Better estrogen-testing methods needed to improve patient care

In a Position Statement unveiled today, The Endocrine Society advocates that all methods for measuring estrogens, which play a crucial role in human biology, be made traceable to a common standard.

In addition to the well-known role of estrogens in , these hormones, particularly estradiol, have a significant impact on the health of the skin, blood vessels, bones, muscle, kidney, liver, digestive system, brain, lung and pancreas. Studies have linked changes in estradiol levels to , stroke and .

"Estradiol levels need to be accurately, precisely and consistently measured to provide the proper care for patients from the cradle to the grave," said the statement's lead author, William Rosner, MD, of Columbia University. " 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 statement identifies 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 concentrations found in men, children, and 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. Quality assessments have found large variations in measurements performed by different laboratories or with different pieces of equipment. Accurate results are needed so that diagnoses are not missed, and patients and health care providers can make informed decisions about treatment options.

In addition, current testing methods limit the ability to generalize results from any given study to the population at large. Furthermore, in the current environment, data from different studies often cannot be compared because measurements and standards were not uniform.

Although a "gold standard" estradiol testing method using mass spectrometry exists, its cost and complexity have discouraged many clinical and research laboratories from implementing this approach.

"The Endocrine Society calls for physicians, members of the research community, government agencies, patient advocates and insurers to collaborate to make accurate testing more accessible," Rosner said.

Recommendations in the statement include:

  • The development of a universally recognized estradiol standard to which all measurements can be traced;
  • The development of estradiol reference ranges specific for age, gender and stage of reproductive development, including puberty/adolescence, menstrual cycle and menopause;
  • A wider recognition among physicians, laboratory staff and researchers that low estradiol values in men, children and menopausal women obtained using current clinical testing methods are likely to be untrustworthy; and
  • The creation of new methods capable of accurately and precisely measuring small concentrations of estradiol in routine clinical specimens. Until such methods are available, a system needs to be implemented to continuously evaluate existing testing and facilitate the improvement of estradiol measurements.
Other authors of the statement include: Susan Hankinson of the University of Massachusetts, Amherst; Patrick Sluss of Massachusetts General Hospital; Hubert Vesper of the U.S. Centers for Disease Control and Prevention; and Margaret Wierman of the University of Colorado School of Medicine.

The statement, "Challenges to the Measurement of Estradiol: An Endocrine Society Position Statement," appears in the April 2013 issue of the Journal of Clinical Endocrinology and Metabolism.

Related Stories

Enzyme may drive breast cancer growth

date May 18, 2011

A recently discovered enzyme drives the production of a potent form of estrogen in human breast cancer tissue, researchers from the University of Illinois at Chicago College of Medicine have found.

Recommended for you

Europe's police crack massive horsemeat trafficking ring

date Apr 25, 2015

Police from seven European countries detained 26 people in a crackdown on a horsemeat trafficking ring two years after a tainted meat scandal that rocked the continent, the EU's judicial agency Eurojust said Saturday.

Text messaging useful for reaching 'at-risk' teens about sex

date Apr 24, 2015

Text messaging that connects teens with sexual health educators is effective for delivering sexual health information, according to a recent study in The Edward R. Murrow College of Communication at Washington State University.The ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.