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The diagnostic role of testosterone and oestradiol in the elderly

Rivista Italiana della Medicina di Laboratorio, ISSN: 1825-859X, Vol: 7, Issue: 2, Page: 94-99
2011
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In the elderly various syndromes are related to deficiency of the steroid hormones testosterone and oestradiol, i.e. late-onset hypogonadism and gynaecomastia in men and menopause in women. In these conditions the measurement of circulating levels of these steroids plays an important diagnostic role. In epidemiological studies determination of the serum level of oestradiol is often used to assess its pathogenetic role in hormone-related conditions, including cancer of the breast, ovary, prostate and liver. In late-onset hypogonadism there is general agreement that patients with total testosterone levels above 350 ng/dl (12 nmol/l) do not require substitution, patients with levels below 230 ng/dl (8 nmol/l) need testosterone treatment, and patients with levels between 230 and 350 ng/dl need close diagnostic examination with measurement of free testosterone. At these decision levels commercial automated direct immunoassays for total testosterone, largely used in clinical laboratories, show sufficient diagnostic accuracy. Free testosterone assays based on analogue displacement immunoassays are widely available, but their use is not recommended. Free testosterone levels can be measured accurately by equilibrium dialysis and ammonium sulphate precipitation or calculated from total testosterone, sex hormone binding globulin and albumin. Accurate and reliable oestradiol assays are essential for the validity of diagnostic and epidemiological studies of menopause and various forms of cancer in elderly men and women; this is especially important when oestradiol levels are low (30-50 pg/ml). Direct automated immunoassays, available in clinical laboratories, are not considered valid tools for the measurement of low oestradiol levels, due to insufficient analytical sensitivity and specificity. The optimum assay for this measurement is chromatography associated with tandem mass spectrometry; however, this technique also needs standardization. © Springer 2011.

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