Estradiol in Pediatric Endocrinology

Abstract

We thank Kushnir and coworkers1 for addressing the subject of how estradiol (E2) is used clinically in pediatric endocrinology. As Kushnir et al2 mention in the introduction of their original article, high-sensitivity methods for accurate measurements of E2 concentrations are necessary for the diagnosis of sex hormone–related disorders, precocious puberty (PP), and E2 deficiency and for determining the strategy for antiestrogenic treatment. Although PP is a clinical diagnosis, the laboratory testing for sex hormones in children suspected of having PP is performed not only for confirming the diagnosis but also, most importantly, to help diagnose the origin of the condition or disease and for the treatment strategy. For girls with PP with prepubertal E2 levels Figure 1 , the origin can be exogenous estrogens or an ovarian cyst that has produced transient estrogens. PP with low E2 levels in the early puberty range (Figure 1) (in combination with increased luteinizing hormone [LH]/follicle-stimulating hormone [FSH]) can be an indication of a low tempo of the pubertal development and may not need treatment with a long-acting gonadotropin releasing hormone agonist, but patients will need close follow-up. PP with high E2 levels in the midpubertal range with increased LH/FSH needs treatment and further investigation of the origin of PP, eg, magnetic resonance imaging of the central nervous system for tumor. These are examples from routine clinical practice showing how important …