Type of test Urine (24-hour); blood .

Normal findings

Test explanation and related physiology

There are three major estrogens. Estradiol (E2 ), the most potent estrogen, is produced predominantly in the ovary. Follicle stimulating hormone (FSH) and luteinizing hormone (LH) stimulate the ovary to produce E2 , which peaks during the ovulatory phase of the menstrual cycle. This hormone is measured most often to evaluate menstrual and fertility problems, menopausal status, sexual maturity, gynecomastia, feminization syndromes, or as a tumor marker for patients with certain ovarian tumors.

Estrone (E1 ) is also secreted by the ovary, but most is con verted from androstenedione in peripheral tissues. E1 is the major circulating estrogen after menopause.

Estriol (E3 ) is the major estrogen in the pregnant female. Serial urine and blood studies for E3 excretion provide objective means of assessing placental function and fetal normality in high risk pregnancies. Unfortunately, only severe placental distress will decrease urinary E3 sufficiently to reliably predict fetoplacental stress. Furthermore, plasma and urinary E3 levels are normally associated with significant daily variation, which may confuse serial results. Most clinicians use nonstress fetal monitoring  to indicate fetoplacental health.

E3 excretion studies can be done using urine tests or blood studies. A serially increasing estriol/creatinine ratio is a favorable sign in pregnancy. The advantage of the plasma E3 determination is that it is more easily obtained than a urine specimen and less affected by medications. E3 is one of the components of the “quad screen” that is obtained in the second trimester of pregnancy to screen for Down syndrome.

 Interfering factors

• Recent administration of radioisotopes may alter test results.

• Glycosuria and urinary tract infections can increase urine E3 levels.

* Drugs that may increase levels include adrenocorticosteroids, ampicillin, estrogen-containing drugs, phenothiazines, and tetracyclines.

* Drugs that may decrease levels include clomiphene.

 Procedure and patient care

• See inside front cover for Routine Blood Testing.

 • Fasting: no

 • Blood tube commonly used: red

 • See inside front cover for Routine Urine Testing for spot urine.

Abnormal findings

Increased levels

- Feminization syndromes

- Precocious puberty

- Ovarian tumor

- Testicular tumor

- Adrenal tumor

- Normal pregnancy

- Hepatic cirrhosis

- Hepatic necrosis

- Hyperthyroidism

Decreased levels

- Failing pregnancy

 - Turner syndrome

- Hypopituitarism

-Primary and secondary hypogonadism

-Stein-Leventhal syndrome

-Menopause

- Anorexia nervosa