Laboratory Services

Estrogens, Estrone (E1) and Estradiol (E2), Fractionated, Serum

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Updated Test Information:

Test Description
Estrogens, Estrone (E1) and Estradiol (E2), Fractionated, Serum
Synonym(s)

Estradiol; Estrogens, total; Estrone; Total Estrogens; E1 (Estrone)

Test ID
ESTF
General Information

Useful for:



  • Simultaneous high-sensitivity determination of serum estrone and estradiol levels

  • Situations requiring either higher sensitivity estradiol measurement, estrone measurement, or both, including:

    • As part of the diagnosis and workup of precocious and delayed puberty in females and, to a lesser degree, males

    • As part of the diagnosis and workup of suspected disorders of sex steroid metabolism, eg, aromatase deficiency and 17 alpha-hydroxylase deficiency

    • As an adjunct to clinical assessment, imaging studies, and bone mineral density measurement in the fracture risk assessment of postmenopausal women and, to a lesser degree, older men

    • Monitoring low-dose female hormone replacement therapy in postmenopausal women

    • Monitoring antiestrogen therapy (eg, aromatase inhibitor therapy)



  • Applications that require moderately sensitive measurement of estradiol including:

    • Evaluation of hypogonadism and oligo-amenorrhea in females

    • Assessing ovarian status, including follicle development, for assisted reproduction protocols (eg, in vitro fertilization)



  • In conjunction with luteinizing hormone measurements, monitoring of estrogen replacement therapy in hypogonadal premenopausal women

  • Evaluation of feminization, including gynecomastia, in males

  • Diagnosis of estrogen-producing neoplasms in males, and, to a lesser degree, females

Specimen Type

Serum

Specimen Requirements

Red Top

Minimum Sample Volume

0.8 mL

Additional Processing Details

Centrifuge and aliquot serum in plastic vial within 2 hours of collection

Stability

  • Refrigerated (preferred): 28 days

  • Ambient: 28 days

  • Frozen: 28 days

Unacceptable Specimen Conditions

Serum Gel (SST)

Limitations

Fulvestrant is a member of a new class of drugs called “selective estrogen receptor degraders“ (SERDS). Fulvestrant has modest cross-reactivity (1%-5%) in estradiol immunoassays, but because the peak dose levels of this drug are between 10-fold (reproductive age women) and more than 200-fold (postmenopausal women) higher than the naturally circulating estradiol concentrations in the treated women, this causes dramatically false-high results in estradiol immunoassays, when blood sampling occurs in close temporal proximity to dosing. By contrast, estradiol measurements by mass spectrometry display more than 1000-fold lower cross-reactivity (<0.001%), meaning that the impact of Fulvestrant on serum estradiol measurements by mass spectrometry is negligible, even if blood sampling occurs at peak dose.

Methodology

Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

Estimated TAT

2-4 days

Testing Schedule

Monday-Saturday

Test Includes

E1 Estrone
EEST Estradiol, Mass
Spectrometry

Retention

14 days

CPT Code(s)

82670; 82671; 82679

Reference Range
Gender Tanner Stage Mean Age (years) E1: Estrone (pg/mL) E2: Estradiol (pg/mL)
Males

Stage I (>14 days and prepubertal)

7.1 < 16 < 13
Stage II* 11.5 < 22 < 16
Stage III 13.6 10 - 25 < 26
Stage IV 15.1 10 - 46 < 38
Stage V 18.0 10 - 60 10 - 40
  Adult 10 - 60 10 - 40
Females

Stage I (>14 days and prepubertal)

7.1 < 29 < 20
Stage II** 10.5 10 - 33 < 24
Stage III 11.6 15 - 43 < 60
Stage IV 12.3 16 - 77 15 - 85
Stage V 14.5 17 - 200 15 - 350***
  Adult - Premenopausal 17 - 200 15 - 350***
  Adult - Postmenopausal 7 - 40 < 10

 

  • Newborns (1-14 days): Estrone & Estradiol levels in newborns are both very elevated at birth but will fall to prepubertal levels within a few days
  • * Boys: Puberty onset (transition from Tanner stage I to Tanner stage II) occurs for boys at a median age of 11.5 (+/- 2) years. For boys there is no proven relationship between puberty onset and body weight or ethnic origin. Progression through Tanner stages is variable. Tanner stage V (adult) should be reached by age 18
  • ** Girls: Puberty onset (transition from Tanner stage I to Tanner stage II) occurs for girls at a median age of 10.5 (+/- 2) years. There is evidence that it may occur up to 1 year earlier in obese girls and in African American girls. Progression through Tanner stages is variable. Tanner stage V (adult) should be reached by age 18.
  • *** E2 levels vary widely through the menstrual cycle
  • The reference ranges for children are based on the published literature,(1,2) cross-correlation of our assay with assays used to generate the literature data and on our data for young adults.
  • Conversion-factor E1: pg/mL x 3.704=pmol/L (molecular weight=270)
  • Conversion factor E2: pg/mL x 3.676=pmol/L (molecular weight=272)
     
Performing Lab

Mayo

LOINC Code(s)

2258-2, 2243-4

Additional Information