Estetrol in molar pregnancies quantitated by a rapid gas chromatographic method in conjunction with estrone, estradiol-17β, estriol, and pregnanediol

Abstract

A gas-liquid chromatographic method allowing the simultaneous quantitation of urinary estetrol, estriol, estradiol, estrone, and pregnanediol in urine throughout the duration of pregnancy is presented. The method consists of an enzymatic hydrolysis, ether extraction, chromatography on Sephadex LH-20 and AGI-X2, and final quantitation of the steroids as heptafluorobutyric anhydride derivative in a gas chromatograph. Ten samples may be assayed for estetrol in one working day. The method was applied to 23 urine specimens of 13 different patients with molar pregnancies prior to evacuation and to 21 urine specimens from women with nonmolar pregnancies as controls. In 77 per cent of the molar pregnancies, no estetrol was detected, and, in the remaining 23 per cent, it was present in a much lower concentration than expected for nonmolar pregnancies. The ratio of estriol to that of estradiol plus estrone was generally lower in the molar than in the nonmolar pregnancies. No discernible pattern for pregnanediol in molar pregnancies was established. It is concluded that: (1) estetrol in some cases of molar pregnancy is synthesized to a small degree by either placental or maternal tissue and the fetal liver is not solely responsible for 15α-hydroxylation of estetrol precursors, and (2) determinations of estetrol are useful in the diagnosis of molar pregnancy.