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Test ID INHA Inhibin A, Tumor Marker, Serum

Reporting Name

Inhibin A, Tumor Marker, S

Useful For

Aiding in the diagnosis of patients with granulosa cell tumors of the ovary when used in combination with inhibin B

 

Monitoring of patients with granulosa cell tumors and epithelial mucinous-type tumors of the ovary known to secrete inhibin A

Specimen Type

Serum


Advisory Information


For the initial evaluation of patients suspected of having a granulosa cell tumor of the ovary, order INHAB / Inhibin A and B, Tumor Marker, Serum. If the results of the profile show that either inhibin A or B are elevated, consider monitoring the patient with the individual tests, INHA / Inhibin A, Tumor Marker, Serum or INHB / Inhibin B, Serum.



Specimen Required


Container/Tube:

Preferred: Red top

Acceptable: Serum gel

Specimen Volume: 0.6 mL


Specimen Minimum Volume

0.5 mL

Specimen Stability Information

Specimen Type Temperature Time
Serum Refrigerated (preferred) 7 days
  Frozen  90 days

Reference Values

Males: <2.0 pg/mL

Females

<11 years: <4.7 pg/mL

11-17 years: <97.5 pg/mL

Premenopausal: <97.5 pg/mL

Postmenopausal: <2.1 pg/mL

Day(s) and Time(s) Performed

Monday through Friday; 5 a.m.-12 a.m.

Saturday; 6 a.m.-6 p.m

Test Classification

This test has been modified from the manufacturer's instructions. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

CPT Code Information

86336

LOINC Code Information

Test ID Test Order Name Order LOINC Value
INHA Inhibin A, Tumor Marker, S 23883-2

 

Result ID Test Result Name Result LOINC Value
INHA Inhibin A, Tumor Marker, S 23883-2

Clinical Information

Inhibins are heterodimeric protein hormones secreted by granulosa cells of the ovary in the female and Sertoli cells of the testis in the male. They selectively suppress the secretion of pituitary follicle stimulating hormone (FSH) and also have local paracrine actions in the gonads. The inhibins consist of a dimer of 2 homologous subunits, an alpha subunit and either a beta A or beta B subunit, to form inhibin A and inhibin B, respectively.

 

In females, inhibin A is primarily produced by the dominant follicle and corpus luteum: whereas inhibin B is predominantly produced by small developing follicles. Serum inhibin A and B levels fluctuate during the menstrual cycle. At menopause, with the depletion of ovarian follicles, serum inhibin A and B decrease to very low or undetectable levels.

 

Ovarian cancer is classified into 3 types: epithelial, stromal sex cord, and germ cell tumors. Epithelial ovarian tumors account for 90% of cases and are further subdivided into: serous (70%), mucinous (10%-15%), and endometrioid (10%-15%) types. Granulosa cell tumors represent the majority of the stromal sex cord tumors, which account for 2% to 5% of all ovarian tumors.

 

Elevations of serum inhibin A and B are detected in some patients with granulosa cell tumors. Inhibin A elevations have been reported in approximately 70% of granulosa cell tumors. In these patients, inhibin A levels tend to show a 6-fold to 7-fold increase over the reference range value. The frequency of elevated levels varies amongst studies, likely due to the different specificities of the antibodies used in the immunoassays.

 

Inhibin A also appears to be suitable markers for epithelial tumors of the mucinous type with about 20% of cases having elevated inhibin A levels. In contrast, inhibin is not a very good marker in nonmucinous epithelial tumors. At best, total inhibin is elevated in 15% to 35% of nonmucinous epithelial ovarian cancer cases.

 

Inhibin seems to be a complementary to cancer antigen 125 (CA 125) as an ovarian cancer marker. CA 125 is not as good of a tumor marker for mucinous and granulosa ovarian cell tumors. Inhibin shows a better performance in those 2 types of ovarian cancer.

 

The majority of the studies for inhibin A and B as an ovarian cancer marker have been limited to postmenopausal women where the levels for both proteins are normally very low. Inhibin A has limited utility as an ovarian cancer marker in premenopausal women, where circulating levels are higher and fluctuate throughout the menstrual cycle and, therefore, are difficult to interpret.

Interpretation

Inhibin A levels are elevated in approximately 70% of patients with granulosa cell tumors and in approximately 20% of patients with epithelial ovarian tumors. A normal inhibin A level does not rule out a mucinous or granulosa ovarian cell tumor. Testing for inhibin B in these cases might be informative as a higher proportion of mucinous or granulosa ovarian cell tumors will have an elevated inhibin B level. Consider ordering INHAB / Inhibin A and B, Tumor Marker, Serum.

 

For monitoring of patients with known ovarian cancer, inhibin A levels decrease shortly after surgery. Elevations of inhibin A after treatment are suggestive of residual, recurrent, or progressive disease. In patients with recurrent disease, inhibin A elevation seems to be present earlier than clinical symptoms. Patients in remission show normal levels of inhibin A.

Clinical Reference

1. Mom CH, Engelen MJ, Willemse PH, et al: Granulosa cell tumors of the ovary: the clinical value of serum inhibin A and B levels in a large single center cohort. Gynecol Oncol 2007 May;105(2):365-372

2. Robertson DM, Pruysers E, Jobling T: Inhibin as a diagnostic marker for ovarian cancer. Cancer Lett 2007; 249:14-17

3. Jamieson S, Fuller PJ: Management of granulosa cell tumour of the ovary. Curr Opin Oncol 2008;20(5):560-564

Analytic Time

1 day/same day

Method Name

Sequential 2-Step Immunoenzymatic Assay