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HelpTest Code UE3 Estriol, Unconjugated, Serum
Reporting Name
Estriol, Unconjugated, SUseful For
As an adjunct biomarker in the prenatal diagnosis of disorders of fetal steroid metabolism, including Smith-Lemli-Opitz syndrome (1,2) and X-linked ichthyosis (placental sulfatase deficiency disorders)
Evaluating primary or secondary fetal adrenal insufficiency after excluding other rare single gene defects, including aromatase deficiency, 17 alpha-hydroxylase deficiency and/or various forms of congenital adrenal hyperplasia
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
SerumSpecimen Required
Collection Container/Tube:
Preferred: Red top
Acceptable: Serum gel
Submission Container/Tube: Plastic vial
Specimen Volume: 0.6 mL
Collection Instructions: Centrifuge and aliquot serum into a plastic vial.
Specimen Minimum Volume
0.5 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Refrigerated (preferred) | 14 days | |
| Frozen | 90 days |
Reference Values
Males: <0.07 ng/mL
Females: <0.08 ng/mL
For SI unit Reference Values, see www.mayocliniclabs.com/order-tests/si-unint-conversion.html
Day(s) Performed
Monday through Friday
Test Classification
This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.CPT Code Information
82677
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| UE3 | Estriol, Unconjugated, S | 2250-9 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| UE3 | Estriol, Unconjugated, S | 2250-9 |
Clinical Information
Estrogens are involved in development and maintenance of the female phenotype, germ cell maturation, and pregnancy. There are 3 major biologically active estrogens in humans: estrone (E1), estradiol (E2), and estriol (E3). Like all members of the steroid hormone family, they diffuse into cells and bind to specific nuclear receptors, which in turn alter gene transcription in a tissue specific manner. E2 is the most potent natural human estrogen, closely followed by E1, while E3 possess only 20% of the E2 affinity for the estrogen receptor. In men and nonpregnant women, E1 and E2 are formed from the androgenic steroids, androstenedione and testosterone, respectively. E3 is derived largely through conversion of E2, and to a lesser degree from 16a-metabolites of E1. E2 and E1 can also be converted into each other, and both can be inactivated via hydroxylation and conjugation.
During pregnancy E3 becomes the dominant estrogen. The fetal adrenal gland secretes dehydroepiandrosterone-sulfate, which is converted to E3 in the placenta and diffuses into the maternal circulation. The half-life of unconjugated E3 (uE3) in the maternal blood system is 20 to 30 minutes since the maternal liver quickly conjugates E3 to make it more water soluble for urinary excretion. E3 levels increase throughout the course of pregnancy, peaking at term.
Interpretation
A low uE3 level can indicate the possibility of aromatase deficiency, congenital adrenal hyperplasia, primary or secondary (including maternal corticosteroid therapy) fetal adrenal insufficiency and/or fetal demise.
This test is reported in ng/mL only. If the multiple of the median (MoM) is desired, please consider ordering QUAD1 / Quad Screen (Second Trimester) Maternal, Serum.
Cautions
In rare cases, some individuals can develop antibodies to mouse or other animal antibodies (often referred to as human anti-mouse antibodies (HAMA) or heterophile antibodies), which may cause interference in some immunoassays. Caution should be used in interpretation of results and the laboratory should be alerted if the result does not correlate with the clinical presentation.
Method Description
The instrument used is the Beckman Coulter UniCel DxI 800. The Access unconjugated estriol assay is a competitive binding immunoenzymatic assay. A sample is added to a reaction vessel with estriol-alkaline phosphatase conjugate, paramagnetic particles coated with goat anti-rabbit IgG, and polyclonal rabbit anti-estriol. Estriol in the sample competes with estriol-alkaline phosphatase conjugate for a limited number of binding sites on the specific anti-estriol antibody. After incubation in a reaction vessel, materials bound to the solid phase are held in a magnetic field while unbound materials are washed away. Then the chemiluminescent substrate Lumi-Phos 530 is added to the vessel and light generated by the reaction is measured with a luminometer. The light production is inversely proportional to the concentration of estriol in the sample. The amount of analyte in the sample is determined by means of a stored, multipoint calibration curve.(Package Insert: Access Unconjugated Estriol Assay. Beckman Coulter, Inc; 2019)
Report Available
1 to 3 daysSpecimen Retention Time
14 daysReject Due To
| Gross hemolysis | Reject |
| Gross lipemia | OK |
| Gross icterus | OK |
Method Name
Immunoenzymatic Assay
Secondary ID
81711Clinical Reference
1. Bradley LA, Palomaki GE, Knight GJ, et al. Levels of unconjugated estriol and other maternal serum markers in pregnancies with Smith Lemli Opitz (RSH) syndrome fetuses [letter]. Am J Med Genet. 1999;82:355-358
2. Reisch N, Idkowiak J, Hughes B. Prenatal diagnosis of congenital adrenal hyperplasia caused by P450 oxidoreductase deficiency. J Clin Endocrinol Metab. 2013;98(3):E528-E536. doi:10.1210/jc.2012-3449
3. Thaniyaporn S, Chanane W, Supatra S, et al. Association between isolated abnormal levels of maternal serum unconjugated estriol in the second trimester and adverse pregnancy outcomes. J Matern Fetal Neonatal Med. 2016;29:13, 2093-2097
4. Minsart AF, Van Onderbergen A, Jacques F, et al. Indication of prenatal diagnosis in pregnancies complicated by undetectable second-trimester maternal serum estriol levels. J Prenat Med. 2008;2(3):27-30
5. Yarbrough ML, Stout M, Gronowski AM. Pregnancy and its disorders. In: Rifai N, Horvath AR, Wittwer CT, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018:1655-1696