Biochemistry of Women: Methods for Clinical Investigation Biochemistry of Women: Methods for Clinical Investigation A. S. Curry M.A., Ph.D., F.R.I.C., F.R.C. Path. Home Office Central Research Establishment Aldermaston Nr Reading Berkshire U.K. J. V. Hewitt M.Sc., A.R.I.C. Area Laboratory King Edward VII Hospital Windsor U.K. published by: CRC Press Taylor & Francis Group Boca Raton London New York CRC Press is an imprint of the Taylor & Francis Group, an informa business First published 1974 by CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 Reissued 2018 by CRC Press © 1974 CRC Press, Inc. CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works This book contains information obtained from authentic and highly regarded sources. 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Disclaimer The publisher has made every effort to trace copyright holders and welcomes correspondence from those they have been unable to contact. ISBN 13: 978-1-315-89108-8 (hbk) ISBN 13: 978-1-351-07018-8 (ebk) Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com INTRODUCTION The biochemistry of women is of interest to all these the laboratory has its role. — to man for obvious reasons, to women for At the same time as the increase in rate of selfish ones! growth of medical knowledge have come major However, few books have dealt solely with the technological developments, for example, gas analytical methodology of those tests that are chromatography and radioimmunoassays. These performed predominantly or solely to investigate have enabled biochemical investigations to delve the clinical chemistry of the female. into hitherto closed areas. Several factors in the last decade have created a This book is written by experts who, using the situation which makes the present time par- latest techniques, describe laboratory investiga- ticularly opportune to bring the various aspects of tions into women from conception to the grave. the subject into one volume. Increased opulence, We asked the authors to pay particular attention better medicine, and higher standards of living to the interpretation of laboratory results, so we have concentrated thoughts onto better antenatal hope the book will be of interest to clinicians as care, the problems of infertility, and, with the well as to medical scientists. impact of the pill, the problems of fertility. We had problems with the title of this book — Considerable medical attention has been focused at one time it was going to be Investigations of on many other conditions affecting women, such Women in the Laboratory — we hope the reader is as breast cancer and the menopause, and in all not disappointed! THE EDITORS Dr. Alan S. Curry is Director of the Home Office Central Research Establishment, Aldermaston, U.K., and has long experience of analytical methodology in chemistry, biochemistry, and toxicology. Although a chemist by training, he is a Fellow of the Royal College of Pathologists and consultant in forensic toxicology to the Royal Air Force. He is a graduate of Cambridge University and has written extensively in the field of forensic chemistry and toxicology. He is the author of Poison Detection in Human Organs and Advances in Forensic and Clinical Toxicology, editor of Methods of Forensic Science, and has contributed numerous chapters to other books. He has also had nearly 100 research publications published. Miss J. V. Hewitt is a clinical biochemist with extensive hospital experience. A graduate of Manchester University, after earning her M.Sc. she joined the staff of the Biochemistry Laboratory, Manchester Royal Infirmary. She worked there under the direction of Mr. H. Varley until moving to King Edward VII Hospital, Windsor, in 1970. Dr. Curry is a Civil Servant and wishes to make it clear that the editing of this book was in no way connected with his official duties. The views expressed in the book are entirely those of the authors of the chapters. CONTRIBUTORS J. D. Acland, M.A., B.Sc., B.M., B.Ch., Ph.D. M. G. Metcalf, M.Sc., Ph.D. Group Pathology Department The Medical Unit Manor Hospital The Princess Margaret Hospital Walsall WS2 9PS Christchurch England New Zealand D. Fahmy, M.Sc., Ph.D. D. W. Moss, M.A., M.Sc., Ph.D. Tenovus Institute for Cancer Research Department of Chemical Pathology Welsh National School of Medicine Royal Postgraduate Medical School The Heath Ducane Road Cardiff CF4 4XX London W12 OHS Wales England B. Furst, M.D. R. E. Oakey, Ph.D. Department of Endocrinology and Metabolism Division of Steroid Endocrinology St. Luke's Hospital Department of Chemical Pathology Cleveland The University of Leeds Ohio 44104 School of Medicine Leeds M. C. Hallberg, B.S. England Department of Endocrinology and Metabolism now St. Luke's Hospital Visiting Scientist Cleveland Pregnancy Research Branch Ohio 44104 National Institute of Child Health and Human Development P. J. Leonard, M.Sc., Ph.D., M.R.C. Path. Bethesda, Md. 20014 Hormone Assay Laboratory G.D. Searle Scienfific Services Lane End Road J. F. Pearson, M.D., M.R.C.O.G. High Wycombe Maternity Department Bucks HP12 4HL Welsh National School of Medicine England Heath Hospital Cardiff M. J. Levell, M.A., Ph.D. Wales Division of Steroid Endocrinology The University of Leeds C. Robyn, M.D. School of Medicine Human Reproduction Research Unit 26-28 Hyde Terrace Hospital St. Pierre Leeds 2 University of Brussels England Brussels Belgium 0. J. Lucis, M.D., Ph.D. Department of National Health and Welfare D. P. Rose, M.D., Ph.D. Place Vanier Division of Clinical Onocology 355 River Road University Hospitals Vanier, Ontario K1A 1B8 University of Wisconsin Canada Madison, Wisc. 53706 C. Swain, M.Phil., Ph.D. D. Y. Wang, M.Sc., Ph.D. Department of Clinical Endocrinology Department of Clinical Endocrinology Imperial Cancer Research Fund Laboratories Imperial Cancer Research Fund Laboratories Lincoln's Inn Fields Lincoln's Inn Fields London WC2A 3PX London WC2A 3PX England England R. G. Wieland, M.D. Department of Endocrinology and Metabolism A. C. Turnbull, M.D., F.R.C.O.G. St. Luke's Hospital Nuffield Department of Obstetrics and Gynaecology Cleveland John Radcliffe Hospital Ohio 44104 Headington Oxford S. Winsten, Ph.D. England Department of Laboratories Albert Einstein Medical Center Northern Division Philadelphia, Pa. 19141 M. Vekemans, M.D. Human Reproduction Research Unit E. M. Zorn, M.S. Hospital St. Pierre Department of Endocrinology and Metabolism University of Brussels St. Luke's Hospital Brussels Cleveland Belgium Ohio 44104 (cid:9)(cid:9) TABLE OF CONTENTS Nonpregnancy Estrogens (cid:9) 1 P. J. Leonard Estrogens in Pregnancy (cid:9) 19 R. E. Oakey Progesterone and Metabolites (cid:9) 45 0. J. Lucis Gonadotropins and Prolactin (cid:9) 79 C. Robyn and M. Vekemans Neutral Steroids 129 M. J. Levell Gas Chromatographic Procedures for the Measurement of Pregnanediol, Andosterone, Etiocholanolone, and Dehydroepiandrosterone 151 M. G. Metcalf Testosterone and Metabolites in Women Using Radioimmunoassay Techniques (cid:9) 181 R. G. Wieland, E. M. Zorn, M. C. Hallberg, and B. Furst Hormones and Breast Cancer (cid:9) 191 D. Y. Wang and M. C. Swain Enzymes in Carcinoma (cid:9) 219 S. Winsten The Selection, Performance, and Interpretation of Serum Enzyme Tests in Pregnancy (cid:9) 237 D. W. Moss Problems of Thyroid Analyses in Pregnancy (cid:9) 257 J. D. Acland Fetal Monitoring — Current Concepts (cid:9) 299 D. Fahmy, J. F. Pearson, and A. C. Turnbull Assessment of Tryptophan Metabolism and Vitamin B6 Nutrition in Pregnancy and Oral Contraceptive Users (cid:9) 317 D. P. Rose Index (cid:9) 351