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Systems Biology of Metabolic Regulation by Estrogen Receptor Signaling in Breast Cancer

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High Estradiol Levels During Postmenopause - Pitfalls in Laboratory Analysis.

I Mebes¹, M Graf¹, M Kellner¹

¹Endokrinologikum Hamburg, Zentrum für Hormon- und Stoffwechselerkrankungen, Reproduktionsmedizin und Pränatale Medizin, Hamburg.

Geburtshilfe Und Frauenheilkunde

|October 27, 2015

Summary

False high estradiol levels in postmenopausal women can occur due to irregular antibodies. This case highlights the importance of accurate hormone testing to avoid misdiagnosis and unnecessary interventions.

Keywords:

cross-reaction estradiol irregular antibodies menopause

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Area of Science:

Endocrinology
Clinical Chemistry
Immunology

Background:

A 54-year-old postmenopausal woman presented with significantly elevated serum estradiol levels (>4300 pg/ml) despite typical menopausal symptoms.
Previous adnexectomy for elevated estradiol did not resolve the issue, with levels remaining high post-surgery.

Purpose of the Study:

To investigate the cause of persistently high serum estradiol levels in a postmenopausal woman.
To identify potential interferences in estradiol measurement assays.

Main Methods:

Repeated estradiol measurements using different antibody sources (polyclonal, monoclonal) and assay methods (radioimmunoassay, fluorescence enzyme immunoassay).
Analysis of other hormone levels (AMH, inhibin B, DHEA-S, estrone) to confirm menopausal status.
Investigation for irregular antibodies using sheep-derived antibodies and FEIA.

Main Results:

Initial tests showed markedly elevated estradiol. Subsequent radioimmunoassay revealed lower but still elevated levels (186 pg/ml).
Testing with sheep-derived antibodies and FEIA confirmed normal menopausal estradiol levels (<5 pg/ml) and detected high levels of irregular antibodies (>200 mg/l).

Conclusions:

The case demonstrates that false-elevated estradiol levels can result from cross-reactions with irregular antibodies in immunoassays.
Accurate estradiol measurement requires careful consideration of potential interferences, especially in the presence of irregular antibodies.