker detected is β HCG.