TM Discover Essential Insights with specialized hormone testing © 2016 Genova Diagnostics e,mp,essence_trifold,031016 GDX-7-144 11-Deoxycortisol Corticosterone Pregnanediol Pregnanetriol THS a-THF THF THE 2-MeO (E1+E2) 2-OH (E1+E2) 16a-OH(E1) 4-OH (E1+E2) 4-MeO (E1+E2) Etiocholanolone Androsterone Androstanediol 11β -OH-Androstenedione Adrenosterone 11-OH-Androsterone 11-OH-Etiocholanolone 11-Keto-Androsterone 11-Keto-Etiocholanolone Cholesterol Pregnenolone Progesterone 17-OH-Progesterone 17-OH-Pregnenolone Androstenedione DHEA Androstenediol Estrone (E1) Estriol (E3) Estradiol (E2) DHT Testosterone Aldosterone* Cortisol Cortisone © 2016 Genova Diagnostics • e,po,steropath,031016 Steroidogenic Pathways the 1A1 = Cytochrome p450 1A1 (CYP1A1) 3A4 = Cytochrome p450 3A4 (CYP3A4) 1B1 = Cytochrome p450 1B1 (CYP1B1) COMT = Catechol-O-Methyl-transferase ESTROGEN METABOLISM: 3βHSD = 3beta-Hydroxysteroid dehydrogenase 5α = 5alpha-Reductase 5β = 5beta-Reductase CYP11b1 = 11beta-Hydroxylase 11βHSD = 11beta-Hydroxysteroid dehydrogenase 17βHSD = 17beta-Hydroxysteroid dehydrogenase 17,20 Lyase = 17,20 Desmolase CYPc17 = 17alpha-Hydroxylase CYP19 = Aromatase CYP21 = 21-Hydroxylase ENZYMATIC STEPS: Mineralocorticoids 17-Hydroxysteroids 17-Ketosteroids Estrogen Metabolites Measurable in Urine Measurable in Blood Measurable in Saliva Hormones measurable by Genova Diagnostics: Sex Hormones Thyroid Adrenals Sex Hormone Assessment Imbalances in estrogen, progesterone and testosterone are common in patients with peri/ menopausal or andropausal symptoms, and are associated with a host of sex-hormone related issues. Risk is also increased for systemic problems such as osteoporosis, heart disease and dyslipidemia, immune dysfunction, and hormone-dependent cancers. Assessment of sex steroid metabolism provides insight into the body’s ability to optimally process endogenous sex hormones as well as bioidentical hormone therapy. Key metabolite ratios can help the clinician identify potential areas of concern in hormone production and metabolism that can impact the risk for hormone-related disease. Sex hormones move through the body’s steroidogenic pathways (graphic, back page) depending on the optimal functioning of numerous key enzymes. These enzymes are impacted by a variety of factors – drugs, foods, supplements, disease states – that can either up-regulate or down-regulate their activity. Targeting the endocrine system to identify imbalances that create symptoms in pa- tients may be an important first clinical consideration. Genova Diagnostics offers a variety of hormone testing profiles that examine core components of the endocrine system – adrenal, thyroid and sex hormone function. Ultimately, a diagnostic approach that supports better understanding of the interrelationship of these components translates into more effective therapeutic interventions. The Endocrine Pyramid Thyroid Assessment While thyroid hormone production is centrally regulated (hypothalamus-pituitary-thyroid or HPT axis), thyroxine (T4) from the thyroid gland is peripherally transformed in liver and kidney cells into its active T3 form and reverse T3 (rT3). Thyroid symptoms may occur due to problems with peripheral conversion (reflected by T3 and rT3 levels) and/or with immune system interference in the form of auto-antibodies (reflected by anti-thyroglobulin and anti- thyroidal peroxidase antibodies). Adrenal assessment is useful in suspected thyroid dysfunction, as stress (via cortisol production) has been shown to inhibit TSH secretion, render target tissues less sensitive, and inhibit the conversion of T4 to T3. Adrenal Assessment The adrenal glands provide a critical foundation for developing and maintaining overall health & well-being. This is increasingly evident in research demonstrating the negative health effects of chronic stress and sustained elevation of cortisol levels. Imbalances in the adrenal hormones, cortisol and DHEA, can adversely affect: • Mood • Sleep • Immune Defense • Thyroid Function • Weight Control • Resistance to Stress • Energy • Cardiovascular Health The adrenal glands provide a critical foundation for developing and maintaining overall health & well-being Thyroid dysfunction may occur even when the HPT axis is operating adequately Assessing the metabolism of sex hormones and steroidogenic precursors gives insight into underlying hormonal imbalances that can affect a wide range of body functions ASHEVILLE • ATLANTA • LONDON 800.522.4762 • www.gdx.net