Clinical Significance:
Serum Elastase, also called Pancreatopeptidase, is a protease present in pancreatic secretion with the unique ability to rapidly hydrolyze elastin. Elastin is a fibrillar protein found in connective tissue. Elastin forms the elastic fibers found mostly in lungs and skin. Elastase is able to hydrolyze denatured hemoglobin, casein, fibrin, albumin and denatured but not native collagen. Elastase has been implicated in the pathogenesis of pulmonary emphysema, atherosclerosis and in the vascular injury of acute pancreatic necrosis. Elastase activity is inhibited by protease inhibitors including a1-anti-Trypsin, a1-anti-Chymotrypsin, anti-Thrombin III, a2-Macroglobulin and b1-anti-Collagenase. Patients with thyroid dysfunction have decreased Elastase activity. Serum pancreatic levels quantify EL 1 for the diagnosis or exclusion of an acute pancreatitis or an inflammatory episode of chronic pancreatitis or gallstone induced pancreatitis.
Reference Range
30–125 ng/mL
Reference range is listed on individual patient test reports.
Procedure
Elastase is measured by direct radioimmunoassay.
Patient Preparation
The patient should fast for 10 to 12 hours prior to collection of specimen. Medications
that affect pancreatic activity should be discontinued, if possible, for at least 48 hours
prior to collection of specimen.
Specimen Collection
Collect 3 mL serum and separate as soon as possible. Freeze serum immediately after
separation. Minimum specimen size is 1 mL.
Special Specimens
For tumor/tissue and various fluids (e.g., CSF, peritoneal fluid, synovial fluid), contact
ISI for requirements and special handling instructions.
Shipping Instructions
Specimens should be shipped frozen in dry ice.
References
1. Wortsman J, Matsuoka LY, Kueppers F. Elastase inhibitory activity in serum of patients with thyroid dysfunction. Clin Chem.
37:108-10, 1991.
2. Geokas MC, Brodrick JW, Johnson JH, et al. Pancreatic elastase in human serum. Determination by radioimmunoassay. J Biol
Chem. 10 Jan; 252(1):61-7, 1977.
CPT Code:
Pancreatic Elastase I
82656
Clinical Significance
Human pancreatic elastase (EL 1) is a glycoprotein synthesized by the acinar cells that differs from other pancreatic proteases in that, in addition to extending a protolytic activity, it combines with bile acids and neutral steroids in the intestinal lumen to transport cholesterol and its metabolites along the intestinal tract. (1992, Ref. 1) This unique function is possible because of the extraordinary stability of this enzyme during its passage. Elastase (EL 1) concentration in stool is five times higher than pancreatic juice (1991, Ref. 2); therefore, fecal elastase (EL 1) concentration accurately reflects the amount of enzyme secreted from the pancreas.
Exocrine pancreatic insufficiency is a major clinical manifestation of Cystic Fibrosis (CF) and its recognition is important for proper diagnosis and management. Fecal elastase (EL 1) is an ideal diagnostic test for pancreatic function in children with Cystic Fibrosis (reliable over the age of two weeks), since it remains intact during its intestinal transition and its concentration reflects the secretory capacity of the pancreas with 100% sensitivity. The fecal EL 1 level allows the diagnosis or exclusion of pancreatic exocrine insufficiency, which can be caused by chronic pancreatitis, Cystic Fibrosis, pancreatic tumor, cholelithiosis or diabetes mellitus.
Since tests for exocrine pancreatic function in children with Cystic Fibrosis have been difficult and unreliable, fecal elastase (EL 1) (employing a monoclonal antibody to measure human pancreatic elastase 1 in stool) is reliable, non-invasive, highly specific, sensitive, easily reproducible and valid to assist without interruption of exogenous pancreatic enzyme therapy for pancreatic function in children and infants (1996, Ref. 3 & 1994, Ref. 4). More recent studies and measurements by Terbrack (1996, Ref. 5), Soldan (1997, Ref. 6), Gullo (1997, Ref. 6), Wallis (1997, Ref. 8), Walkowiek (1999, Ref. 9) and Code (2000, Ref. 10) have shown an excellent sensitivity and specificity for the diagnosis of Cystic Fibrosis with pancreatic involvement.
116
Reference Ranges
Normal: 200 to >500 μg/g stool
Moderate to mild pancreatic insufficiency: 100–200 μg/g stool
Severe exocrine pancreatic insufficiency: <100 μg/g stool
Procedure
EL1 is measured by a monoclonal antibody specific only to human pancreatic EL1
employing ELISA.
Patient Preparation
No special patient preparation is required, because substitution therapy has no
influence on the specific fecal EL1 levels.
Specimen Collection
Collect 100 mg formed stool and store at –20°C. Stool specimens are stable for 7 days
when refrigerated. Minimum specimen size is 20 mg of formed stool. Note if sample
has watery diarrhea consistency, as the concentration of EL1 may be decreased due to
the dilution factor.
Special Specimens
Stool is the only appropriate specimen for this test (see Elastase, Pancreatic, Serum).
Elastase-1 (EL1), Fecal (continued)
Shipping Instructions
Specimens should be shipped frozen in dry ice.
References
1. Hahn JU, Bochnig S, Kerner W, et al. A new fecal elastase 1 test using polyclonal antibodies for the detection of exocrine
pancreatic insufficiency. Pancreas. Mar;30(2):189-91, 2005.
2. Luth S, Teyssen S, Forssmann K, et al. Fecal elastase-1 determination: ‘gold standard’ of indirect pancreatic function tests?
Scand J Gastroenterol. Oct;36(10):1092-9, 2001.
3. Gullo L, Ventrucci M, Tomassetti P, et al. Fecal elastase 1 determination in chronic pancreatitis. Dig Dis Sci. Jan;44(1):210-3, 1999.
CPT Code:
Fecal Elastase 82656
Endorphin, Alpha, Beta, Gamma*
* Test available on a research basis only. Contact ISI for details.
Clinical Significance:
Endothelin I is a 21 amino acid peptide produced primarily by vascular endothelial cells. It is also produced by renal mesangial and epithelial cells. Endothelin I has potent effects on peripheral vascular resistance, renal blood flow and glomerular filtration rate. Endothelin I appears to be a mediator of hypertension and acute renal failure of hemolytic uremic syndrome. Levels of Endothelin I are increased in patients with hemolytic uremic syndrome with hypertension anuria and oligonuria. Endothelin I has potent vasoconstriction properties. Endothelin I stimulates the oppositive vasodilator called Endothelium Derived Releasing Factor. Levels are also increased in trauma patients.
Reference Range:
4.0 - 9.0 pg/ml
Procedure:
Endothelin I is measured by direct radioimmunoassay.
Patient Preparation:
Patient should not be on any ACTH, Corticosteroid or hypertension medications, if possible, for at least 48 hours prior to collection of specimen.
Specimen Collection:
3 ml serum or EDTA plasma should be collected and separated as soon as possible. Minimum specimen size is 1 ml.
Special Specimens:
For tumor/tissue and various fluids (i.e. CSF, peritoneal, synovial, etc.), contact the Institute for requirements and special handling.
Shipping Instructions:
Ship specimens frozen in dry ice.
References:
1. RL Siegler, SS Edwin, RD Christofferson, and MD Mitchell. Endothelin in the Urine of Children with the Hemolytic Uremic Syndrome. Pediatrics 88: 1063-1066, 1991.
2. WL Miller, MM Redfield and JC Burnett Jr. Integrated Cardiac, Renal and Endocrine Actions of Endothelin. Journal of Clinical Investigations 83: 317-320, 1989.
Clinical Significance:
Endothelin I is a 21 amino acid peptide produced primarily by vascular endothelial cells. It is also produced by renal mesangial and epithelial cells. Endothelin I is excreted directly into the urine. Endothelin I has potent effects on peripheral vascular resistance, renal blood flow and glomerular filtration rate. Endothelin I appears to be a mediator of hypertension and acute renal failure of hemolytic uremic syndrome. Levels of Endothelin I are increased in patients with hemolytic uremic syndrome with hypertension anuria and oligonuria. Endothelin I has potent vasoconstriction properties. Endothelin I stimulates the oppositive vasodilator called Endothelium Derived Releasing Factor. Levels are also increased in trauma patients.
Reference Range:
Up to 3.0 ng/24 hours
Procedure:
Endothelin I is measured by direct radioimmunoassay.
Patient Preparation:
Patient should not be on any ACTH, Corticosteroid or hypertension medications, if possible, for at least 48 hours prior to collection of specimen.
Specimen Collection:
10 ml of a 24 hour urine collection should be submitted. No special preservatives are required. Minimum specimen size is 1 ml.
Shipping Instructions:
Ship specimens frozen in dry ice.
References:
1. RL Siegler, SS Edwin, RD Christofferson, and MD Mitchell. Endothelin in the Urine of Children with the Hemolytic Uremic Syndrome. Pediatrics 88: 1063-1066, 1991.
2. WL Miller, MM Redfield and JC Burnett Jr. Integrated Cardiac, Renal and Endocrine Actions of Endothelin. Journal of Clinical Investigations 83: 317-320, 1989.
Clinical Significance:
Endothelin II is a 21 amino acid peptide produced primarily by vascular endothelial cells. It is also produced by renal mesangial and epithelial cells. Endothelin II has potent effects on peripheral vascular resistance, renal blood flow and glomerular filtration rate. Endothelin II is structurally similar to Endothelin I. Endothelin II appears to be a mediator of hypertension and acute renal failure of hemolytic uremic syndrome. Levels of Endothelin II are increased in patients with hemolytic uremic syndrome with hypertension anuria and oligonuria. Endothelin II has potent vasoconstriction properties. Endothelin II stimulates the oppositive vasodilator called Endothelium Derived Releasing Factor. Levels are also increased in trauma patients.
Reference Range:
2.1 - 7.4 pg/ml
Procedure:
Endothelin II is measured by direct radioimmunoassay.
Patient Preparation:
Patient should not be on any ACTH, Corticosteroid or hypertension medications, if possible, for at least 48 hours prior to collection of specimen.
Specimen Collection:
3 ml serum or EDTA plasma should be collected and separated as soon as possible. Freeze specimen immediately after separation. Minimum specimen size is 1 ml.
Special Specimens:
For tumor/tissue and various fluids (i.e. CSF, peritoneal, synovial, etc.), contact the Institute for requirements and special handling.
Shipping Instructions:
Ship specimens frozen in dry ice.
References:
1. J Koller, P Mair, C Wieser, A Pomaroli, B Puschendorf, and M Herold. Endothelin and Big Endothelin Concentrations in Injured Patients. New England Journal of Medicine 325; 1518, 1991.
2. WL Miller, MM Redfield and JC Burnett Jr. Integrated Cardiac, Renal and Endocrine Actions of Endothelin. Journal of Clinical Investigations 83: 317-320, 1989.
* Test available on a research basis only. Contact ISI for details.
* Test available on a research basis only. Contact ISI for details.
Clinical Significance:
Epiandrosterone is an androgen derived primarily from metabolism of Epitestosterone. It is excreted into the urine as conjugated and unconjugated derivatives. This assay measures the total of the conjugated and unconjugated Epiandrosterone. Epiandrosterone is a weak androgen, produced in an inverse relationship with Androsterone, a potent androgen. Elevated Epiandrosterone levels occur in patients with elevated androgen precursors but without androgenization of target organs. Hypogonadic males also often have elevated levels of Epiandrostrone demonstrating the Androsterone/Epiandrostrone balance.
Reference Range:
Male: 0.5 - 2.0 ug/24 hours
Female: 0.2 - 1.5 ug/24 hours
Procedure:
Epiandrosterone, urine is measured by GC/MS following hydrolysis, derivatizations and chromatographic purification of specimens.
Patient Preparation:
Patient should not be on any ACTH, Steroid, Gonadotropin, or Estrogen medications, if possible, for at least 48 hours prior to collection of specimen.
Specimen Collection:
10 ml of a 24 hour urine specimen should be submitted. No special preservatives are required. Minimum specimen size is 1 ml.
Shipping Instructions:
Ship specimens frozen in dry ice.
References:
1. CW Weykamp, TJ Penders, NA Schmidt, AJ Borburgh, F van de Calseyde, and BJ Wolthers. Steroid Profile for :Urine: Reference Values. Clinical Chemistry 2281-2284, 1989.
2. E Carmina, FZ Stanczyk, RK Matteir, and RA Lobo. Serum Androstrone Conjugates Differentiate Between Acne and Hirsutism in Hyperandrogenic Women. Fertility and Sterility 55: 872-876, 1991.
* Test available on a research basis only. Contact ISI for details.
Clinical Significance:
Epiandrosterone is an androgen derived primarily from metabolism of Epitestosterone. It is excreted into the urine as conjugated and unconjugated derivatives. This assay measures the total of the conjugated and unconjugated Epiandrosterone. Epiandrosterone is a weak androgen, produced in an inverse relationship with Androsterone, a potent androgen. Elevated Epiandrosterone levels occur in patients with elevated androgen precursors but without androgenization of target organs. Hypogonadic males also often have elevated levels of Epiandrostrone demonstrating the Androsterone/Epiandrostrone balance.
Reference Range:
Male: 0.5 - 2.0 ug/24 hours
Female: 0.2 - 1.5 ug/24 hours
Procedure:
Epitestosterone, urine is measured by GC/MS following hydrolysis, derivatizations and chromatographic purification of specimens.
Patient Preparation:
Patient should not be on any ACTH, Steroid, Gonadotropin, or Estrogen medications, if possible, for at least 48 hours prior to collection of specimen.
Specimen Collection:
10 ml of a 24 hour urine specimen should be submitted. No special preservatives are required. Minimum specimen size is 1 ml. Provide total volume per 24 hours, if possible; otherwise, state that it is a random specimen.
Shipping Instructions:
Ship specimens frozen in dry ice.
References:
1. CW Weykamp, TJ Penders, NA Schmidt, AJ Borburgh, F van de Calseyde, and BJ Wolthers. Steroid Profile for :Urine: Reference Values. Clinical Chemistry 2281-2284, 1989.
2. E Carmina, FZ Stanczyk, RK Matteir, and RA Lobo. Serum Androstrone Conjugates Differentiate Between Acne and Hirsutism in Hyperandrogenic Women. Fertility and Sterility 55: 872-876, 1991./p>
Clinical Significance:
Estradiol is one of the three main Estrogens derived from metabolism of Testosterone and also converted reversibly to Estrone. Estradiol is produced by ovarian follicles. Estradiol is the most biologically potent of the Estrogens. Estradiol is excreted into the urine in several different conjugated forms and also as unconjugated Estradiol. Estradiol is bound strongly to Estrogen Binding Globulin but is also present in the "free" (unbound) form or loosely bound to Albumin. Estradiol exhibits a biphasic secretion with levels higher in the luteal phase. Estradiol peaks at ovulation and is frequently used as an indicator of ovulation. Estradiol levels decrease dramatically after menopause with the major source of Estradiol being peripheral conversion from Testosterone.
Reference Ranges:
Male: 0.8 - 3.5 ng/dl
Female:
Follicular: 3.0 - 11.0 ng/dl
Luteal: 7.0 - 30.0 ng/dl
Menopausal: Up to 1.3 ng/dl
Procedure:
Estradiol is measured by radioimmunoassay following extraction of specimens.
Patient Preparation:
Patient should not be on any Steroid, ACTH, Gonadotropin or Estrogen medications, if possible, for at least 48 hours prior to collection of specimen. Oral contraceptives and estrogen replacement therapy may influence Estradiol levels.
Specimen Collection:
3 ml serum or EDTA plasma should be collected and separated as soon as possible. Minimum specimen size is 0.5 ml.
Special Specimens:
For tumor/tissue and various fluids (i.e. CSF, peritoneal, synovial, etc.) contact the Institute for requirements and special handling.
Shipping Instructions:
Ship specimens at room temperature or frozen in dry ice.
References:
1. CJ Munro, GH Stabenfeldt, JR Cragun, LA Addiego, JW Overstreet and BL Lasley. Relationship of Serum Estradiol and Progesterone Concentrations to the Excretion Profiles of Their Major Urinary Metabolites as Measured by Enzyme Immunoassay and Radioimmunoassay. Clinical Chemistry 37: 838-844, 1991.
2. MJ Reed, RW Cheng, CT Noel, HAF Dudley, and VHT James. Plasma Levels of Estrone, Estrone Sulfate, and Estradiol and the Percentage of Unbound Estradiol in Postmenopausal Women with and without Breast Disease. Cancer Research 43: 3940-3943, 1983.
Estradiol (E2)
Estradiol, 17β, Saliva
Clinical Significance:
Estradiol is one of the three main Estrogens derived from metabolism of Testosterone and also converted reversibly to Estrone. Estradiol is produced by ovarian follicles. Estradiol is the most biologically potent of the Estrogens. Estradiol is excreted into the urine in several different conjugated forms and also as unconjugated Estradiol. Estradiol is bound strongly to Estrogen Binding Globulin but is also present in the "free" (unbound) form or loosely bound to Albumin. stradiol exhibits a biphasic secretion with levels higher in the luteal phase. Estradiol peaks at ovulation and is frequently used as an indicator of ovulation. Estradiol levels decrease dramatically after menopause with the major source of Estradiol being peripheral conversion from Testosterone.
Reference Ranges:
By report.
Procedure:
Estradiol is measured by radioimmunoassay.
Patient Preparation:
Patient should not be on any Steroid, ACTH, Gonadotropin or Estrogen medications, if possible, for at least 48 hours prior to collection of specimen. Oral contraceptives and estrogen replacement therapy may influence Estradiol levels. A fasting (10-12 hours) specimen should be submitted via instructions below.
Specimen Collection:
Special Specimens:
For tumor/tissue and various fluids (i.e. CSF, peritoneal, synovial, etc.) contact the Institute for requirements and special handling.
Shipping Instructions:
Ship specimens frozen in dry ice.
References:
CPT Code: E2 82670
Estradiol (E2), urine
17β-Estradiol, urine
Clinical Significance:
Estradiol is one of the three main Estrogens derived from metabolism of Testosterone and also converted reversibly to Estrone. Estradiol is the most potent Estrogen. Estradiol is excreted into the urine in several different conjugated forms and also as unconjugated Estradiol. This assay measures the total of the conjugated and unconjugated forms of Estradiol. In postmenopausal women, very little glandular Estradiol is produced. The levels found usually come from peripheral conversion of Testosterone. Urinary Estradiol measurement offers a non-invasive method for monitoring ovarian function for such purposes as detection of ovulation. Urinary Estradiol levels offer an advantage over blood levels when determinations are required over a long period of time and when frequent sampling is required.
Reference Ranges:
Male: Up to 6.0 ug/24 hours
Female: Up to 15 ug/24 hours
Procedure:
Urine Estradiol is measured by radioimmunoassay following hydrolysis and extraction of specimens.
Patient Preparation:
Patient should not be on any Steroid, ACTH, Gonadotropin or Estrogen medications, if possible, for at least 48 hours prior to collection of specimen. Oral contraceptives and estrogen replacement therapy may influence Estradiol levels.
Specimen Collection:
10 ml of a 24 hour urine specimen should be submitted. No special preservatives are required. Minimum specimen size is 1 ml.
Shipping Instructions:
Ship specimens at room temperature or frozen in dry ice.
References:
1. CJ Munro, GH Stabenfeldt, JR Cragun, L A Addiego, JW Overstreet and BL Lasley. Relationship of Serum Estradiol and Progesterone Concentrations to the Excretion Profiles of Their Major Urinary Profiles as Measured by Enzyme Immunoassay and Radioimmunoassay. Clinical Chemistry 37: 838-844, 1991.
2. AC Speight, KW Hancock, and RE Oakely. Non-Protein Bound Oestrogens in Plasma and Urinary Excretion of Unconjugated Oestrogens in Non-Pregnant Women. Journal of Endocrinology 83: 385-391, 1979.
Clinical Significance:
Estriol is one of the three major Estrogens along with Estrone and Estradiol. Estriol is primarily produced from Estradiol and is excreted into the urine as conjugated and unconjugated Estriol. Estriol conjugates also circulate in the blood in much higher concentrations than the unconjated form. During pregnancy, Estriol is the most abundant Estrogen present with significant quantities formed from Dehydroepiandrosterone derivatives. Estriol increases dramatically throughout the pregnancy and is often used to test for pregnancy and monitor fetal well-being. In males, Estriol is found in very low concentrations. This assay measures the unconjugated form of Estriol.
Reference Ranges:
Male: Up to 10 ng/dl
Female:
Non-pregnant: Up to 10 ng/dl
Pregnant: Varies with length of term
Procedure:
Estriol is measured by radioimmunoassay following extraction of specimens.
Patient Preparation:
Patient should not be on any Steroid, ACTH, Gonadotropin or Estrogen medications, if possible, for at least 48 hours prior to collection of specimen.
Specimen Collection:
3 ml serum or EDTA plasma should be collected and separated as soon as possible. Minimum specimen size is 1 ml.
Special Specimens:
For tumor/tissue and various fluids (i.e. CSF, peritoneal, synovial, etc.) contact the Institute for requirements and special handling.
Shipping Instructions:
Ship specimens at room temperature or frozen in dry ice.
References:
1. PR Huber and U Gawron. Radioimmunoassay of Low Concentrations of Total Estriol in Serum. Clinical Chemistry 32: 406, 1986.
2. M Schoneshofer, TK Dhar, and D Ioanides. Total Urinary Estriol Determined by "On Line" Liquid Chromatography with Ultraviolet Detection. Clinical Chemistry 32: 1948-1950, 1986,
Clinical Significance:
Estriol is one of the three major Estrogens along with Estrone and Estradiol. Estriol is primarily produced from Estradiol and is excreted into the urine as conjugated (primarily Sulfates) and unconjugated Estriol. Estriol conjugates also circulate in the blood in much higher concentrations than the unconjated form. During pregnancy, Estriol is the most abundant Estrogen present with significant quantities formed from Dehydroepiandrosterone derivatives. Estriol increases dramatically throughout the pregnancy and is often used to test for pregnancy and monitor fetal well-being. In males and in non-pregnant females, Estriol is found in very low concentrations. This assay measures the total of the conjugated and unconjugated forms of Estriol.
Reference Ranges:
Male: 1 - 11 ug/24 hours
Female:
Non-pregnant: Up to 75 ug/24 hours
Pregnant: Varies with length of term
Procedure:
Estriol is measured by radioimmunoassay following hydrolysis and extraction of specimens.
Patient Preparation:
Patient should not be on any Steroid, ACTH, Gonadotropin or Estrogen medications, if possible, for at least 48 hours prior to collection of specimen.
Specimen Collection:
5 ml of a 24 hour urine collection should be submitted. No special preservatives are required. Minimum specimen size is 1 ml.
Shipping Instructions:
Ship specimens at room temperature or frozen in dry ice.
References:
1. PR Huber and U Gawron. Radioimmunoassay of Low Concentrations of Total Estriol in Serum. Clinical Chemistry 32: 406, 1986.
2. M Schoneshofer, TK Dhar, and D Ioanides. Total Urinary Estriol Determined by "On Line" Liquid Chromatography with Ultraviolet Detection. Clinical Chemistry 32: 1948-1950, 1986.
Estrogen Binding Globulin Index
(EBGI)
Clinical Significance:
Estrogen Binding Globuln is a Beta-Globulin that binds several steroids in varying degrees. Estradiol binds strongly to Estrogen Binding Globulin but Estrone and Estriol do not. Estrogen Binding Globulin levels are influenced by Estrogens, Thyroid medications, oral contraceptives, and pregnancy, all of which can greatly increase the binding capacity and/or the concentration of Estrogen Binding Globulin. Elevated levels of Estrogen Binding Globulin Index have also been detected in patients with Estradiol Receptor positive breast cancer. In males the Estrogen Binding Globulin Index increases after the age of 50 often leading to decreased androgenization and increased estrogenization.
Reference Range:
Male: 1.0 - 2.0 ug/dl
Female: 1.0 - 3.4 ug/dl
Procedure:
Estrogen Binding Globulin Index is measured by a radiodisplacement assay.
Patient Preparation:
Patient should not be on any Steroid, ACTH, Gonadotropin, Estrogen, or Thyroid medications if possible, for at least 48 hours prior to collection of specimen.
Specimen Collection:
3 ml serum or EDTA plasma should be collected and separated as soon as possible. Minimum specimen size is 1 ml.
Shipping Instructions:
Ship specimens at room temperature or frozen in dry ice.
References:
1. S Pearce, M Dowsett, and SL Jeffcoate. Three Methods Compared for Estimating the Fraction of Testosterone and Estradiol Not Bound to Sex-Hormone-Binding Globulin. Clinical Chemistry 35: 632-635, 1989.
2. BC Nisula, DL Loriaux, and YA Wilson. Solid Phase Method for Measurement of the Binding Capacity of Testosterone-Estradiol Binding Globulin in Human Serum. Steroids 31: 681, 1978.
Clinical Significance:
The three main Estrogens, Estrone, Estradiol, and Estriol, are derived from metabolism of Testosterone and Androstenedione. The Estrogens are excreted into the urine in several different conjugated forms and also as unconjugated Estrogens. Fractionated Estrogens exhibit a biphasic secretion with levels higher in the luteal phase. Estrogen levels decrease dramatically after menopause with the major source of Estrogens being peripheral conversion from Testosterone and Androstenedione. The clinical significance of Fractionated Estrogens is stated in the individual Estrogen listings.
Reference Ranges:
See each individual Estrogen for male and female reference ranges.
Procedure:
Fractionated Estrogens are measured by radioimmunoassay following extraction of specimens.
Patient Preparation:
Patient should not be on any Steroid, ACTH, Gonadotropin or Estrogen medications, if possible, for at least 48 hours prior to collection of specimen. Oral contraceptives and estrogen replacement therapy may influence Estradiol levels.
Specimen Collection:
3 ml serum or EDTA plasma should be collected and separated as soon as possible. Minimum specimen size is 1 ml.
Shipping Instructions:
Ship specimens at room temperature or frozen in dry ice.
References:
1. JL Stock, JA Coderre, and JT Posillico. Effects of Estrogen on Mineral Metabolism in Postmenopausal Women as Evaluated by Multiple Assays Measuring Parathyrin Bioactivity. Clinical Chemistry 35: 18-22, 1989.
2. MJ Reed, RW Cheng, CT Noel, HAF Dudley, and VHT James. Plasma Levels of Estrone, Estrone Sulfate, and Estradiol and the Percentage of Unbound Estradiol in Postmenopausal Women with and without Breast Disease. Cancer Research 43: 3940-3943, 1983.
Clinical Significance:
The three main Estrogens, Estrone, Estradiol, and Estriol, are derived from metabolism of Testosterone and Androstenedione. The Estrogens are excreted into the urine in several different conjugated forms and also as unconjugated Estrogens. Total Estrogens exhibit a biphasic secretion with levels higher in the luteal phase. Estrogen levels decrease dramatically after menopause with the major source of Estrogens being peripheral conversion from Testosterone and Androstenedione.
Reference Ranges:
Male: 3.5 - 10.0 ng/dl
Female:
Follicular: 5.0 - 20.0 ng/dl
Luteal: 12 - 44 ng/dl
Procedure:
Total Estrogens are measured by radioimmunoassay following extraction of specimens.
Patient Preparation:
Patient should not be on any Steroid, ACTH, Gonadotropin or Estrogen medications, if possible, for at least 48 hours prior to collection of specimen. Oral contraceptives and estrogen replacement therapy may influence Estrogen levels.
Specimen Collection:
3 ml serum or EDTA plasma should be collected and separated as soon as possible. Minimum specimen size is 1 ml.
Shipping Instructions:
Ship specimens at room temperature or frozen in dry ice.
References:
1. JL Stock, JA Coderre, and JT Posillico. Effects of Estrogen on Mineral Metabolism in Postmenopausal Women as Evaluated by Multiple Assays Measuring Parathyrin Bioactivity. Clinical Chemistry 35: 18-22, 1989.
2. MJ Reed, RW Cheng, CT Noel, HAF Dudley, and VHT James. Plasma Levels of Estrone, Estrone Sulfate, and Estradiol and the Percentage of Unbound Estradiol in Postmenopausal Women with and without Breast Disease. Cancer Research 43: 3940-3943, 1983.
Estrogens, Fractionated and Total, urine
Clinical Significance:
The three main Estrogens, Estrone, Estradiol, and Estriol, are derived from metabolism of Testosterone and Androstenedione. The Estrogens are excreted into the urine in several different conjugated forms and also as unconjugated Estrogens. Fractionated Estrogens exhibit a biphasic secretion with levels higher in the luteal phase. Estrogen levels decrease dramatically after menopause with the major source of Estrogens being peripheral conversion from Testosterone and Androstenedione. The clinical significance of Fractionated Estrogens is stated in the individual Estrogen listings.
Reference Ranges:
See each individual Estrogen for male and female reference ranges for Fractionated Estrogens.
Total Estrogens:
Male: 5 - 25 ug/24 hours
Female: 10 - 120 ug/24 hours
Procedure:
Fractionated and/or Total Estrogens are measured by radioimmunoassay following hydrolysis and extraction of urine specimens.
Patient Preparation:
Patient should not be on any Steroid, ACTH, Gonadotropin or Estrogen medications, if possible, for at least 48 hours prior to collection of specimen. Oral contraceptives and estrogen replacement therapy may influence Estradiol levels.
Specimen Collection:
10 ml of a 24 hour urine collection should be submitted. No special preservative is required. Minimum specimen size is 1 ml.
Shipping Instructions:
Ship specimens at room temperature or frozen in dry ice.
References:
1. JL Stock, JA Coderre, and JT Posillico. Effects of Estrogen on Mineral Metabolism in Postmenopausal Women as Evaluated by Multiple Assays Measuring Parathyrin Bioactivity. Clinical Chemistry 35: 18-22, 1989.
2. MJ Reed, RW Cheng, CT Noel, HAF Dudley, and VHT James. Plasma Levels of Estrone, Estrone Sulfate, and Estradiol and the Percentage of Unbound Estradiol in Postmenopausal Women with and without Breast Disease. Cancer Research 43: 3940-3943, 1983.
Clinical Significance:
Estrone is one of the three main Estrogens derived from metabolism of Androstenedione and also converted reversibly to Estradiol. Estrone has only weak Estrogenic properties but converts very rapidly to Estradiol, a very potent Estrogen. Estrone is excreted into the urine in several different conjugated forms and also as unconjugated Estrone. Estrone does not bind strongly to Estrogen Binding Globulin but is present in the "free" (unbound) form or loosely bound to Albumin. Aging and obesity are two major factors controlling production of Estrone. In postmenopausal women, very little glandular Estrone is produced. The levels found usually come from peripheral conversion of Androstenedione. Estrone levels increase throughout pregnancy. Estrone exhibits a biphasic secretion with levels higher in the luteal phase.
Reference Range:
Male: 3.0 - 6.0 ng/dl
Female:
Follicular: 3.0 - 10.0 ng/dl
Luteal: 9.0 - 16.0 ng/dl
Menopausal: Up to 2.8 ng/dl
Procedure:
Estrone is measured by direct radioimmunoassay.
Patient Preparation:
Patient should not be on any Steroid, ACTH, Gonadotropin or Estrogen medications, if possible, for at least 48 hours prior to collection of specimen. Oral contraceptives, and estrogen replacement therapy may influence Estrone levels.
Specimen Collection:
3 ml serum or EDTA plasma should be collected and separated as soon as possible. Minimum specimen size is 0.5 ml.
Special Specimens:
For tumor/tissue and various fluids (i.e. CSF, peritoneal, synovial, etc.) contact the Institute for requirements and special handling.
Shipping Instructions:
Ship specimens at room temperature or frozen in dry ice.
References:
1. L Berta, N Fortunati, P Gennari, M Appendino, A Casella, and R Frairia. Influence of Cigarette Smoking on Pituitary and Sex Hormone Balance in Healthy Premonopausal Women. Fertility and Sterility 56: 788-789, 1991.
2. AC Speight, KW Hancock, and RE Oakely. Non-Protein Bound Oestrogens in Plasma and Urinary Excretion of Unconjugated Oestrogens in Non-Pregnant Women. Journal of Endocrinology 83: 385-391, 1979.
Clinical Significance:
Estrone is one of the three main Estrogens derived from metabolism of Androstenedione and also converted reversibly to Estradiol. Estrone has only weak Estrogenic properties but converts very rapidly to Estradiol, a very potent Estrogen. Estrone is excreted into the urine in several different conjugated forms and also as unconjugated Estrone. This assay measures the total of the conjugated and unconjugated forms of Estrone. Aging and obesity are two major factors controlling production of Estrone. In postmenopausal women, very little glandular Estrone is produced. The levels found usually come from peripheral conversion of Androstenedione. Estrone exhibits a biphasic secretion with levels higher in the luteal phase. Urine Estrone measurements give an integrated picture of Estrone production and activity over a 24 hour interval.
Reference Range:
Male: 3.0 - 8.0 ug/24 hours
Female: 4.0 - 30 ug/24 hours
Procedure:
Urine Estrone is measured by radioimmunoassay following hydrolysis and extraction of specimens.
Patient Preparation:
Patient should not be on any steroid, ACTH, gonadotropin or Estrogen medications, if possible, for at least 48 hours prior to collection of specimen. Oral contraceptives and estrogen replacement therapy may influence Estrone levels.
Specimen Collection:
10 ml of a 24 hour urine specimen should be submitted. No special preservatives are required. Minimum specimen size is 1 ml.
Shipping Instructions:
Ship specimens at room temperature or frozen in dry ice.
References:
1. L Berta, N Fortunati, P Gennari, M Appendino, a Casella, and R Frairia. Influence of Cigarette Smoking on Pituitary and Sex Hormone Balance in Healthy Premenopausal Women. Fertility and Sterility 56: 788-789, 1991.
2. AC Speight, KW Hancock, and RE Oakely. Non-Protein Bound Oestrogens in Plasma and Urinary Excretion of Unconjugated Oestrogens in Non-Pregnant Women. Journal Endocrinology 83: 385-391, 1979.
* Test available on a research basis only. Contact ISI for details.
Clinical Significance:
Etiocholanolone is one of the three major 17-ketosteroids. It is derived primarily from Androstenedione although it can also be produced from other androgens. It is excreted into the urine as conjugated (Sulfate and Glucuronide forms) and unconjugated (free) derivatives. Etiocholanolone is a potent pyrogen and has been found in elevated concentrations in patients with Meditterranean fever (Etiocholanolone fever). Etiocholanolone has been found to be elevated in hirsute females. Patients suffering from long term diseases usually have decreased levels of Etiocholanolone.
Reference Range:
By report.
Procedure:
Etiocholanolone (U) is measured by GC/MS following hydrolysis, derivatizations and chromatographic purification of specimens.
Patient Preparation:
Patient should not be on any Steroid, ACTH, Gonadotropin or Estrogen medications, if possible, for at least 48 hours prior to collection.
Specimen Collection:
5 ml of a 24 hour urine collection should be submitted. Store specimen refrigerated during collection. Minimum specimen size is 1 ml.
Shipping Instructions:
Ship specimens frozen in dry ice.
References:
By report.
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