Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy.
Clinical Biochemistry Laboratory, City of Health and Science University Hospital, 10126 Turin, Italy.
Molecules. 2022 Dec 28;28(1):248. doi: 10.3390/molecules28010248.
The simultaneous measurement of dexamethasone and cortisol has proven the ability to increase the diagnostic performance of the overnight dexamethasone-suppression test. Furthermore, the therapeutic drug monitoring of administered corticosteroid drugs could represent a crucial tool for investigating unexpected variations of steroid hormones' circulating levels. In this work, an LC-MS/MS method for the quantification of cortisol, cortisone, dexamethasone and six additional exogenous corticosteroids in the serum/plasma matrix was developed and validated in compliance with the ISO/IEC requirements. To assess the efficiency of the validated method, serum samples of 75 patients undergoing the dexamethasone-suppression test and 21 plasma samples of patients under immunosuppressive treatment after kidney transplant were analyzed. In all dexamethasone-suppression test samples, it was possible to measure the circulating levels of cortisol, cortisone and dexamethasone. Concentrations of the latter were for all tested patients above the proposed cutoff for the dexamethasone-suppression test's results, and the cortisol concentrations showed good correlation with the ones measured by routine immunometric analysis, therefore confirming the screening outcome for all enrolled patients. Prednisone was detected and quantified in all enrolled patients, confirming the use of such a corticosteroid for immunosuppressive therapy. Thanks to these two applications, we proved the overall performance of the developed LC-MS/MS method for four target analytes. The future implementation of such an analytical tool in the clinical biochemistry laboratory's routine will guarantee a single and versatile tool for simultaneously monitoring dexamethasone-suppression-test results and corticosteroid drugs' administration.
同时测量地塞米松和皮质醇已被证明能够提高 overnight dexamethasone-suppression test 的诊断性能。此外，管理的皮质类固醇药物的治疗药物监测可以代表研究类固醇激素循环水平意外变化的重要工具。在这项工作中，开发并验证了一种 LC-MS/MS 方法，用于定量测定血清/血浆基质中的皮质醇、可的松、地塞米松和六种额外的外源性皮质类固醇。为了评估验证方法的效率，分析了 75 名接受地塞米松抑制试验的患者的血清样本和 21 名接受肾移植后免疫抑制治疗的患者的血浆样本。在所有地塞米松抑制试验样本中，均能测量到皮质醇、可的松和地塞米松的循环水平。所有测试患者的地塞米松浓度均高于地塞米松抑制试验结果的建议截止值，且皮质醇浓度与常规免疫分析测量的浓度具有良好的相关性，因此确认了所有入组患者的筛查结果。在所有入组患者中均检测到并定量了泼尼松，证实了这种皮质类固醇用于免疫抑制治疗。通过这两种应用，我们证明了开发的 LC-MS/MS 方法对四种目标分析物的整体性能。该分析工具在临床生化实验室常规中的未来实施将保证一种单一且通用的工具，用于同时监测地塞米松抑制试验结果和皮质类固醇药物的管理。
