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Test Code ESDL or LAB523 Estradiol, Serum or Plasma

Important Note

Patient Preparation: For 12 hours before this test do not take multivitamins or dietary supplements containing biotin (vitamin B7), which is commonly found in hair, skin, and nail supplements and multivitamins. Biotin can interfere with many immunoassay tests.

Please note the following information regarding Estradiol testing:

  1. Requests for "Ultra-sensitive" Estradiol as may be specified for some test requests on children or men:  the Mayo test EEST,  Estradiol by LC-MS is more appropriate.
  2. Requests for "Total Estrogens"  The recommended test in most clinical cases where "Total Estrogen" is requested will be the in-house performed test ESDL. Contact the clinician and inform that "total estrogen" is no longer available and estradiol will be performed instead.
  3. Warning:  Estradiol testing on patients being treated with Fulvestrant (Faslodex®).Manufacturers of immunoassay methods for Estradiol, including those used at Bronson, show cross-reactivity and falsely increased results on patients treated with this drug. Immunoassay methods  should not be used when monitoring estradiol levels on patients being treated with Fulvestrant.  On such patients, please request the Mayo test code EEST,  Estradiol by LC-MS.

Specimen Requirements

Container Type:

Optimal: Gold or Mint*

*For STAT requests

Acceptable: Red or Green
Optimal Collection Volume: 

4.5mL; full tube
Minimum Volume:

1 mL whole blood
Collection Instructions:

Gently invert the sample 5-6 times after collection.
Specimen Transport:

Refrigerate
Processing Instructions: 

1. If serum, allow the specimen to clot for 30 minutes.

2. Centrifuge specimen within 2 hours of collection.

3. After centrifugation, specimen tubes without a gel barrier should have the serum or plasma aliquoted to a false bottom container.

4. Keep serum or plasma refrigerated until testing can be performed.

Specimen Stability

Specimen Type Temperature Time
Serum or Plasma Refrigerated 2 days
Room Temperature 24 hours
Frozen 6 months

Specimen Rejection Criteria

Hemolysis Mild OK; Moderate OK; Gross Reject
Lipemia Mild OK; Moderate OK; Gross Reject
Icterus Mild OK; Moderate OK; Gross Reject
Other Quantity not sufficient

Useful For

The determination of estradiol is utilized clinically in elucidating fertility disorders in the hypothalamus-pituitary-gonad axis, gynecomastia, estrogen-producing ovarian and testicular tumors, and in hyperplasia of the adrenal cortex. Further clinical indications are the monitoring of fertility therapy and determining the time of ovulation within the framework of in vitro fertilization (IVF).

Methodology

Roche Cobas - Electrochemiluminescence assay

Reference Ranges

Males

Median (pg/mL)

2 SD Range (pg/mL)

36

27-52

 

Females: non-pregnant

Phase

Median (pg/mL)

2 SD Range (pg/mL)

Follicular Phase

55

27-156

Ovulation Phase

132

48-314

Luteal Phase

101

33-298

Post-menopause

7

< 5-50

 

Females: pregnant

Trimester

Median (pg/mL)

2 SD Range (pg/mL)

1st

703

154-3,065

2nd 

6873

1,561-18,950

3rd

18470

10,030 to > 30,000

Interpretive

Optimal time for conception is within 48 to 72 hours following the midcycle estradiol peak. Serial specimens must be drawn over several days to evaluate baseline and peak estradiol levels. Low baseline levels and a lack of rise, as well as persistent high levels without midcycle rise, are indicative of anovulatory cycles.

 

For determining the timing of initiation of ovarian stimulation in in vitro fertilization (IVF) studies, low levels before stimulation are critical, as higher values often are associated with poor stimulation cycles. Before final human chorionic gonadotropin (hCG) stimulation at mid-IVF cycle, estradiol concentrations above 2000 to 3000 pg/mL are considered by some IVF specialists to be indicative of an increased likelihood of ovarian hyperstimulation and it may be advisable to consider withholding further hCG stimulation.

 

Estradiol (E2) concentrations below 200 pg/mL following midcycle stimulation (hCG or follicle-stimulating hormone [FSH]) are associated with very low pregnancy success rates.

 

E2 concentrations change during the menstrual cycle, as follows:

-less than 50 pg/mL before midfollicular phase

-250 to 500 pg/mL midcycle peak as the follicle matures

-Abrupt decrease after ovulation

-125 pg/mL peak during the luteal phase

 

Estrogen replacement in reproductive-age women should aim to mimic natural estrogen levels as closely as possible. E2 levels should be within the reference range for premenopausal women and luteinizing hormone and FSH should be within the normal range.

 

Source: Mayo Medical Labs

Day(s) Performed

24/7

Expected TAT

Same day

Performing Laboratory

Bronson Laboratory, Chemistry - Kalamazoo

Sample Retention Time

7 days

CPT Code

82670

LOINC Code

2243-4