Urine studies: hormone profiling, bone resorption markers and patient care

Townsend Letter for Doctors and Patients,  Nov, 2004  by Jason Barker,  Chris Meletis

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The advent of new technology in laboratory testing is now providing busy clinicians with increasingly accurate and reliable testing methods. Although sticking to the basics can still provide salient information, adopting newer testing methods allows doctors to further explore the causes of their patients' health conditions. Classical hormone testing focused on estradiol, progesterone, follicle stimulating hormone and luteinzing hormone is now augmented with new methods of hormone quantification; doctors can now integrate a large amount of data obtained from the patient, focusing on the homeostatic mechanisms which govern the body's hormonal pathways. Observing the complete hormonal picture, and therefore the body's attempt at homeostasis, provides factual results that can lead to positive clinical outcomes. Additionally, advanced screening for bone resorptive products allows physicians to predict, monitor, and adjust osteoporosis therapies, ensuring a more accurate outcome.

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Steroid Hormone Profiling

Utilizing mass spectrometry to identify and quantify steroid hormones in the urine provides a quantum amount of new information in comparison to individual hormone measurements. Steroid hormones can be grouped into two categories, primary and secondary. Primary hormones include estradiol, testosterone, progesterone, cortisol and aldosterone; they have common biological functions and are secreted in extremely low amounts in the body. Secondary hormones exert less effect than the primary hormones; they include estrone, estriol, and dehydroepiandrosterone (DHEA), among others. Quantification of only the primary hormones provides little information as to the state of the productive or destructive pathways whereas complete hormonal profiling provides information about the metabolic pathways of each hormone, allowing the clinician to detect the origins of possible hormone related symptoms.

Steroid hormone profiling typically identifies at least 20 different metabolic products involved in the hormonal continuum. (Figure 1) Included are metabolites of estrogen, progesterone, testosterone, and adrenal hormones. Review of the biochemical trends of each hormonal pathway and its resultant metabolite levels provides clinical insights and understanding of patient symptomology that would otherwise be unknown to the clinician. Bottom line, these insights allow for broader clinical interventions that can be prescribed with greater specificity.

Hormones, simply put, are the body's chemical messengers that are used to affect the function of a grouping of cells or organs in order to encourage that organ to perform its duties. Hormones perform a large number of functions in the body, including maintenance and regulation of sexual and reproductive functions, assisting the body in coping with stressors, and stabilizing biologic homeostatic mechanisms. Production of steroid hormones is controlled by the pituitary gland, which signals the ovaries, testes, and adrenal gland to produce hormones in response to physiologic stimuli. The interworkings of primary hormones and their metabolites are quite complex to say the least, and profiling allows the practitioner to obtain a snapshot of the entire hormonal landscape.

Pursuit of hormonal balance is extremely individualized from patient to patient, and multitudes of clinical considerations must be made when clinicians endeavor to promote a patient's hormonal wellness. Many variables can be brought into balance, and in doing so, the risk of disease is minimized, including cancers related to hormonal modulation. (1) Hormone profiling can help to elaborate on the specific causes of perimenopause and menopausal symptoms that are recalcitrant to therapy, as well as premenstrual syndrome (PMS) symptoms, reconciliation of hormone replacement therapy (HRT) dose specificity, patients taking other hormone preparations such as DHEA, androstenodione, and testosterone, and women with irregular hair growth (hirsutism) and female pattern baldness, polycystic ovarian syndrome (PCOS), and decreased libido. Men can experience hormone-related symptoms as well, with decreased libido, impotence, decreased muscle strength and tone, and depression beginning in middle age.

Hormone profiling is especially important in patients who are supplementing with non-prescription hormonal medicines. Although symptoms may be abated through the use of such preparations, symptom-based dosing is an inaccurate method to determine adequate dosage of said medicines. Additionally, resolution of symptoms does not ensure that excessive dosing has not occurred, and the risk of hormone-related disease is a possibility in unquantified amounts of over-the-counter hormone preparations, including breast cancer. (2) One laboratory that performs steroid hormone profiling indicates that patients supplementing with over-the-counter hormone preparations are often found to have hormone levels exceeding the norm. (3) By determining an accurate dosage of hormones, the risk of excessive dosing leading to as yet unknown consequences, is minimized while patient satisfaction is achieved with individualized standardization of hormone dosing.