Dearest Colleagues
I wonder if I may ask for help on a dilemma for which I am stumped.
A 63 yo female, not on hormone replacement therapy has an elevated serum total estrogen, an elevated urine estradiol yet the fractionalization is not showing the same elevation.
Patient concern: need treatment for high estrogen that no one can find ie fractions seem fine yet serum total and urine total high
Estrogen test data
Lab 1
low estradiol (E2), slightly high estrone (E1), and high total estrogens (177 vs a range max of 44) (Lab 1 did not provide numerical fraction values nor tests for E3)
Lab 2: new draw several weeks later and included urine test
Total estrogens : 87, upper expected range range max 40
Urine test kit Clearblue Advanced Digital OPK
per pack insert measuring Estrone-3-glucuronide, a principal urinary metabolite of estradiol (E2).
serum fractionation:
E1 105 vs. upper expected 103). E2 low (16). E3 inconsequential.
Results verified by 2 labs using different serum total and fraction techniques
Assessment:
Based on this, urine matching serum total, fraction not showing increase?
meds:
1) Lamotrigine tradename lamictal used for seizures due to epilepsy/bi polar affected disorder.
found Lamotrigine may increase how quickly your body removes contraceptive medicine.
2) sertraline tradename Zoloft used for It can treat depression, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), social anxiety disorder, and panic disorder
found no interactions
3) lisinopril
found estradiol (E2), and sex hormone binding globulin (SHBG) concentrations were not significantly affected. Lisinopril had no effect on plasma T,
4) Vitamin D3
Diet
clinical features
no evidence of hairiness, acne, lowered voice, ovarian cysts,
Literature search
Nothing found in which another investigator had reported this
Any thoughts?
Joseph M Indovina Clinical Biochemist (retired
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