drug stimulation test

In the clinic, some diseases of the reproductive endocrine system, such as lesions of the hypothalamus, pituitary or testis, can cause a decrease in testosterone levels. How to distinguish the site of the glandular axis is in the hypothalamus, pituitary, or testis. To this end, medical researchers designed three experimental clomiphene drug trials, gonadotropin-releasing hormone (LHRH) drug stimulation test, and human chorionic gonadotropin (HCG) drug stimulation test. Basic Information Specialist classification: growth and development examination classification: blood examination Applicable gender: whether men and women apply fasting: fasting Analysis results: Below normal: Normal value: no Above normal: negative: Adults with negative clomiphene stimulating test can diagnose adult pituitary infancy. Positive: Primary azoospermia and oligozoospermia positive for clomiphene stimulating test. Tips: Do not overeating (especially drinking) the day before the test, to ensure adequate sleep, to avoid affecting the results. Normal value The pituitary, hypothalamic, and testicular interstitial cells function normally and are negative. Clinical significance Abnormal result 1, patients with negative clomiphene stimulating test can diagnose adult pituitary infancy. Those with primary testicular dysfunction have high ICSH values. Primary azoospermia and oligozoospermia positive for clomiphene stimulating test. 2. ICSH and FSH did not increase after stimulation with clomiphene, and ICSH and FSH increased significantly after injection of GnRH, suggesting that dysfunction is in the hypothalamus. 3, human chorionic gonadotropin (HCG) stimulation test positive (injection of testosterone after HCG) suggest that functional testicular tissue does exist. In patients without testosterone, the testosterone base value is low and the HCG test is negative (testosterone does not increase after HCG injection). The cryptorchidism response is low or close to the normal level, because the warm stimulation of the cryptorchidism mainly damages the spermatogenic function of the seminiferous tubule, while the interstitial cells still maintain the function of secreting testosterone. Those who need to be examined have low testosterone levels. Precautions Inappropriate population: Patients who are sensitive to clomiphene, exogenous gonadotropin-releasing hormone, and human chorionic gonadotropin. Taboo before inspection: 1. Do not overeating (especially drinking) the day before, to ensure adequate sleep and avoid affecting the results. 2. Gonadotropin-releasing hormone (GnRH) stimulation test must be fasted for 8-12 hours. 3. If there is any discomfort after the injection of the drug, you should inform the medical staff in time. Requirements for inspection: 1. After blood is drawn, use a sterile cotton ball to squeeze the puncture site for 3-5 minutes to stop bleeding, and at the same time relax the sleeves of the upper jaw. Do not rub the puncture site to avoid "cyan" in local congestion. Do not touch the puncture point after hemostasis to avoid infection. Occasionally, due to factors such as fasting, poor rest, and nervousness, the mountain is now "stunned": dizziness, pale face, weak body, and difficulty breathing. At this point, you should immediately ask the doctor for help. At the same time, you can lie flat on the waiting chair, loosen your belt, take a deep breath, and get relief after a few minutes with the help of a doctor. People with a history of "halo" can bring some candy, chocolate, etc. the next time they take the blood. After taking the blood, they can be taken immediately to avoid such a phenomenon. 2, human chorionic gonadotropin stimulation test needs to take blood on different dates, so go to the hospital for examination at the prescribed time. Inspection process (1) Clomiphene stimulation test: There is an estrogen (mainly estradiol, ie E2) receptor in the hypothalamus, and estradiol in the blood can bind to this receptor, inhibiting the secretion of gonadotropin-releasing hormone from the hypothalamus. GnRH), clomiphene enters the human body and competes with estradiol, binds to the receptor, blocks the negative feedback of estradiol, increases the secretion of GnRH, and acts on the pituitary gland by GnRH, which increases the secretion of FSH and ICSH. ICSH in turn increases testosterone secretion. Test method: FSH, ICSH and T values ​​were measured before taking the drug. On the third day, clomiphene citrate 200 mg was administered for 10 consecutive days. The FSH, ICSH and T contents were measured on the last two days. After taking clomiphene, the increase of blood FSH, ICSH and T concentration was positive, and the increase was not negative. (2) Gonadotropin-releasing hormone (GnRH) stimulation test: GnRH is secreted by the hypothalamus, which can stimulate pituitary production and secretion of FSH and ICSH. After injection of GnRH, blood FSH rises to three times the baseline value, while ICSH can increase by three to six times. Those who were significantly elevated were positive, and those who did not rise were negative. Test method: morning fasting, the second blood draw 15 minutes after the first blood draw, then immediately GnRH100mg, 3, 4, 5 times after 20 minutes, 60 minutes and 120 minutes, respectively, blood, FSH, ICSH content. A positive indicates that the pituitary function is good, and a negative indicates that the pituitary function is low. (3) Human chorionic gonadotropin (HCG) stimulation test: HCG is secreted by the placenta of pregnant women and has the activity of ICSH, which can stimulate the synthesis of testicular stromal cells and secrete testosterone. Test method: Blood was taken for control on the first day, and HCG2000 IU was injected into the posterior muscle. On the fourth day, the second intramuscular injection of HCG2000 international unit was performed after blood was drawn. Blood was drawn on the 7th day. Testosterone was measured in 3 times of blood. In patients with undeveloped testicular or cryptorchidism, two intramuscular injections of HCG are not sufficient to cause adequate response. If necessary, intramuscularly, HCG2000 international units are administered every 3 days for a total of 12 times. Blood is taken before each injection to determine testosterone. Not suitable for the crowd 1. Patients who have taken contraceptives, thyroid hormones, steroid hormones, etc., may affect the results of the examination and prohibit patients who have recently taken the drug history. 2, special diseases: patients with hematopoietic function to reduce disease, such as leukemia, various anemia, myelodysplastic syndrome, etc., unless the examination is essential, try to draw less blood. Adverse reactions and risks 1, subcutaneous hemorrhage: due to pressing time less than 5 minutes or blood draw technology is not enough, etc. can cause subcutaneous bleeding. 2, discomfort: the puncture site may appear pain, swelling, tenderness, subcutaneous ecchymosis visible to the naked eye. 3, dizzy or fainting: in the blood draw, due to emotional overstress, fear, reflex caused by vagus nerve excitement, blood pressure decreased, etc. caused by insufficient blood supply to the brain caused by fainting or dizziness. 4. Risk of infection: If you use an unclean needle, you may be at risk of infection.