Estrogen provocation test

Estrogen provocation test
Synonyms	Estrogen stimulation test; Estrogen challenge test
Purpose	Evaluate hypothalamic–pituitary–gonadal function

An estrogen provocation test showing gonadotropin surge after a single intramuscular injection of estradiol benzoate early in the menstrual cycle in normal premenopausal women.[1]

The estrogen provocation test, also known as the estrogen stimulation test or estrogen challenge test, is a diagnostic procedure used to evaluate the function of the hypothalamic–pituitary–gonadal axis.[2][3][4] It involves the administration of a large amount of estrogen, resulting in estrogenic exposure similar to or greater than normal preovulatory estradiol levels, in an attempt to induce a positive feedback surge in levels of the gonadotropins, luteinizing hormone (LH) and follicle-stimulating hormone (FSH).[2][3] Estrogens that have been used in the estrogen provocation test include estradiol benzoate, estradiol valerate, ethinylestradiol, and high-dose transdermal estradiol patches.[2][3][4][5] The test involves sustained estrogenic exposure equivalent to estradiol levels of 200 to 300 pg/mL or more for at least 50 hours[6] and results in a surge in gonadotropin levels about 32 to 72 hours following initiation of estrogenic exposure.[7][5] Levels of LH and FSH increase during the gonadotropin surge by about 10-fold and 4-fold, respectively.[5]

See also

• Progestogen challenge test
• Pharmacodynamics of estradiol § Progonadotropic effects

References

1. Shaw, Robert W. (November 1978). "Neuroendocrinology of the menstrual cycle in humans". Clinics in Endocrinology and Metabolism. 7 (3): 531–559. doi:10.1016/S0300-595X(78)80008-5. ISSN 0300-595X. PMID 365398.
2. Shaw RW (December 1976). "Tests of the hypothalamic-pituitary-ovarian axis". Clinics in Obstetrics and Gynaecology. 3 (3): 485–503. doi:10.1016/S0306-3356(21)00360-5. PMID 1009729.
3. Goh HH, Ratnam SS (June 1988). "The LH surge in humans: its mechanism and sex difference". Gynecol Endocrinol. 2 (2): 165–82. doi:10.3109/09513598809023624. PMID 3055821.
4. Shaw RW, Butt WR, London DR, Marshall JC (May 1975). "The oestrogen provocation test: a method of assessing the hypothalamic-pituitary axis in patients with amenorrhoea". Clinical Endocrinology. 4 (3): 267–76. doi:10.1111/j.1365-2265.1975.tb01534.x. PMID 1149302. S2CID 22809364.
5. McCartney, Christopher R; Gilrain, Melissa; Lundgren, Jessica A; Kim, Su Hee; Solorzano, Christine Michele Burt (2021-05-01). "Assessment of Estradiol-Induced Gonadotropin Surge Generation: Preliminary Results From a Protocol of Graded Transdermal Estradiol Dosing". Journal of the Endocrine Society. 5 (Supplement_1). The Endocrine Society: A729 – A730. doi:10.1210/jendso/bvab048.1484. ISSN 2472-1972. PMC 8089709.
6. Young JR, Jaffe RB (March 1976). "Strength-duration characteristics of estrogen effects on gonadotropin response to gonadotropin-releasing hormone in women. II. Effects of varying concentrations of estradiol". J Clin Endocrinol Metab. 42 (3): 432–42. doi:10.1210/jcem-42-3-432. PMID 767352.
7. Shaw RW (November 1978). "Neuroendocrinology of the menstrual cycle in humans". Clin Endocrinol Metab. 7 (3): 531–59. doi:10.1016/s0300-595x(78)80008-5. PMID 365398.