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  • Title: [Hormonal dynamics during pregnancy: critical discussion and clinical interpretations].
    Author: Bélisle S.
    Journal: Can Med Assoc J; 1978 Dec 09; 119(11):1307-9. PubMed ID: 153779.
    Abstract:
    Although the clinical interpretation of its results varies greatly among perinatologists, the dehydroepiandrosterone sulfate (DHEA-S) loading test has become an integral part of fetal monitoring in many centres dealing with high-risk pregnancies. Currently four main metabolic responses to administration of DHEA-S to the mother are monitored to predict the functional state of the fetoplacental unit: the metabolic clearance of DHEA-S, the metabolic clearance of DHEA-S into estradiol, the conversion of DHEA-S into estradiol or esterol, and the increase in the plasma concentrations of DHEA and androstenedione after administration of DHEA-S. This article critically reviews each of these responses and its possible clinical interpretation, and assesses the clinical future of the DHEA-S loading test. Although the clinical interpretation of its results varies greatly among perinatologists, the dehydroepiandrosterone sulfate (DHEA-S) loading test has become an integral part of fetal monitoring in many centres dealing with high-risk pregnancies. Currently four main metabolic responses to administration of DHEA-S to the mother are monitored to predict the functional state of the fetoplacental unit: the metabolic clearance of DHEA-S, the metabolic clearance of DHEA-S into estradiol, the conversion of DHEA-S into estradiol or esterol, and the increase in the plasma concentrations of DHEA and androstenedione after administration of DHEA-S. This article critically reviews each of these responses and its possible clinical interpretation, and assesses the clinical future of the DHEA-S loading test. The dehydroepiandrosterone sulfate (DHEA-S) loading test is increasingly used to detect fetal disorders in high risk pregnancies. There are 4 types of metabolic responses to the injection of DHEA-S: 1) metabolic clearance of DHEA-S, which represents the proportion between production and plasma concentrations of DHEA-S; 2) metabolic clearance of DHEA-S into estradiol, which presupposes the utilization of radioactive materials and is, therefore, unadvisable; 3) metabolic conversion of DHEA-S into estrogens, which can be measured in the urine or in the blood plasma; and 4) increase in the plasma concentrations of DHEA-S and androstenedione, caused by the enzymatic process implied in the conversion of DHEA-S into estrogens. The clinical interpretations of the DHEA-S test is very limited and controversial, and its application cannot yet replace the other methods of antenatal investigation.
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