Endocrine Labs: Available at Vancouver wellness studio

The second section we will move into is the endocrine system, which comprises of the hypothalamus and pituitary, thyroid gland, adrenal glands, pancreas, kidney, and bones. A key concept to understand is that the hormones produced and released by the hypothalamus & pituitary glands directly affect several different downstream organs, which is why we will start at this primary duo and incorporate the other endocrine organs as we go.  

Functional Testing for the Hypothalamus & Pituitary (H-P)

Lab testing for the hypothalamus-pituitary glands is mainly ordered by an endocrinologist after abnormal values have been identified via testing of the downstream organs that are affected by hormones secreted by the H-P. The H-P system produces a variety of hormones that include the following:

• Growth hormone (GH) – Growth hormone production from the anterior pituitary is regulated by exercise, stress, nutrition, and sleep patterns. This hormone functions to induce growth and increase metabolic activity in nearly every tissue of the body. There is a tight relationship between GH & Insulin-like growth factor-1 (IGF-1), which can be measured via blood testing as a surrogate marker to assess for a deficiency or excess of growth hormone. 

• Growth hormone and IGF-1 are fundamental in promoting the growth of bones during puberty and maintenance of a strong and healthy skeletal system throughout the lifespan. Growth hormone deficiencies in childhood can lead to reduced bone mineral density and an increased risk for fractures. IGF-1 is essential for skeletal maturation and maintenance of bone mass, and it has been recently shown that low serum IGF-1 levels in females correlate with an increased prevalence of fractures and osteoporosis. Estrogen is one of the key factors regulating the expression of IGF-1 in maintaining skeletal integrity, and hormone assessment is an essential component of our functional lab testing at VWS.
  Two prominent conditions that can be discussed here, include osteopenia and osteoporosis. These conditions can lead to an increased risk for fractures of the hip, spine, and other important weight-bearing bones of the skeleton. Evaluation for these conditions frequently occurs with a DEXA scan that can be ordered by your VWS practitioner. Osteopenia is defined as a t-score between -1 and -2.5, indicating that your bone density is 10 - 25% below the average healthy 30-year-old adult. Osteoporosis is diagnosed when the t-score is below -2.5, where bone density is lower than 25% of the average 30-year-old. The lower the T-score, the more porous the bone, and the higher the fracture risk becomes.
  When we suspect that our patients are at risk for osteopenia or osteoporosis, or they have had prior DEXA scans showing low T-scores, we are able to order a battery of other functional tests to get a fuller picture of what could be causing poor bone health so we can figure out how to reverse the process & strengthen bone. These tests include:

• Complete blood counts – to assess if there is in issue within the marrow & blood cell production

• Chemistry levels of Calcium, Phosphorus, and Magnesium

• Liver function testing (AST/ALT/ALP/GGT/Albumin & Protein/Bilirubin/Lactate Dehydrogenase)

• Vitamin D

• Parathyroid Hormone 

• Estrogen, Testosterone, and IGF-1

If a DEXA scan hasn’t been completed or isn’t an option due to cost, and you would like to know about your bone density, there are less invasive blood and urine tests that can be ordered to understand bone mineral density and fracture risk with equal precision. With the results of this testing, we can implement targeted strategies for building bone and assess progress using the same functional labs:

• Serum CTX (carboxy-terminal terlopeptides of type 1 collagen). CTX is produced during the process of bone remodeling, and elevated levels have been shown to correlate with low bone mineral density and increased fracture risk. The normal range for females between the ages of 18 - 49 years old is between 40 - 650 pg/mL. For patients already diagnosed with osteoporosis, a >25% reduction from baseline to 3-6 months after the start of therapy indicates that therapy is having a beneficial impact.

• Urinary NTX (amino-terminal telopeptides of type 1 collagen). A baseline urine NTX value >38 can indicate an increased risk of low bone mineral density. 

• Urinary Pyrilinks-D - a measure of the abundance of proteins that adds strength to the collagen matrix upon which bone mineralization can occur.

References

Biver E, Chopin F, Coiffier G, Brentano TF, Bouvard B, Garnero P, Cortet B. Bone turnover markers for osteoporotic status assessment? A systematic review of their diagnosis value at baseline in osteoporosis. Joint Bone Spine. 2012 Jan;79(1):20-5. doi: 10.1016/j.jbspin.2011.05.003. Epub 2011 Jul 2. PMID: 21724445.

Ivaska KK, Gerdhem P, Väänänen HK, Akesson K, Obrant KJ. Bone turnover markers and prediction of fracture: a prospective follow-up study of 1040 elderly women for a mean of 9 years. J Bone Miner Res. 2010 Feb;25(2):393-403. doi: 10.1359/jbmr.091006. PMID: 19961336.

Tamaki J, Iki M, Kadowaki E, Sato Y, Chiba Y, Akiba T, Matsumoto T, Nishino H, Kagamimori S, Kagawa Y, Yoneshima H; JPOS Study Group. Biochemical markers for bone turnover predict risk of vertebral fractures in postmenopausal women over 10 years: the Japanese Population-based Osteoporosis (JPOS) Cohort Study. Osteoporos Int. 2013 Mar;24(3):887-97. doi: 10.1007/s00198-012-2106-7. Epub 2012 Aug 11. PMID: 22885773.

This next biomarker we will explore is related to the hypothalamus-pituitary-adrenal axis and is important for understanding adrenal function and cortisol activity.  

• Adrenocorticotropic hormone (ACTH) – Produced by the anterior pituitary and stimulated by corticotropic releasing hormone from the hypothalamus.  ACTH triggers the adrenal glands to produce a variety of important hormones, including progesterone, aldosterone, testosterone, DHEA, and cortisol. Cortisol is most well-known, and we will discuss functional testing to assess the H-P-A axis whenever we get to discussing the adrenal glands. Normal production of ACTH can be inhibited by taking prescription glucocorticoid therapy (prednisone, hydrocortisone, dexamethasone, and budesonide). Prolonged exposure to exogenous glucocorticoid therapy can suppress ACTH to such an extent that the adrenal glands atrophy and the body becomes unable to produce adequate cortisol, leading to symptoms of weakness, lethargy, anorexia, nausea/vomiting, muscle cramps, and headaches.
  

• Follicle-stimulating hormone (FSH) and Luteinizing hormone (LH) – Produced by the anterior pituitary and stimulated by gonadotropin-releasing hormone from the hypothalamus, FSH & LH are part of the functional testing to assess reproductive hormones in both males and females who may be experiencing symptoms of perimenopause, dysregulated menstrual cycles, low energy and weight gain, as well as infertility. We offer a few methods of assessment, and for our female patients, it is imperative that we time sample collection based on the rhythm of luteinizing hormone that is measured with ovulation predictor kits. 

• DUTCH testing, stands for Dried Urine Test for Comprehensive Hormones, offers an extensive assessment of sex and adrenal hormones along with their metabolites, plus eight different markers measuring various organic acids that reveal clues about neurotransmitter metabolism, glutathione levels, and B12 status. The DUTCH Plus includes a measure of cortisol awakening response that brings another important piece of H-P-A axis function into focus. 

• There are some special instructions to follow before collecting samples of saliva and urine that come supplied within each kit, which our patients can also access through the Rupa Health website before their kit arrives at their home.
  

• Oxytocin & Vasopressin (also known as anti-diuretic hormone) are both produced by the posterior pituitary. Each of these hormones is produced in response to different physiological stressors, and each triggers a unique physiological response. It is rare that these are measured through testing, but analogues of these compounds have been created and utilized as treatment strategies for certain conditions including labor and delivery, addiction, depression, diabetes insipidus, and two bleeding disorders (von Willebrand disease and hemophilia A).