Estrogen Testing Methods Need Improving

Scientists from The Endocrine Society (Chevy Chase, MD, USA) have put forward a position paper that identified a number of issues with the current testing methods used for a typical patient's care. Most of the tests used in the clinical setting cannot detect the low estradiol (E2) concentrations found in men, children, menopausal women, and breast cancer patients taking drugs that decrease estradiol levels. In addition, other compounds in the body can interfere with the testing, leading to results that can be 10 times the true estradiol level.

Most methods used in patient care measure E2 directly, without prior isolation from serum, are enzyme-based immunoassays. A survey on instruments for the automated immunoassay of E2 lists 28 different assay platforms from eight different companies. New methods, like the original mass spectrometry (MS) method, use extraction plus a chromatographic step to separate E2 from similar compounds in the serum sample before quantification by MS. Measurements based on MS depend upon the accuracy of calibration, freedom from interference, and appropriateness of any analytical corrections.

The author recommend the development of a universally recognized estradiol standard to which all measurements can be traced and of estradiol reference ranges specific for age, gender and stage of reproductive development. A wider recognition among physicians, laboratory staff that low estradiol values in men, children, and menopausal women obtained using current clinical testing methods are likely to be untrustworthy. New methods should be created capable of accurately and precisely measuring small concentrations of estradiol in routine clinical specimens.

William Rosner, MD, the lead author of the study, said, "Estradiol levels need to be accurately, precisely and consistently measured to provide the proper care for patients from the cradle to the grave. Health care providers rely on estradiol testing to diagnose and help treat a variety of conditions, including infertility, osteoporosis, and breast cancer. Current testing methods need to evolve to meet patients' needs.” The study was published on March 5, 2013, in the Journal of Clinical Endocrinology and Metabolism.

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The Endocrine Society