ISSN 1662-4009 (online)

ESPE Yearbook of Paediatric Endocrinology (2018) 15 8.9 | DOI: 10.1530/ey.15.8.9

Department of Clinical Science and K.G, University of Bergen, Bergen, Norway


To read the full abstract: J Clin Endocrinol Metab. 2018; 103(4):1696-1703

How we measure steroids has been a constant debate in recent years because current routinely used immunoassays lack both specificity and sensitivity. Therefore, chromatographic, mass spectrometric methods have been pushed forward for their higher sensitivity and specificity, and for their advantage to provide multiple measurements in the same sample. Both equipment and methods are now developed and standardized for routine clinical use, with liquid chromatography, tandem mass spectrometry (LCMSMS) providing a prominent method.

Here, Ueland et al. nicely demonstrate that when using novel measurement methods, we also need to re-standardize the normative values. This also applies to cortisol and 17-hydroxyprogesterone values measured after standard ACTH stimulation testing (250µg) for diagnosing adrenal insufficiency (AI) or non-classic CAH (NCCAH). Applying old cut-off levels for immunoassays (which are higher) would result in false-positive diagnosis of AI as well as false-negative diagnosis of NCCAH. Over the past year, there were several publications providing information on novel standardized steroid LCMSMS methods and data on new normative values (12, 13). Although journals are not always keen to publish them, we need to share this information to be able to standardize these novel diagnostic methods between laboratories. This will also be of importance for cut-off values of other clinical tests such as the low-dose ACTH test (1µg) or the dexamethasone suppression tests.

12. Greaves RF, Ho CS, Loh TP, Chai JH, Jolly L, Graham P, Hartmann MF, de Rijke YB, Wudy SA. Working Group 3 “Harmonisation of Laboratory Assessment” European Cooperation in Science and Technology (COST) Action BM1303 “DSDnet”. Current state and recommendations for harmonization of serum/plasma 17-hydroxyprogesterone mass spectrometry methods. Clin Chem Lab Med. 2018 Feb 3. [Epub ahead of print]

13. Kulle A, Krone N, Holterhus PM, Schuler G, Greaves RF, Juul A, de Rijke YB, Hartmann MF, Saba A, Hiort O, Wudy SA. EU COST Action. Steroid hormone analysis in diagnosis and treatment of DSD: position paper of EU COST Action BM 1303 'DSDnet'. Eur J Endocrinol. 2017; 176(5): P1-P9.

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