17-Hydroxyprogesterone

What is a 17-Hydroxyprogesterone Test?

The 17-hydroxyprogesterone or 17-OHP is a blood test that measures the amount of 17-OHP in one�??s blood. 17-OHP is a substance that adrenal glands make and use to turn into cortisol which is a hormone that helps individuals control their energy levels, blood glucose, stress response, injury, and illness. The purpose of the 17-OHP test is to help diagnose a group of uncommon, inherited genetic disorders that affect how well one�??s adrenal glands make cortisol. 

The primary disorder being referred to here is called congenital adrenal hyperplasia (CAH). CAH is a disorder wherein, because of a change in gene, the individual doesn�??t have the enzyme 21-hydroxylase�??said enzyme is one that their adrenal glands need to make hormones. The result of this disorder is that the adrenal glands work harder to do their job, consequently making abnormally high levels of 17-OHP. 

The test is often employed when the patient exhibits symptoms of CAH. Classic CAH is diagnosed at birth and has symptoms like arrhythmia, dehydration, and low blood pressure. Nonclassic CAH, also called late-onset CAH, which is diagnosed between early childhood and adulthood, has symptoms like early puberty, increased facial/body hair, a deeper voice, and infertility. 

The procedure of a 17-Hydroxyprogesterone test is as simple as other blood tests, wherein a sample will be collected from the patient and processed in a laboratory to be analyzed/interpreted by the referring physician.

How does it work?

Step One. Acquire a Copy of the Template

To obtain a digital or printable 17-Hydroporgesterone test template when needed, you have two options:

• Click on the "Download Template" or "Use Template" button.
• Navigate to Carepatron's template library through the website or app and search for "17-Hydroprogesterone."

Step Two. Generate a Request

Utilizing our template, you can swiftly create a request after determining the test's necessity through patient interviews, analysis, or physical examinations. Simply complete the designated request form section with the essential information. At this point, it�??s best to remind the patient to fast before the test.

Step Three. Present the Form

To initiate the collection and processing of the specimen, it is imperative to show the completed request form to the phlebotomist. This verifies and is a prerequisite for the procedure, whether presented by yourself, the patient, or a fellow healthcare practitioner.

Step Four. Analyze and Interpret

The time it takes to receive results can vary based on the laboratory, but you should analyze and interpret the findings as soon as possible. Maintain a record of your observations and insights by documenting them in the second portion of the template, intended for notes.

Step Five. Safeguard the Template

After utilizing the template, it is advisable to store it securely. Whether you utilize the template's request form or the document section, consider Carepatron, a HIPAA-compliant, free patient record software, to safeguard your patient's records for convenient retrieval.

When would you use this test?

The 17-Hydroxyprogesterone (17-OHP) test is a diagnostic tool that�??s employed in specific situations to identify, diagnose, and monitor Congenital Adrenal Hyperplasia (CAH). Here�??s a breakdown of the specific situations:

Screening and Diagnosing

The 17-OPH test is generally included in routine newborn screening to identify severe CAH (classic CAH) due to 21-hydroxylase deficiency as early as possible. 

Referring physicians who are caring for children and adults who are suspected of having CAH or are exhibiting symptoms of CAH may order the 17-OHP to confirm or rule out the condition. Note that symptoms may vary based on the patient�??s age and gender. However, some symptoms you may want to keep an eye out for are acne, dehydration, pubic hair development, and low blood pressure in children; a deep voice, irregular menstruation, ambiguous genitalia in young women; and small testes, infertility, large penis, early puberty, a deep voice in young men. 

In the case mentioned above, the results obtained from the test can also be used to aid in diagnosing CAH for older children and adults who may have the late-onset form of CAH. 

Monitoring Treatment

If a patient tests positive for CAH, ongoing tests are necessary to monitor the individual�??s condition and the effectiveness of any prescribed treatment. 

Do note that samples should be obtained at least 48 hours after birth to avoid false elevated levels, during early morning hours, and before administering any corticosteroids.

What do the results mean?

The results and interpretation you will write on the free 17-Hydroxyprogesterone test template will provide valuable insights into the functioning of the adrenal glands and the potential of CAH for diagnosis, monitoring, etc. For a general idea of what your patient�??s 17-OHP levels may mean, keep reading below:

Normal Levels

If your patient�??s 17-OHP levels are normal, it means that your patient�??s adrenal glands are operating within the expected range and that there�??s no indication of CAH. 

Elevated Levels

If your patient has elevated 17-OHP levels, it signals the potential presence of CAH. The severity of the condition can be inferred based on the extent of the elevation:

• Moderately High Levels: Moderately elevated levels of 17-OHP imply a mild form of CAH which indicates a disruption of adrenal function but not as severe compared to classic CAH cases. 
• Excessively High Levels: Excessively elevated 17-OHP levels are indicative of a severe form of CAH which indicates a significant impairment in adrenal gland function that�??s often associated with classic CAH

Equivocal Levels

In the case where the patient�??s 17-OHP levels fall between >9.8 nmol/L and <30 nmol/L, it�??s considered equivocal. This means that CAH cannot be exclusively excluded, and the patient is recommended to be under further evaluation. 

Diagnostic Levels

If the levels of an infant patient reach above 50 nmol/L, their levels are considered diagnostic of CAH and strongly indicate the presence of CAH.

When interpreting, don�??t forget to consider the context of the patient�??s clinical presentation, sex, age - especially for babies -  medical history, and symptoms to develop a comprehensive evaluation.

Research & Evidence

The 17-Hydroxyprogesterone test (17-OHP) test has been the subject of research and studies that underscore its importance and effectiveness in diagnosing and monitoring conditions related to adrenal function, especially in the context of Congenital Adrenal Hyperplasia. Here are some articles and studies that contribute to the body of knowledge surrounding this test:

According to articles published on NHS Gloucestershire Hospitals and other reputable medical websites, the 17-OHP test has been used to diagnose and monitor congenital adrenal hyperplasia (CAH), identify heterozygotes, and identify late-onset CAH. It has been a reliable test so far that not only is it used for routine screening for infants in the U.S., but it was also used as a test to support the need for screening for CAH in Brazil, as seen in the study entitled �??Neonatal screening for congenital adrenal hyperplasia in Southern Brazil: a population-based study with 108,409 infants.�?� 

However, as effective as the 17 OHP test is, some studies explore the limitations of the test. According to a study entitled �??Neonatal screening for congenital adrenal hyperplasia:17-hydroxyprogesterone levels and CYP21 genotypes in preterm infants,�?� neonatal screening with 17-OHP isn�??t capable of detecting milder forms of CAH. Meanwhile, a commentary entitled �??Congenital Adrenal Hyperplasia: Time to replace 17OHP with 21-Deoxycortisol,�?� introduces the idea of measuring 21-deoxy in combination with 17OHP to diagnose and monitor CAH.

Given these bodies of work, one can say that the 17OHP can still be considered useful. However, for more accurate diagnosis and monitoring, one may consider additional tests or further examination.

References

17-hydroxyprogesterone (17OHP). (n.d.). Gloucestershire Hospitals NHS Foundation Trust. https://www.gloshospitals.nhs.uk/our-services/services-we-offer/pathology/tests-and-investigations/17-hydroxyprogesterone-17ohp/

Kopacek, C., de Castro, S. M., Prado, M. J., da Silva, C. M., Beltrǜo, L. A., & Spritzer, P. M. (2017). Neonatal screening for congenital adrenal hyperplasia in Southern Brazil: a population based study with 108,409 infants. BMC pediatrics, 17(1), 22. https://doi.org/10.1186/s12887-016-0772-x

Nordenstrm, A., Wedell, A., Hagenfeldt, L., Marcus, C., & Larsson, A. (2001). Neonatal screening for congenital adrenal hyperplasia: 17-hydroxyprogesterone levels and CYP21 genotypes in preterm infants. Pediatrics, 108(4), E68. https://doi.org/10.1542/peds.108.4.e68

Walter L. Miller; Congenital Adrenal Hyperplasia: Time to Replace 17OHP with 21-Deoxycortisol. Horm Res Paediatr 22 October 2019; 91 (6): 416??420. https://doi.org/10.1159/000501396