Limitations of direct estradiol and testosterone immunoassay kits

Estradiol (E2) and testosterone (T) are biologically active hormones that serve as important diagnostic markers in serum of premenopausal and postmenopausal women and in men. These hormones are measured frequently by immunoassay in clinical laboratories and the test results are used in the diagnosis and treatment of patients. For measuring the hormones by immunoassay, most laboratories utilize commercially available reagents that are packaged in the form of a kit and are used either in an automated instrument or manually. However, both the diagnostic kit manufacturer and testing laboratory seldom thoroughly validate the assay methods generated with these kits. This deficiency may lead to unreliable test results that could affect clinical evaluation and treatment of patients. The purpose of the present study was to assess the reliability of immunoassays that quantify serum E2 and T levels with commercial diagnostic kits. The data generally show wide differences in the apparent levels of each hormone in a given sample obtained with kits from different manufacturers. This was especially true when measuring postmenopausal E2 and T levels. However, a purification step, which included organic solvent extraction, prior to radioimmunoassay (RIA) of E2 gave values that compared well with those obtained by conventional RIA (with preceding extraction/chromatographic steps). Our results point out the importance of more thoroughly validating assays performed with commercial immunoassay kits, especially with respect to sensitivity and specificity, prior to their use for measuring hormone levels in patient samples.