Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.
Mol Cell Endocrinol. 2013 May 22;371(1-2):201-7. doi: 10.1016/j.mce.2012.12.026. Epub 2013 Jan 16.
The diagnosis and management of adrenal diseases hinge upon accurate determination of hormone concentrations in blood and other body fluids. The advent of immunoassays for various steroid hormones has enabled the remarkable progress in adrenal disease over the last several decades, with some limitation. Sequential immunoassay of single analytes is a tedious process, which requires aliquots for each assay. In many complex adrenal diseases, including adrenal cancer and congenital adrenal hyperplasia, the patterns or ratios of multiple steroids rather than the value of any one steroid is more relevant. Although gas chromatography/mass spectrometry of urinary steroid metabolites has been employed to profile steroid production, throughput is slow, and availability is sparse. Recent generations of liquid chromatography-tandem mass spectrometry instruments (LC-MS/MS) provide the throughput and sensitivity required to measure many steroids simultaneously using small samples for commercial and research uses. Even in the best hands, however, LC-MS/MS suffers from limitations and requires diligent attention to detail during method development and implementation. This article reviews the theory, instrumentation principles and terminology, and practical application of mass spectrometry to clinical adrenal disorders.
肾上腺疾病的诊断和治疗取决于血液和其他体液中激素浓度的准确测定。各种类固醇激素的免疫分析方法的出现使得过去几十年中在肾上腺疾病方面取得了显著进展，但也存在一些局限性。单个分析物的顺序免疫分析是一个繁琐的过程，需要为每个分析物留出等分试样。在许多复杂的肾上腺疾病中，包括肾上腺癌和先天性肾上腺增生，多种类固醇的模式或比值比任何一种类固醇的价值更相关。虽然尿液类固醇代谢物的气相色谱/质谱分析已被用于分析类固醇的产生，但通量较慢，可用性也较少。新一代液相色谱-串联质谱仪（LC-MS/MS）提供了使用小样本进行商业和研究用途的同时测量多种类固醇所需的通量和灵敏度。然而，即使在最好的手中，LC-MS/MS 也存在局限性，并且在方法开发和实施过程中需要认真注意细节。本文综述了质谱法在临床肾上腺疾病中的理论、仪器原理和术语以及实际应用。
