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Related to luteotropin: prolactin
prolactinA gonadotropic hormone encoded by PRL on chromosome 6p22.2-p21.3 and secreted by the anterior pituitary, which in females stimulates mammary gland growth and lactation after childbirth.
Synonym/acronym: LH, luteotropin, interstitial cell–stimulating hormone (ICSH).
To assess gonadal function related to fertility issues and response to therapy.
SpecimenSerum (1 mL) collected in a gold-, red-, or red/gray-top tube. Plasma (1 mL) collected in a green-top (heparin) tube is also acceptable.
|Concentration by Gender and by Phase (in Females)||Conventional and SI Units|
|Less than 2 yr||0.5–1.9 international units/mL|
|2–10 yr||Less than 0.5 international units/mL|
|11–20 yr||0.5–5.3 international units/mL|
|Adult||1.2–7.8 international units/mL|
|Less than 2–10 yr||Less than 0.5 international units/mL|
|11–20 yr||0.5–9 international units/mL|
|Phase in Females|
|Follicular||1.7–15 international units/mL|
|Ovulatory||21.9–80 international units/mL|
|Luteal||0.6–16.3 international units/mL|
|Postmenopausal||14.2–52.3 international units/mL|
The secretion and inhibition of human reproductive hormones is maintained by a fine balance of feedback mechanisms involving the hypothalmus, pituitary gland, ovaries, and testes. Gonadotropin-releasing hormone (Gn-RH), a peptide neurohormone produced and released by the hypothalamus, signals the anterior pituitary gland to release luteinizing hormone and follicle-stimulating hormone. GnRH is secreted during the neonatal period and gonadotropins are detectable in the blood at an early age. A negative feedback mechanism initiated by FSH and LH levels inhibits further secretion by suppressing the release of Gn-RH until puberty. During the prepubital period and following into adulthood, nocturnal pulses of Gn-RH induce nocturnal, pulsatile secretions of luteinizing hormone (LH). The mechanism by which increased release of Gn-RH permits increased secretion of gonadotropins is not well understood. LH affects gonadal function in both men and women. In women, a surge of LH normally occurs at the midpoint of the menstrual cycle (ovulatory phase) due to initiation of a positive feedback loop involving estrogen and which results in ovulation. As the corpus luteum develops progesterone levels rise, signaling the pituitary to stop secreting LH. In males, LH stimulates the interstitial cells of Leydig, located in the testes, to produce testosterone. For this reason, in reference to males, LH is sometimes called interstitial cell–stimulating hormone. Serial specimens may be required to accurately demonstrate blood levels.
This procedure is contraindicated for
- Distinguish between primary and secondary causes of gonadal failure
- Evaluate children with precocious puberty
- Evaluate male and female infertility, as indicated by decreased LH levels
- Evaluate response to therapy to induce ovulation
- Support diagnosis of infertility caused by anovulation, as evidenced by lack of LH surge at the midpoint of the menstrual cycle
Conditions of decreased gonadal function cause a feedback response that stimulates LH secretion.
- Gonadal failure
- Primary gonadal dysfunction
- Anorexia nervosa (pathophysiology is unclear) Kallmann’s syndrome (pathophysiology is unclear) Malnutrition (pathophysiology is unclear) Pituitary or hypothalamic dysfunction (these organs control production of LH; failure of the pituitary to produce LH or of the hypothalamus to produce gonadotropin-releasing hormone results in decreased LH levels) Severe stress (pathophysiology is unclear)
- Drugs and hormones that may increase LH levels include clomiphene, gonadotropin-releasing hormone, goserelin, ketoconazole, leuprolide, mestranol, nafarelin, naloxone, nilutamide, spironolactone, and tamoxifen.
- Drugs and hormones that may decrease LH levels include anabolic steroids, anticonvulsants, conjugated estrogens, cyproterone, danazol, digoxin, d-Trp-6-LHRH, estradiol valerate, estrogen/progestin therapy, finasteride, ganirelix, goserelin, ketoconazole, leuprolide, desogestrel/ethinylestradiol (Marvelon), medroxyprogesterone, megestrol, metformin, methandrostenolone, norethindrone, octreotide, oral contraceptives, phenothiazine, pimozide, pravastatin, progesterone, stanozolol, and tamoxifen.
- In menstruating women, values vary in relation to the phase of the menstrual cycle.
- LH secretion follows a circadian rhythm, with higher levels occurring during sleep.
Nursing Implications and Procedure
Potential nursing problems
|Problem||Signs & Symptoms||Interventions|
|Self-esteem (Related to altered self-view associated with infertility)||Verbalizes feelings that express being a failure as a man or woman associated with inability to impregnate or become pregnant; dissatisfaction with present state of intimacy with significant other||Monitor for negative self-statements; assess for withdrawal; monitor for real or perceived rejection of others; encourage verbalization of self-worth; encourage discussion of perceived changes in family role; monitor for anxiety; recommend personal and family counseling; facilitate support group participation|
|Knowledge (Related to recent diagnosis; complexity of treatment; poor understanding of provided information; cultural or language barriers; anxiety; emotional disturbance; unfamiliar with medical management)||Lack of interest or questions; multiple questions; anxiety in relation to disease process and management; verbalizes inaccurate information; lack of follow-through with directions||Identify patient’s, family’s, and significant other's concerns about disease process; provide information regarding fertility testing and treatment; encourage participation in a support group to decrease anxiety|
|Anxiety (Related to failure versus desire to conceive)||Stated feelings of inadequacy, helplessness; restlessness and irritability; altered sleep pattern; lack of appetite or overeating; difficulty concentrating and focusing||Assess the level of anxiety; assist the patient to identify coping strategies that will decrease anxiety; administer prescribed medications to decrease anxiety; provide education that is culturally and age appropriate, and at an appropriate literacy level; encourage a discussion of fears and concerns causing the anxiety; refer to social services and a support group as applicable|
|Powerlessness (Related inability to become pregnant secondary to failure to ovulate)||Expression of loss of control over situation, self, outcome of disease; passive; apathetic; submissive; decreased participation in self-care; reluctant to express feelings||Assess need to be in control; assess feelings of hopelessness, depression, apathy; assess the impact of the sense of powerlessness on the patient's sense of self; encourage verbalization of feelings; discuss therapeutic options offered by health-care provider (HCP); assist to identify strengths; identify coping strategies|
- Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
- Patient Teaching: Inform the patient this test can assist in assessing hormone and fertility disorders.
- Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex.
- Obtain a history of the patient’s endocrine and reproductive systems, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
- Record the date of the last menstrual period and determine the possibility of pregnancy in perimenopausal women.
- Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
- Review the procedure with the patient. If the test is being performed to detect ovulation, inform the patient that it may be necessary to obtain a series of samples over a period of several days to detect peak LH levels. Inform the patient that specimen collection takes approximately 5 to 10 min. Address concerns about pain and explain that there may be some discomfort during the venipuncture.
- Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
- Note that there are no food, fluid, or medication restrictions unless by medical direction.
- Potential complications: N/A
- Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
- Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
- Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection. Perform a venipuncture.
- Remove the needle and apply direct pressure with dry gauze to stop bleeding. Observe/assess venipuncture site for bleeding or hematoma formation and secure gauze with adhesive bandage.
- Promptly transport the specimen to the laboratory for processing and analysis.
- Inform the patient that a report of the results will be made available to the requesting health-care provider (HCP), who will discuss the results with the patient.
- Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.
- Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP.
- Instruct the patient in the use of home ovulation test kits approved by the U.S. Food and Drug Administration, as appropriate.
- Answer any questions or address any concerns voiced by the patient or family.
Expected Patient Outcomes
- States understanding of the purpose of repeating laboratory studies to monitor and trend hormone levels
- States understanding of alternative methods to achieve pregnancy as described by HCP
- Accurately describes the purpose of future laboratory studies to monitor hormone levels and evaluate response to therapy
- Accurately self-administers medication to decrease anxiety
- Agrees to attend a support group for those who have infertility concerns
- Identifies nonpharmacological coping strategies that will help to decrease anxiety
- Related tests include ACTH, antisperm antibody, estradiol, FSH, progesterone, prolactin, and testosterone.
- Refer to the Endocrine and Reproductive systems tables at the end of the book for related tests by body system.