Laboratory tests for female and male genital system

1. Reproductive
assays
GYNECOLOGY
AND
ANDROLOGY
Dr. Ayat Samy
Assistant lecturer of biochemistry, faculty of veterinary
medicine, Suez canal university

2. Hormonal regulation

3. FSH &LH
 Follicle-stimulating Hormone (FSH)
Follicle-stimulating hormone (FSH) is a hormone associated with reproduction and the
development of eggs in women and sperm in men.
Luteinizing hormone (LH) is a hormone associated with reproduction. Its stimulation of either
ovary or testicles results in the release of an egg from the ovary (ovulation) in women or
testosterone production in men.
 Luteinizing hormone (LH)

4. FSH &LH
Why Get Tested?
 To evaluate fertility issues (difficulty getting pregnant or are having irregular or no menstrual
periods), the health of your reproductive organs (ovaries or testicles), predicting when or if a
woman is entering menopause or pituitary function
 In children, to evaluate early or delayed puberty
 For men, when your partner cannot get pregnant, or you have a low sperm count, low muscle
mass or decreased sex drive

5. FSH &LH
In Women
FSH and LH levels can help to differentiate between a condition affecting the ovaries themselves
(primary) and dysfunction of the ovaries due to disorders of either the pituitary or the
hypothalamus (secondary).
High levels of FSH and LH
Conditions affecting the ovaries themselves
Developmental defects:
 Failure to develop ovaries (ovarian agenesis)
 Chromosome disorder, such as Turner syndrome
 Defect in the steroid production by the ovaries, such as 17 alpha hydroxylase deficiency

6. FSH &LH
Damage to the ovaries due to:
 Radiation exposure
 Chemotherapy
 Autoimmune disease
In Women
High levels of FSH and LH
Underlying conditions that affect ovary function:
 Polycystic ovary syndrome (PCOS)
 Adrenal disease
 Thyroid disease
 Ovarian tumor
When a woman enters menopause and her ovaries stop working, FSH levels will rise.

7. FSH &LH
Low levels of FSH and LH
In Women
 Low levels of FSH and LH are consistent with a pituitary disorder or problem with the
hypothalamus.
 Low FSH serum levels have been associated with increased risk of ovarian cancer.

8. FSH &LH
In Men
High FSH levels are due to conditions affecting the testicles themselves. Some examples
include:
 Viral infection (mumps)
 Trauma, injury
 Radiation exposure
 Chemotherapy
 Autoimmune disease
 Germ cell tumor
 Failure to develop normal gonads (gonadal agenesis)
 Chromosome disorder, such as Klinefelter syndrome
Low levels are consistent with pituitary or hypothalamic disorders.

9. Higher levels of FSH and LH than expected for age plus the development of secondary sexual
characteristics at an unusually young age are an indication of early puberty.
FSH &LH
In Children
This premature development is usually due to a problem with the central nervous system and
can have a few different underlying causes. Examples include:
 Central nervous system tumor
 Brain injury, trauma
 Inflammation within the central nervous system (e.g. meningitis, encephalitis)

10. In delayed puberty, LH and FSH levels can be normal or below what is expected for a youth
within this age range. Examples of some causes of delayed puberty include:
In Children
FSH &LH
 Dysfunction of the ovaries or testicles
 Hormone deficiency
 Turner syndrome
 Klinefelter syndrome
 Chronic infections
 Cancer
 Eating disorder (anorexia nervosa)

11. Estrogens
Estrogen tests measure one of three components: estrone (E1), estradiol (E2), or estriol (E3)
in the blood or urine.
 Estrone (E1) is directly converted from androstenedione (from the adrenal gland) or indirectly
from other androgens. E1 can also be produced by the ovaries and placenta, testicles, and
adipose (fat) tissues. E2 and E1 can be converted into each other as needed. E1 is the primary
estrogen in men and in post-menopausal women.
 Estradiol (E2) is primarily produced in the ovaries under stimulation of FSH and LH in pre-
menopausal women and in the testicles in men. E2 is converted from E1 in post-menopausal
women. It is the most potent estrogen and the one that is present in the highest concentration in
non-pregnant, pre-menopausal women. E2 levels vary depending on a woman’s age and
reproductive status. They are a good marker of ovarian function.

12. Estrogens
 Estriol (E3) is produced by the placenta, with concentrations rising throughout a woman’s
pregnancy. Increasing levels are an indication of the health of the pregnancy and developing
baby. Estriol is part of the second trimester maternal serum screen, a test performed to
evaluate fetal risk due to certain chromosomal abnormalities. Very low levels of E3 are
present in non-pregnant women or men.

13. When is it ordered?
Estrogens

14. In Girls and Women
Estradiol (E2) and/or estrone (E1) testing in girls and women may be ordered when:
 A girl’s sex organs develop earlier or later than normally expected
 A woman has symptoms such as abnormal vaginal bleeding after menopause or abnormal or
lack of menstrual cycles
 A woman is experiencing infertility; a series of estradiol measurements over the course of a
woman’s menstrual cycle may be done to monitor follicle development prior to in vitro
fertilization techniques (timed with a surge in estradiol).
 A woman is having symptoms of menopause, including hot flashes, night sweats, insomnia,
and/or irregular or lack of menstrual periods
 A menopausal woman is taking hormone replacement therapy; her health practitioner may
periodically order estrone levels to monitor treatment.
Estrogens

15. Estriol (E3) testing in women may be ordered:
 During pregnancy, a healthcare practitioner may order serial estriol samples to look for a
trend, whether there is a rise or fall in the estriol level over time.
 Unconjugated estriol is often measured in the 15th to 20th week of gestation as part of the
triple/quad screen.
In Girls and Women
Estrogens

16. In Boys and Men
Estradiol (E2) and/or estrone (E1) testing in boys and men may be ordered when:
 A boy has delayed puberty, characterized by delayed development of muscle mass, lack of
deepening of the voice or growth of body hair, slow or delayed growth of testicles and
penis
 A man shows signs of feminization, such as enlarged breasts
Estrogens

17. Factors affect on estradiol test:-
Estrogens
1-Medications :
 Birth control pills
 Estrogen therapy
 Glucocorticoids
 Antibiotics tetracycline and ampicillin
2- Estradiol level can vary throughout the day and with a woman's menstrual cycle
3- Conditions can affect estradiol level include :
 Anemia
 High blood pressure
 Kidney disease
 Reduced liver function

18. Increased levels of estradiol (E2) or estrone (E1) are seen in
Girls and Women:
 Early (precocious) puberty
 Tumors of the ovary or adrenal glands
Boys and Men:
 Enlarged breasts (gynecomastia)
 Tumors of the testicles (testicular cancer) or adrenal glands
 Delayed puberty
Both Women and Men:
 Hyperthyroidism
 Cirrhosis
Estrogens

19. In women, decreased levels of estrogen are seen in:
 Turner syndrome, an inherited condition in women caused by a missing or abnormal
X chromosome and characterized by underdeveloped female sex characteristics
 Low level of pituitary hormones (hypopituitarism)
 Dysfunction of the ovaries (female hypogonadism)
 Failing pregnancy (estriol)
 Eating disorders such as anorexia nervosa
 After menopause (estradiol)
 Polycystic ovary syndrome (PCOS, also called Stein-Levanthal syndrome)
 Extreme endurance exercise
Estrogens

20. Progesterone
Progesterone is the dominant ovarian hormone secreted during the luteal (second) phase of the
menstrual cycle. Its main function is to prepare the uterus for implantation of an embryo, in the
event that fertilization occurs during that cycle.
If pregnancy occurs, human chorionic gonadotropin (hCG) is released which maintains the
corpus luteum, which in turn allows progesterone levels to remain raised. At approximately
twelve weeks gestation, the placenta begins to produce progesterone in place of the corpus
luteum. Progesterone levels decrease after delivery and during breastfeeding. Progesterone
levels are low in women after menopause. In males almost all progesterone is converted to
testosterone in the testes.

21. Progesterone
When is it ordered?

22. Progesterone
 During an infertility assessment, when a woman is having trouble getting pregnant and her
healthcare practitioner wants to verify that she is ovulating normally; the test may be
ordered a few times during a woman’s menstrual cycle to evaluate the change in
progesterone concentrations.
 When it is necessary to determine when ovulation has occurred and following drug therapy
to induce ovulation
 When symptoms, such as abdominal pain and spotting, suggest an ectopic pregnancy or
threatened miscarriage
 On a regular basis when a woman requires progesterone replacement therapy to help
maintain her pregnancy
 Periodically throughout a high-risk pregnancy to monitor placenta and fetal health
 When a non-pregnant woman is experiencing abnormal uterine bleeding
When is it ordered?

23. Progesterone
If levels do not rise normally during an early pregnancy, the pregnancy may be ectopic and/or may
be failing. If serial measurements do not show increasing progesterone levels over time, there may
be problems with the viability of the placenta and fetus.
Low levels of progesterone may be associated with:
 Ectopic pregnancy
 Fetal death/miscarriage
 Pre-eclampsia
 Decreased function of ovaries
 Lack of menstruation (amenorrhea)

24. Progesterone
Increased progesterone levels are seen occasionally with:
 Some ovarian cysts
 Non-viable pregnancies known as molar pregnancies
 A rare form of ovarian cancer
 Overproduction of progesterone by the adrenal glands
 Adrenal cancer
 Congenital adrenal hyperplasia (CAH)

25. Prolactin (PRL)
Prolactin is a hormone that is produced by the anterior of the pituitary gland and whose primary
role is to promote breast milk production (lactation). It is normally elevated in women during
pregnancy and just after childbirth. It is normally low in men and non-pregnant women.
Prolactin levels do, however, need to be evaluated based on the time of day that they are
collected. The levels will vary over a 24-hour period, rising during sleep and peaking in the early
morning. Ideally, a person’s blood sample should be drawn 3 to 4 hours after waking.

26. Prolactin
When is it ordered?

27. Prolactin
 A person has signs and symptoms of a prolactinoma, such as unexplained headaches, visual
impairment, and/or unexplained breast nipple discharge
 A woman is experiencing infertility or irregular menstrual periods
 A man has symptoms such as decreased sex drive (libido), nipple discharge, or infertility or has a
low testosterone level
 When a person has a prolactinoma, prolactin levels may be ordered periodically to monitor
tumor growth and its response to treatment. They may also be ordered at regular intervals to
monitor for prolactinoma recurrence.
Prolactin levels may be ordered, along with other hormone levels such as growth hormone, when a
healthcare practitioner suspects that a person has a pituitary disorder such as hypopituitarism.
 When a person has a condition or is taking medications that may affect dopamine production,
prolactin concentrations may sometimes be monitored.
When is it ordered?

28. Prolactin
A high level of prolactin is normal during pregnancy and after childbirth while the mother is
nursing
A high level may also be seen with a few other conditions, such as:
 Tumors that produce and release prolactin (prolactinomas)
 The eating disorder anorexia nervosa
 Diseases of the hypothalamus
 Underactive thyroid (hypothyroidism)
 Kidney disease
 Liver disease
 Polycystic ovary syndrome
 Other pituitary diseases and tumors

29. Prolactin
Levels of prolactin that are below normal are not usually treated but may indicate a general
decrease in pituitary hormones caused by a pituitary disorder such as hypopituitarism.

30. Anti-Mullerian Hormone (AMH)
Anti-Müllerian hormone (AMH) is a hormone produced by reproductive tissues, including the
testicles in males and the ovaries in females. The role of AMH and the amount normally present
varies depending upon sex and age.
Very early in the development of a baby boy, AMH is produced by the testicles, inhibiting the
development of female reproductive organs while promoting the development of other male
reproductive organs. In boys, the level of AMH remains high until puberty, when it begins to taper
off.
In girls, low levels of AMH are produced, thus allowing the development of female reproductive
structures. The AMH level in young girls remains low until puberty, when the ovaries begin to
produce it and levels increase. AMH will then steadily decline in women over their reproductive
years, becoming very low and eventually undetectable after menopause.

31. Anti-Mullerian Hormone (AMH)
When is it ordered?
 AMH may be ordered when a woman has signs and symptoms of polycystic ovary
syndrome (PCOS)
 AMH may be ordered periodically for a woman with an AMH-producing ovarian cancer to
monitor the effectiveness of treatment and to monitor for recurrence.
 An AMH test may be ordered when an infant has ambiguous genitalia or when a male
child’s testicles have not descended properly.
 An AMH test may be ordered when a female begins to develop male characteristics

32. Anti-Mullerian Hormone (AMH)
During a woman’s childbearing years, a decreased level of AMH may indicate a low number and
quality of eggs (low ovarian reserve) with diminishing fertility, resulting in minimal or less
responsiveness to IVF treatment. It can also indicate that the ovaries are not functioning normally
(premature ovarian failure). Increased AMH may indicate an increased or even excessive
responsiveness to IVF and a need to tailor the procedure accordingly.
A decreasing level and/or significant decline in AMH may signal the imminent onset of menopause
or that a woman has entered menopause. Negative to low levels of AMH are normal in a female
during infancy and after menopause.
An increased level of AMH is often seen with PCOS but is not diagnostic of this condition.
When AMH is used as a tool to monitor an AMH-producing ovarian cancer, then a decrease in AMH
indicates a response to treatment while an increase may indicate cancer recurrence.
Women

33. In a female who develops male characteristics, if the AMH levels are in the male reference
range, it is most likely coming from a tumor or testicular tissue and if the levels are in the
female range, it is likely from the adrenal glands.
Anti-Mullerian Hormone (AMH)
N.B.:

34. Anti-Mullerian Hormone (AMH)
Infants
In a male infant, absence or low levels of AMH may indicate a problem with the AMH gene
located on chromosome 19 that directs AMH production and may be seen with absent or
dysfunctional testicles. Lack of male hormones may result in ambiguous genitalia and may
cause abnormal internal reproductive structures. Normal levels of AMH and androgens in a
male infant whose testicles have not descended indicate that they are present and functional but
not physically located where they are supposed to be.

35. Human chorionic gonadotropin (hCG) is a glycoprotein hormone that rises quickly in the
first few weeks of pregnancy, typically reaching a peak at 8- to 10-weeks gestational age.
hCG is produced by what will become the placenta.
Pregnancy test (hCG)
Human chorionic gonadotropin (hCG):
Secretion of hCG can occur as soon as 6 days following ovulation and on average 8-10 days
following ovulation； this is the earliest hCG can be detected in a blood sample. The hCG
concentration in blood is higher than in urine. Therefore, a blood test can be positive while
the urine test is still negative.

36. Why Get Tested?
To confirm a pregnancy; to help identify an ectopic pregnancy; to monitor a pregnancy that may
be at risk of failing; occasionally to screen a woman for pregnancy prior to some medical
treatments; as part of a panel of tests used to screen for fetal abnormalities
Pregnancy test (hCG)
Sample
 Urine pregnancy test
It is done 5 to 7 days after late menstrual period
A first morning urine sample (that has accumulated in the bladder overnight) provides the most
accurate test results.
 Blood pregnancy test
It is done 3 to 4 days after late menstrual period

37. Pregnancy detection kits
 It is either a strip or card impregnated with anti-HCG globulin
 Most tests employ a monoclonal antibody, which is specific to the β-subunit of hCG (β-
hCG) to ensure that tests do not make false positives by confusing hCG with LH and FSH.
Pregnancy test
Test Preparation Needed?
Do not drink large amounts of fluid before collecting a urine sample for a pregnancy test
because overly diluted urine may result in a false negative; no preparation is needed for a blood
sample.

38. Human chorionic gonadotropin (hCG) detection thresholds by test type and sample type
Pregnancy test
Blood pregnancy test
Urine pregnancy test
Qualitative test:
5 to 10 mlIU/mL, depending
on test
Quantitative test:
1 to 2 mIU/mL for an
ultrasensitive test
High-sensitivity:
Qualitative test: 20 to 50
mIU/mL, depending on test
Low- sensitivity:
Qualitative test: 1500-2000
mIU/ml, depending on test
Detection thresholds

39. Pregnancy test
Quantitative hCG testing, often called beta hCG (β-hCG), measures the amount of hCG present
in the blood. It may be used to:
 hCG blood measurements may also be used, along with a few other tests, as part of screening
for fetal abnormalities.
 A quantitative hCG blood test may also be used as a tumor marker in some cancers.
 Confirm a pregnancy
 Help diagnose an ectopic pregnancy, along with a progesterone test
 Help diagnose and monitor a pregnancy that may be failing
 Monitor a woman after a miscarriage

40. Pregnancy test
A positive hCG means that a woman is likely pregnant. However, false-positive tests can occur if
a woman is post-menopausal or taking hormone supplements.
The blood level of hcG in a woman with an ectopic pregnancy usually rises at a slower rate than
normal. Typically, hCG levels double every 48 to 72 hours for the first four weeks of a normal
pregnancy, then slow to every 96 hours by six weeks. Those with failing pregnancies will also
frequently have a longer doubling time early on or may even show falling hCG concentrations
during the doubling period. hCG concentrations will drop rapidly following a miscarriage.

41. Urine hCG tests may give a false-negative result if the urine is too diluted or if testing is
done too soon in the pregnancy. Certain drugs such as diuretics and promethazine (an
antihistamine) may cause false-negative urine results.
False-positive result of HCG
False-negative result of HCG
 Drugs such as antihistamines, anti-anxiety medications, diuretics, anti-convulsants,
anti-parkinson drugs, hypnotics, and tranquilizers may cause false-positive results.
 The presence of protein in the urine (proteinuria), blood in the urine (hematuria), or excess
pituitary gonadotropin may also cause a false-positive urine hCG test.
 Certain forms of cancer, such as choriocarcinoma can cause an elevation in hCG levels as
well as certain types of breast, or ovarian cancer leading to a false positive result.
Pregnancy test

42. Pregnancy test

43. Testosterone
Testosterone is the main sex hormone (androgen) in men. Although it is considered a “male”
sex hormone, it is present in the blood of both men and women. However, testosterone levels
are normally much higher in men than in women.
Testosterone is mainly produced by the male testicles. It is also produced by the adrenal glands
in both males and females and, in small amounts, by the ovaries in females.
 In males, testosterone stimulates development of secondary sex characteristics, including
enlargement of the penis, growth of body hair, muscle development, and a deepening voice. It
is present in large amounts in males during puberty and adulthood to regulate the sex drive
and maintain muscle mass.
 In women, most testosterone is converted to estradiol, the main sex hormone in females.

44. Testosterone
Testosterone production is stimulated and controlled by luteinizing hormone (LH), which is
made by the pituitary gland. Testosterone works within a negative feedback loop:
 A low level of testosterone causes increased production of LH, which in turn stimulates
testosterone production.
 As the testosterone level increases, LH production decreases, which slows testosterone
production.
N.B.:
Testosterone levels are diurnal, with the highest (peak) levels occurring in the early morning
hours (about 4:00 to 8:00 am) and the lowest levels occurring in the evening (about 4:00 to 8:00
pm). Levels also increase after exercise and decrease with age.

45. Testosterone
About two-thirds of testosterone circulates in your blood bound to the protein sex hormone binding
globulin (SHBG) and slightly less than one-third is bound to the protein albumin, the most
abundant protein in the blood. A small percent (less than 4%) circulates as free (not bound to
protein) testosterone. Free testosterone plus the testosterone that is bound to albumin is the
testosterone that can act on target tissues. This is called bioavailable testosterone.

46. Testosterone
In men, the test may be ordered when infertility is suspected or when you have a decreased sex
drive or erectile dysfunction. Some other symptoms of low testosterone include lack of beard and
body hair, very small testicles, decreased muscle mass, and development of breast tissue
(gynecomastia).
In boys with delayed or slowly progressing puberty, or very early puberty, the test is often
ordered with the FSH and LH tests. Although there are differences among boys as to when
puberty begins, it is generally between ages 9 and 14. Testing may be ordered when these
common physical signs of puberty in boys developer early or later:
- Increase in muscle mass - Deepening of the voice
- Growth of body hair and pubic hair - Growth of testicles and penis
When is it ordered?

47. Testosterone
In females, testosterone testing may be ordered when you have irregular or no menstrual
periods (amenorrhea), are having difficulty getting pregnant, or appear to have masculine
features, such as excess facial and body hair, male pattern baldness, and/or a low voice.
In infants, testosterone testing may be ordered when the genitals are not clearly male or
female.
When is it ordered?

48. Testosterone
The normal range for testosterone levels in men is broad and varies by stage of maturity and
age. It is normal for testosterone levels to slowly decline, usually starting after age 30. This is a
normal part of aging and typically doesn’t cause health problems.
 Chronic diseases such as type 2 diabetes, HIV, liver disease, kidney disease or autoimmune diseases
 Physical injury or trauma to the testicles
 Viral diseases like mumps
 Chemotherapy or radiation therapy
 Removal of testicles to treat cancer
 Use of medications such as antidepressants or narcotic pain medications
 Hypothalamic or pituitary disease
 Genetic diseases that can cause decreased testosterone production in young men or testicular failure
and infertility (e.g., myotonic dystrophy, a form of muscular dystrophy)
Males:
A low testosterone level (male hypogonadism) may be due to:

49. Testosterone
Increased testosterone levels can indicate:
 Testicular tumors
 Adrenal tumors that are producing testosterone
 Use of anabolic steroids, which contain synthetic testosterone
 Early puberty of unknown cause in boys
 Congenital adrenal hyperplasia in babies and children
Males:

50. Testosterone
Females:
Increased testosterone levels can indicate:
 Polycystic ovary syndrome (PCOS)
 Ovarian tumor or adrenal gland tumor
 Congenital adrenal hyperplasia
 Testosterone exposure (from physical contact with someone around them using
testosterone topical products)

51. Testosterone
What are total testosterone, free testosterone, and bioavailable testosterone?
Most testosterone (up to 98%) circulates in the blood bound to proteins. A small amount of
testosterone (less than 4%) circulates in the blood as free testosterone (it is not bound to protein).
The bound plus unbound (free) testosterone is measured by labs as total testosterone.
Slightly less than one-third of the protein-bound testosterone is loosely bound to albumin, the main
protein in the fluid portion of the blood. About two-thirds is tightly bound to another protein called
sex hormone binding globulin or SHBG. The binding between testosterone and albumin is not very
strong and is easily reversed. The free testosterone plus the albumin-bound testosterone is the
bioavailable testosterone (BAT), which is the portion of testosterone that is available to act on target
tissues.

52. In many cases, measurement of total testosterone provides a healthcare practitioner with adequate
information. However, in certain cases, for example when the level of SHBG is abnormal, a test
for free or bioavailable testosterone may be performed as it may more accurately reflect the
presence of a medical condition. Decreased SHBG levels may be seen in obesity, hypothyroidism,
androgen use, and nephrotic syndrome (a form of kidney disease). Increased SHBG levels may be
seen with low testosterone production, cirrhosis, hyperthyroidism, and estrogen use.
Testosterone
What are total testosterone, free testosterone, and bioavailable testosterone?

53. This test measures the levels of SHBG in blood. SHBG stands for sex hormone binding globulin. It's
a protein made by the liver and attaches itself to sex hormones found in both men and women. Other
name (testosterone-estrogen binding globulin)
These hormones are:
 Testosterone, the main sex hormone in men
 Dihydrotestosterone (DHT), another male sex hormone
 Estradiol, a form of estrogen, the main sex hormone in women
 SHBG controls how much of these hormones are delivered to the body's tissues.
 Although SHBG attaches to all three of these hormones, an SHBG test is mostly used to look
at testosterone.
 SHBG levels can show if there is too much or too little testosterone being used by the body.
SHBG blood test

54. Too low levels, means the protein is not attaching itself to enough testosterone. This allows more
unattached testosterone to be available in your system. It may cause too much testosterone to go
to body's tissues.
Low SHBG level can indicate:
SHBG blood test
 Hypothyroidism.
 Type 2 diabetes.
 Overuse of steroid medications.
 Cushing's syndrome
 For men, it can mean cancer of the testicles or adrenal glands.

55. SHBG blood test
Too high levels, means the protein is attaching itself to too much testosterone. So less of
the hormone is available, and tissues may be not be getting enough testosterone.
High SHBG level can indicate:
 Liver disease
 Hyperthyroidism,
 Eating disorders
 For men, it can mean a problem with the testicles or pituitary gland.

56. Acid phosphatase
Prostatic acid phosphatase (PAP), which is produced in the prostate, was the first major serum
marker for prostate cancer. PAP was used widely for screening, staging, and posttreatment
monitoring in prostate cancer, but its use has largely been displaced by that of Prostate-Specific
Antigen (PSA).
Indications for testing of PAP include the following:
 Additional prognostic information for predicting recurrence after radical prostatectomy for
clinically localized prostate cancer
 Additional monitoring of therapeutic response in prostate cancer treated by androgen ablation

57. Conditions associated with elevations in prostatic acid phosphatase (PAP) include the following:
Acid phosphatase
Interpretation
 Prostate cancer
 Benign prostatic hyperplasia
 Prostatic infarction

58.  Marked rise is seen in Gaucher’s disease and it is characteristic of that disorder.
 Occasional rise is seen in Paget’s disease, hyperparathyroidism, and osteolytic metastasis
from breast and other carcinomas.
 Marked rise seen with thrombocytosis, chronic granulocytic leukemia, myeloproliferative
disorders
Acid phosphatase
Acid phosphatase activity in serum may also rise in certain other diseases:

59. Acid phosphatase
1. It is extremely labile enzyme. Enzyme assays should done on fresh samples
immediately.
2. Avoid hemolysis (due to presence of acid phosphatase in RB cells. Hemolysis sample
gives high result.
Precautions

60. Recommended hormone tests in the general practice setting

61. Questions