High Estradiol Levels During Postmenopause – Pitfalls in Laboratory Analysis

Abstract

A 54-year-old woman was admitted with a result of high serum estradiol levels (> 4300 pg/ml) and typical postmenopausal symptoms. She had a history of an adnexectomy (normal histopathology) due to the elevated estradiol levels. After surgery, estradiol levels were as high as before. Analyzing the anti-mullerian hormone (AMH), inhibin B, DHEA-S and estrone, typical postmenopausal levels were found. Serum estradiol levels were controlled several times with rabbit-derived polyclonal as well as monoclonal antibodies to optimize the selectivity of the test system. Secondary, a radioimmunoassay was performed to exclude interferences of the detection system where lower, but still elevated estradiol levels (186 pg/ml) were found. Hypothesizing that our patient underwent a cross reaction with irregular antibodies, a control was done using sheep-derived antibodies, which proved a postmenopausal hormone level (estradiol level < 5 pg/ml). This result was confirmed using a fluorescence enzyme immunoassay (FEIA) revealing high levels of irregular antibodies (> 200 mg/l; reference < 30 mg/l). This case depicts the pitfalls of estradiol measurement detecting false elevated estradiol levels in a postmenopausal woman.

Zusammenfassung

Eine 54-jährige Patientin (167 cm, 60 kg) stellte sich mit klimakterischer Beschwerdesymptomatik (Hitzewallungen, Schlafstörungen) bei der behandelnden Gynäkologin vor. Im Rahmen der Diagnostik erfolgte eine Laborkontrolle, die einen deutlich erhöhten Estradiolwert (> 4300 pg/ml) zeigte. Da eine Estradiolproduktion im Rahmen einer Neoplasie vermutet wurde, wurde die Patientin zur operativen Abklärung in ein peripheres Krankenhaus eingewiesen und erhielt eine beidseitige Adnexektomie mit nachfolgend unauffälligem histopathologischen Ergebnis. In der postoperativen Kontrolle zeigte sich der Estradiolwert erneut deutlich erhöht. Die übrigen Hormonwerte entsprachen einem unauffälligen postmenopausalen Befund. Zur Optimierung der Sensitivität des Labortests wurde zunächst ein monoklonaler Antikörper eingesetzt. Auch eine Analyse mittels Radioimmunoassay ergab bereits niedrigere, dennoch weiterhin erhöhte Werte (186 pg/ml). In der Annahme, dass möglicherweise eine Kreuzreaktivität gegen irreguläre Antikörper vorliegen könnte, wurde eine Kontrolle mit Schafsantikörpern durchgeführt, die nun einen typisch postmenopausalen Estradiolspiegel ergaben (< 5 pg/ml). Ein Fluoreszenz-Enzym-Immunoassay konnte in der Tat das Vorliegen irregulärer Antikörper bestätigen (> 200 mg/l; Referenz < 30 mg/l). In diesem Fallbericht werden somit mögliche Fehlerquellen der Estradiolmessung bei postmenopausalen Frauen aufgezeigt.

Key words

menopause - estradiol - irregular antibodies - cross-reaction

Schlüsselwörter

Hormone - Östrogen - Postmenopause

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