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Santonocito R, Puglisi R, Cavallaro A, Pappalardo A, Trusso Sfrazzetto G. Cortisol sensing by optical sensors. Analyst 2024; 149:989-1001. [PMID: 38226461 DOI: 10.1039/d3an01801f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
During a stress condition, the human body synthesizes catecholamine neurotransmitters and specific hormones (called "stress hormones"), the most important of which is cortisol. The monitoring of cortisol levels is extremely important for controlling the stress levels. For this reason, it has important medical applications. Common analytical methods (HPLC, GC-MS) cannot be used in real life due to the bulkiness of the instruments and the necessity of specialized operators. Molecular probes solve this problem. This review aims to provide a description of recent developments in this field, focusing on the analytical aspects and the possibility to obtain real practical devices from these molecular probes.
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Affiliation(s)
- Rossella Santonocito
- Department of Chemical Sciences, University of Catania, Viale Andrea Doria 6, 95125, Catania, Italy.
| | - Roberta Puglisi
- Department of Chemical Sciences, University of Catania, Viale Andrea Doria 6, 95125, Catania, Italy.
| | - Alessia Cavallaro
- Department of Chemical Sciences, University of Catania, Viale Andrea Doria 6, 95125, Catania, Italy.
| | - Andrea Pappalardo
- Department of Chemical Sciences, University of Catania, Viale Andrea Doria 6, 95125, Catania, Italy.
- INSTM Udr of Catania, Viale Andrea Doria 6, 95125, Catania, Italy
| | - Giuseppe Trusso Sfrazzetto
- Department of Chemical Sciences, University of Catania, Viale Andrea Doria 6, 95125, Catania, Italy.
- INSTM Udr of Catania, Viale Andrea Doria 6, 95125, Catania, Italy
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2
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Weber CJ, Clay OM, Lycan RE, Anderson GK, Simoska O. Advances in electrochemical biosensor design for the detection of the stress biomarker cortisol. Anal Bioanal Chem 2024; 416:87-106. [PMID: 37989847 DOI: 10.1007/s00216-023-05047-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/30/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023]
Abstract
The monitoring of stress levels in humans has become increasingly relevant, given the recent incline of stress-related mental health disorders, lifestyle impacts, and chronic physiological diseases. Long-term exposure to stress can induce anxiety and depression, heart disease, and risky behaviors, such as drug and alcohol abuse. Biomarker molecules can be quantified in biological fluids to study human stress. Cortisol, specifically, is a hormone biomarker produced in the adrenal glands with biofluid concentrations that directly correlate to stress levels in humans. The rapid, real-time detection of cortisol is necessary for stress management and predicting the onset of psychological and physical ailments. Current methods, including mass spectrometry and immunoassays, are effective for sensitive cortisol quantification. However, these techniques provide only single measurements which pose challenges in the continuous monitoring of stress levels. Additionally, these analytical methods often require trained personnel to operate expensive instrumentation. Alternatively, low-cost electrochemical biosensors enable the real-time detection and continuous monitoring of cortisol levels while also providing adequate analytical figures of merit (e.g., sensitivity, selectivity, sensor response times, detection limits, and reproducibility) in a simple design platform. This review discusses the recent developments in electrochemical biosensor design for the detection of cortisol in human biofluids. Special emphasis is given to biosensor recognition elements, including antibodies, molecularly imprinted polymers (MIPs), and aptamers, as critical components of electrochemical biosensors for cortisol detection. Furthermore, the advantages and limiting factors of various electrochemical techniques and sensing in complex biofluid matrices are overviewed. Remarks on the current challenges and future perspectives regarding electrochemical biosensors for stress monitoring are provided, including matrix effects (pH dependence and biological interferences), wearability, and large-scale production.
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Affiliation(s)
- Courtney J Weber
- Department of Chemistry and Biochemistry, University of South Carolina, Columbia, SC, 29208, USA
| | - Olivia M Clay
- Department of Chemistry and Biochemistry, University of South Carolina, Columbia, SC, 29208, USA
| | - Reese E Lycan
- Department of Chemistry and Biochemistry, University of South Carolina, Columbia, SC, 29208, USA
| | - Gracie K Anderson
- Department of Chemistry and Biochemistry, University of South Carolina, Columbia, SC, 29208, USA
| | - Olja Simoska
- Department of Chemistry and Biochemistry, University of South Carolina, Columbia, SC, 29208, USA.
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3
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Mohammadi F, Zahraee H, Izadpanah Kazemi M, Habibi ZS, Taghdisi SM, Abnous K, Khoshbin Z, Chen CH. Recent advances in aptamer-based platforms for cortisol hormone monitoring. Talanta 2024; 266:125010. [PMID: 37541008 DOI: 10.1016/j.talanta.2023.125010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/19/2023] [Accepted: 07/28/2023] [Indexed: 08/06/2023]
Abstract
The stressful conditions of today-life make it urgent the timely prevention and treatment of many physiological and psychological disorders related to stress. According to the significant progress made in the near future, rapid, accurate, and on-spot measurement of cortisol hormone as a dominant stress biomarker using miniaturized digital devices is not far from expected. With a special potency in the fields of diagnosis and healthcare monitoring, aptamer-mediated biosensors (aptasensors) are promising for the quantitative monitoring of cortisol levels in the different matrices (sweat, saliva, urine, cerebrospinal fluid, blood serum, etc.). Accordingly, this in-depth study reviews the superior achievements in the aptasensing strategies to detect cortisol hormone with the synergism of diverse two/three dimensional nanostructured materials, enzymatic amplification components, and antibody motifs. The represented discussions offer a universal perspective to achieve lab-on-chip aptasensing arrays as future user-friendly skin-patchable electronic gadgets for on-site and real-time quantification of cortisol levels.
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Affiliation(s)
- Fatemeh Mohammadi
- Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran; Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamed Zahraee
- Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran; Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Zahra Sadat Habibi
- Department of Environmental Engineering, Faculty of Natural Resources and Environment, University of Birjand, Birjand, Iran
| | - Seyed Mohammad Taghdisi
- Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Pharmaceutical Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Khalil Abnous
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Medicinal Chemistry, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Khoshbin
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Medicinal Chemistry, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Chih-Hsin Chen
- Department of Chemistry, Tamkang University, New Taipei City, 25137, Taiwan.
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Lorde N, Elgharably A, Kalaria T. Impact of Variation between Assays and Reference Intervals in the Diagnosis of Endocrine Disorders. Diagnostics (Basel) 2023; 13:3453. [PMID: 37998589 PMCID: PMC10670091 DOI: 10.3390/diagnostics13223453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023] Open
Abstract
Method-related variations in the measurement of hormones and the reference intervals used in the clinical laboratory can have a significant, but often under-appreciated, impact on the diagnosis and management of endocrine disorders. This variation in laboratory practice has the potential to lead to an errant approach to patient care and thus could cause harm. It may also be the source of confusion or result in excessive or inadequate investigation. It is important that laboratory professionals and clinicians know about these impacts, their sources, and how to detect and mitigate them when they do arise. In this review article, we describe the historical and scientific context from which inconsistency in the clinical laboratory arises. Examples from the published literature of the impact of the method, reference interval, and clinical decision threshold-related discordances on the assessment and monitoring of various endocrine disorders are discussed to illustrate the sources, causes, and effects of this variability. Its potential impact on the evaluation of growth hormone deficiency and excess, thyroid and parathyroid disorders, hyperandrogenism, hypogonadism, glucocorticoid excess and deficiency, and diabetes mellitus is elaborated. Strategies for assessment and mitigation of the discordance are discussed. The clinical laboratory has a responsibility to recognise and address these issues, and although a lot has been accomplished in this area already, there remains more to be done.
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Affiliation(s)
- Nathan Lorde
- Black Country Pathology Services, The Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK; (A.E.); (T.K.)
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Liu H, Qin W, Li X, Feng L, Gu C, Chen J, Tian Z, Chen J, Yang M, Qiao H, Guo X, Zhang Y, Zhao B, Yin S. Molecularly Imprinted Electrochemical Sensors Based on Ti 3C 2T x-MXene and Graphene Composite Modifications for Ultrasensitive Cortisol Detection. Anal Chem 2023; 95:16079-16088. [PMID: 37883745 DOI: 10.1021/acs.analchem.3c01715] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
The increasing pressure and unhealthy lifestyle are gradually eroding the physical and mental health of modern people. As a key hormone responsible for maintaining the normal functioning of human systems, cortisol plays a vital role in regulating physiological activities. Moreover, cortisol can serve as a marker for monitoring psychological stress. The development of cortisol detection sensors carries immense potential, as they not only facilitate timely adjustments and treatments by detecting abnormal physiological indicators but also provide comprehensive data for conducting research on the correlation between cortisol and several potential diseases. Here, we report a molecularly imprinted polymer (MIP) electrochemical biosensor that utilizes a porous composite (MXG) modified electrode. MXG composite is prepared by combining Ti3C2Tx-MXene sheets and graphene (Gr). MXG composite material with high conductive properties and large electroactive surface area promotes the charge transfer capability of the electrode surface, expands the effective surface area of the sensor, and increases the content of cortisol-imprinted cavities on the electrode, thereby improving the sensing ability of the sensor. By optimizing the preparation process, the prepared sensor has an ultralow lower limit of detection of 0.4 fM, a wide detection range of 1 fM-10 μM, and good specificity for steroid hormones and interfering substances with similar cortisol structure. The ability of the sensor to detect cortisol in saliva was also confirmed experimentally. This highly sensitive and selective cortisol sensor is expected to be widely used in the fields of physiological and psychological care.
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Affiliation(s)
- Hengchao Liu
- School of Materials Science and Engineering, Key Laboratory of Display Materials and Photoelectric Devices, Ministry of Education, and Tianjin Key Laboratory for Photoelectric Materials and Devices, Tianjin University of Technology, Tianjin 300384, China
| | - Wenjing Qin
- School of Materials Science and Engineering, Key Laboratory of Display Materials and Photoelectric Devices, Ministry of Education, and Tianjin Key Laboratory for Photoelectric Materials and Devices, Tianjin University of Technology, Tianjin 300384, China
| | - XinXin Li
- School of Materials Science and Engineering, Key Laboratory of Display Materials and Photoelectric Devices, Ministry of Education, and Tianjin Key Laboratory for Photoelectric Materials and Devices, Tianjin University of Technology, Tianjin 300384, China
| | - Lei Feng
- School of Materials Science and Engineering, Key Laboratory of Display Materials and Photoelectric Devices, Ministry of Education, and Tianjin Key Laboratory for Photoelectric Materials and Devices, Tianjin University of Technology, Tianjin 300384, China
| | - Changshun Gu
- School of Materials Science and Engineering, Key Laboratory of Display Materials and Photoelectric Devices, Ministry of Education, and Tianjin Key Laboratory for Photoelectric Materials and Devices, Tianjin University of Technology, Tianjin 300384, China
| | - Junji Chen
- School of Materials Science and Engineering, Key Laboratory of Display Materials and Photoelectric Devices, Ministry of Education, and Tianjin Key Laboratory for Photoelectric Materials and Devices, Tianjin University of Technology, Tianjin 300384, China
| | - Zhenhao Tian
- School of Materials Science and Engineering, Key Laboratory of Display Materials and Photoelectric Devices, Ministry of Education, and Tianjin Key Laboratory for Photoelectric Materials and Devices, Tianjin University of Technology, Tianjin 300384, China
| | - Jianxing Chen
- School of Materials Science and Engineering, Key Laboratory of Display Materials and Photoelectric Devices, Ministry of Education, and Tianjin Key Laboratory for Photoelectric Materials and Devices, Tianjin University of Technology, Tianjin 300384, China
| | - Min Yang
- School of Materials Science and Engineering, Key Laboratory of Display Materials and Photoelectric Devices, Ministry of Education, and Tianjin Key Laboratory for Photoelectric Materials and Devices, Tianjin University of Technology, Tianjin 300384, China
| | - Hanying Qiao
- School of Materials Science and Engineering, Key Laboratory of Display Materials and Photoelectric Devices, Ministry of Education, and Tianjin Key Laboratory for Photoelectric Materials and Devices, Tianjin University of Technology, Tianjin 300384, China
| | - Xiujie Guo
- School of Materials Science and Engineering, Key Laboratory of Display Materials and Photoelectric Devices, Ministry of Education, and Tianjin Key Laboratory for Photoelectric Materials and Devices, Tianjin University of Technology, Tianjin 300384, China
| | - Yan Zhang
- School of Materials Science and Engineering, Key Laboratory of Display Materials and Photoelectric Devices, Ministry of Education, and Tianjin Key Laboratory for Photoelectric Materials and Devices, Tianjin University of Technology, Tianjin 300384, China
| | - Boxin Zhao
- School of Materials Science and Engineering, Key Laboratory of Display Materials and Photoelectric Devices, Ministry of Education, and Tianjin Key Laboratory for Photoelectric Materials and Devices, Tianjin University of Technology, Tianjin 300384, China
| | - Shougen Yin
- School of Materials Science and Engineering, Key Laboratory of Display Materials and Photoelectric Devices, Ministry of Education, and Tianjin Key Laboratory for Photoelectric Materials and Devices, Tianjin University of Technology, Tianjin 300384, China
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Karuppaiah G, Lee MH, Bhansali S, Manickam P. Electrochemical sensors for cortisol detection: Principles, designs, fabrication, and characterisation. Biosens Bioelectron 2023; 239:115600. [PMID: 37611448 DOI: 10.1016/j.bios.2023.115600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/09/2023] [Accepted: 08/12/2023] [Indexed: 08/25/2023]
Abstract
Psychological stress is a major factor contributing to health discrepancies among individuals. Sustained exposure to stress triggers signalling pathways in the brain, which leading to the release of stress hormones in the body. Cortisol, a steroid hormone, is a significant biomarker for stress management due to its responsibility in the body's reply to stress. The release of cortisol in bloodstream prepares the body for a "fight or flight" response by increasing heart rate, blood pressure, metabolism, and suppressing the immune system. Detecting cortisol in biological samples is crucial for understanding its role in stress and personalized healthcare. Traditional techniques for cortisol detection have limitations, prompting researchers to explore alternative strategies. Electrochemical sensing has emerged as a reliable method for point-of-care (POC) cortisol detection. This review focuses on the progress made in electrochemical sensors for cortisol detection, covering their design, principle, and electroanalytical methodologies. The analytical performance of these sensors is also analysed and summarized. Despite significant advancements, the development of electrochemical cortisol sensors faces challenges such as biofouling, sample preparation, sensitivity, flexibility, stability, and recognition layer performance. Therefore, the need to develop more sensitive electrodes and materials is emphasized. Finally, we discussed the potential strategies for electrode design and provides examples of sensing approaches. Moreover, the encounters of translating research into real world applications are addressed.
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Affiliation(s)
- Gopi Karuppaiah
- Electrodics and Electrocatalysis Division, CSIR-Central Electrochemical Research Institute (CECRI), Karaikudi, 630 003, Tamil Nadu, India; School of Integrative Engineering, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul, 06974, Republic of Korea
| | - Min-Ho Lee
- School of Integrative Engineering, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul, 06974, Republic of Korea
| | - Shekhar Bhansali
- Department of Electrical and Computer Engineering, Florida International University, Miami, FL, 33174, USA.
| | - Pandiaraj Manickam
- Electrodics and Electrocatalysis Division, CSIR-Central Electrochemical Research Institute (CECRI), Karaikudi, 630 003, Tamil Nadu, India; Academy of Scientific and Innovative Research, Ghaziabad, 201 002, Uttar Pradesh, India.
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7
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Bäcklund N, Brattsand G, Lundstedt S, Aardal E, Bartuseviciene I, Berinder K, Höybye C, Burman P, Edén Engström B, Isaksson A, Blomgren A, Ragnarsson O, Rüetschi U, Wahlberg J, Olsson T, Dahlqvist P. Salivary cortisol and cortisone in diagnosis of Cushing's syndrome - a comparison of six different analytical methods. Clin Chem Lab Med 2023; 61:1780-1791. [PMID: 37013440 DOI: 10.1515/cclm-2023-0141] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES Salivary cortisol and cortisone at late night and after dexamethasone suppression test (DST) are increasingly used for screening of Cushing's syndrome (CS). We aimed to establish reference intervals for salivary cortisol and cortisone with three liquid chromatography-tandem mass spectrometry (LC-MS/MS) techniques and for salivary cortisol with three immunoassays (IAs), and evaluate their diagnostic accuracy for CS. METHODS Salivary samples at 08:00 h, 23:00 h and 08:00 h after a 1-mg DST were collected from a reference population (n=155) and patients with CS (n=22). Sample aliquots were analyzed by three LC-MS/MS and three IA methods. After establishing reference intervals, the upper reference limit (URL) for each method was used to calculate sensitivity and specificity for CS. Diagnostic accuracy was evaluated by comparing ROC curves. RESULTS URLs for salivary cortisol at 23:00 h were similar for the LC-MS/MS methods (3.4-3.9 nmol/L), but varied between IAs: Roche (5.8 nmol/L), Salimetrics (4.3 nmol/L), Cisbio (21.6 nmol/L). Corresponding URLs after DST were 0.7-1.0, and 2.4, 4.0 and 5.4 nmol/L, respectively. Salivary cortisone URLs were 13.5-16.6 nmol/L at 23:00 h and 3.0-3.5 nmol/L at 08:00 h after DST. All methods had ROC AUCs ≥0.96. CONCLUSIONS We present robust reference intervals for salivary cortisol and cortisone at 08:00 h, 23:00 h and 08:00 h after DST for several clinically used methods. The similarities between LC-MS/MS methods allows for direct comparison of absolute values. Diagnostic accuracy for CS was high for all salivary cortisol and cortisone LC-MS/MS methods and salivary cortisol IAs evaluated.
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Affiliation(s)
- Nils Bäcklund
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Göran Brattsand
- Department of Medical Biosciences, Umeå University, Umeå, Sweden
| | | | - Elisabeth Aardal
- Department of Clinical Chemistry, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Inga Bartuseviciene
- Department of Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
| | - Katarina Berinder
- Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Höybye
- Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Pia Burman
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
| | - Britt Edén Engström
- Department of Medical Sciences, Endocrinology and Mineral Metabolism, Uppsala University, Uppsala, Sweden
- Department of Endocrinology and Diabetes, Uppsala University Hospital, Uppsala, Sweden
| | - Anders Isaksson
- Department of Clinical Chemistry and Pharmacology, Lund University, Lund, Sweden
| | - Anders Blomgren
- Department of Clinical Chemistry and Pharmacology, Lund University, Lund, Sweden
| | - Oskar Ragnarsson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Center for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Ulrika Rüetschi
- Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jeanette Wahlberg
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Medicine, Örebro University Hospital, Örebro, Sweden
| | - Tommy Olsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Per Dahlqvist
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Ben Halima H, Bellagambi FG, Brunon F, Alcacer A, Pfeiffer N, Heuberger A, Hangouët M, Zine N, Bausells J, Errachid A. Immuno field-effect transistor (ImmunoFET) for detection of salivary cortisol using potentiometric and impedance spectroscopy for monitoring heart failure. Talanta 2023; 257:123802. [PMID: 36863297 DOI: 10.1016/j.talanta.2022.123802] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 11/28/2022]
Abstract
Cortisol, a steroid hormone mostly known as "the stress hormone," plays many essential functions in humans due its involvement in several metabolic pathways. It is well-known that cortisol dysregulation is implied in evolution and progression of several chronic pathologies, including cardiac diseases such as heart failure (HF). However, although several sensors have been proposed to date for the determination of cortisol, none of them has been designed for its determination in saliva in order to monitor HF progression. In this work, a silicon nitride based Immuno field-effect transistor (ImmunoFET) has been proposed to quantify salivary cortisol for HF monitoring. Sensitive biological element was represented by anti-cortisol antibody bound onto the ISFET gate via 11-triethoxysilyl undecanal (TESUD) by vapor-phase method. Potentiometric and electrochemical impedance spectroscopy (EIS) measurements were carried out for preliminary investigations on device responsiveness. Subsequently, a more sensitive detection was obtained using electrochemical EIS. The proposed device has proven to have a linear response (R2 always >0.99), to be sensitive (with a limit of detection, LoD, of 0.005 ± 0.002 ng/mL), selective in case of other HF biomarkers (e.g. N-terminal pro B-type natriuretic peptide (NT-proBNP), tumor necrosis factor-alpha (TNF-α), and interleukin 10 (IL-10)), and accurate in cortisol quantification in saliva sample by performing the standard addition method.
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Affiliation(s)
- Hamdi Ben Halima
- Institute of Analytical Sciences (ISA) - UMR 5280, Claude Bernard Lyon 1 University, 69100, Lyon, France
| | - Francesca G Bellagambi
- Institute of Analytical Sciences (ISA) - UMR 5280, Claude Bernard Lyon 1 University, 69100, Lyon, France.
| | - Fabien Brunon
- Institute of Analytical Sciences (ISA) - UMR 5280, Claude Bernard Lyon 1 University, 69100, Lyon, France
| | - Albert Alcacer
- Institute of Microelectronics of Barcelona (IMB-CNM, CSIC), Campus UAB, 08193, Bellaterra, Barcelona, Spain
| | - Norman Pfeiffer
- Fraunhofer IIS, Fraunhofer Institute for Integrated Circuits, 91058, Erlangen, Germany
| | - Albert Heuberger
- Information Technology (LIKE), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91058, Erlangen, Germany
| | - Marie Hangouët
- Institute of Analytical Sciences (ISA) - UMR 5280, French National Center for Scientific Research (CNRS), 69100, Lyon, France
| | - Nadia Zine
- Institute of Analytical Sciences (ISA) - UMR 5280, Claude Bernard Lyon 1 University, 69100, Lyon, France
| | - Joan Bausells
- Institute of Microelectronics of Barcelona (IMB-CNM, CSIC), Campus UAB, 08193, Bellaterra, Barcelona, Spain
| | - Abdelhamid Errachid
- Institute of Analytical Sciences (ISA) - UMR 5280, Claude Bernard Lyon 1 University, 69100, Lyon, France.
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9
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Flowers KC, Shipman KE. Pitfalls in the Diagnosis and Management of Hypercortisolism (Cushing Syndrome) in Humans; A Review of the Laboratory Medicine Perspective. Diagnostics (Basel) 2023; 13:diagnostics13081415. [PMID: 37189516 DOI: 10.3390/diagnostics13081415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/28/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
Biochemical confirmation of a diagnosis of hypercortisolism (Cushing syndrome) is vital to direct further investigations, especially given the overlap with non-autonomous conditions, such as pseudo-Cushing, and the morbidity associated with missed diagnoses. A limited narrative review was performed focusing on the laboratory perspective of the pitfalls of making a biochemical diagnosis of hypercortisolism in those presenting with presumed Cushing syndrome. Although analytically less specific, immunoassays remain cheap, quick, and reliable in most situations. Understanding cortisol metabolism can help with patient preparation, specimen selection (e.g., consideration of urine or saliva for those with possible elevations of cortisol binding globulin concentration), and method selection (e.g., mass spectrometry if there is a high risk of abnormal metabolites). Although more specific methods may be less sensitive, this can be managed. The reduction in cost and increasing ease of use makes techniques such as urine steroid profiles and salivary cortisone of interest in future pathway development. In conclusion, the limitations of current assays, particularly if well understood, do not impede diagnosis in most cases. However, in complex or borderline cases, there are other techniques to consider to aid in the confirmation of hypercortisolism.
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Affiliation(s)
- Kade C Flowers
- Department of Clinical Chemistry, University Hospitals Sussex NHS Trust, Worthing BN11 2DH, UK
| | - Kate E Shipman
- Department of Clinical Chemistry, University Hospitals Sussex NHS Trust, Worthing BN11 2DH, UK
- Department of Medical Education, Brighton and Sussex Medical School, University of Sussex, Falmer Campus, Brighton BN1 9PX, UK
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10
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Yeasmin S, Ullah A, Wu B, Zhang X, Cheng LJ. Enzyme-Mimics for Sensitive and Selective Steroid Metabolite Detection. ACS APPLIED MATERIALS & INTERFACES 2023. [PMID: 36908226 DOI: 10.1021/acsami.2c21980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
We present an enzyme-like functional polymer that recognizes nonelectroactive targets and catalyzes their redox reactions for simple, selective steroid metabolite detection. Measuring steroid metabolites, such as cortisol, has been widely adopted to diagnose stress and chronic diseases. Conventional detection method based on competitive immunoassay requires time-consuming labeling processes for signal transduction and unstable biological receptors for biorecognition yet with limited selectivity. Inspired by natural enzymes' target specificity and catalytic nature, we report an enzyme-mimic using electrocatalytic molecularly imprinted polymers (EC-MIP) to achieve label-free, external redox reagent-free, sensitive, and selective electrochemical detection of cortisol. The EC-MIP sensor contains molecularly imprinted cavities for specific cortisol binding and embedded copper phthalocyanine tetrasulfonate (CuPcTS) for electrocatalytic reduction of the ketones on the captured cortisol into alcohols. The direct sensing approach resolves the intrinsic limitations of conventional MIP-based sensors, most notably the use of external redox probes and weak sensing signals. The sensor exhibited a detection limit of 181 pM with significantly enhanced selectivity using a differential sensing mechanism. The new enzyme-like sensor can be modified to detect other targets, offering a simple, robust approach to future health monitoring technologies.
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Affiliation(s)
- Sanjida Yeasmin
- School of Electrical Engineering and Computer Science, Oregon State University, Corvallis, Oregon 97331, United States
| | - Ahasan Ullah
- School of Electrical Engineering and Computer Science, Oregon State University, Corvallis, Oregon 97331, United States
| | - Bo Wu
- School of Electrical Engineering and Computer Science, Oregon State University, Corvallis, Oregon 97331, United States
| | - Xueqiao Zhang
- School of Electrical Engineering and Computer Science, Oregon State University, Corvallis, Oregon 97331, United States
| | - Li-Jing Cheng
- School of Electrical Engineering and Computer Science, Oregon State University, Corvallis, Oregon 97331, United States
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Khumngern S, Jeerapan I. Advances in wearable electrochemical antibody-based sensors for cortisol sensing. Anal Bioanal Chem 2023:10.1007/s00216-023-04577-y. [PMID: 36781449 DOI: 10.1007/s00216-023-04577-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/15/2023]
Abstract
Cortisol is a crucial hormone involving many physiological processes. Hence, cortisol detection is essential. This review highlights the key progress made on wearable electrochemical sensors using antibodies. It covers the design, principle, and electroanalytical methodology for detecting cortisol noninvasively. This article also analyzes and collects the analytical performances of electrochemical cortisol sensors. The development of these sensors continues to face challenges such as biofouling, sample management, sensitivity, flexibility, stability, and recognition layer performance. It is also necessary to develop a sensitive electrode and material. This article also presents potential strategies for designing antibody electrodes and provides examples of sensing systems. Additionally, it discusses the challenges in translating research into practical applications.
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Affiliation(s)
- Suntisak Khumngern
- Division of Physical Science, Faculty of Science, Prince of Songkla University, Hat Yai, 90110, Songkhla, Thailand.,Center of Excellence for Trace Analysis and Biosensor, Prince of Songkla University, Hat Yai, 90110, Songkhla, Thailand
| | - Itthipon Jeerapan
- Division of Physical Science, Faculty of Science, Prince of Songkla University, Hat Yai, 90110, Songkhla, Thailand. .,Center of Excellence for Trace Analysis and Biosensor, Prince of Songkla University, Hat Yai, 90110, Songkhla, Thailand. .,Center of Excellence for Innovation in Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, 90110, Songkhla, Thailand.
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12
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Guo X, Zhang L, Lei Z, Hou Z, Li H, Li X, Dong J, Song L, Chen D, Liu D. A simple LC-MS/MS method for the simultaneous quantification of drug metabolic enzymes. J Chromatogr B Analyt Technol Biomed Life Sci 2023; 1214:123536. [PMID: 36473299 DOI: 10.1016/j.jchromb.2022.123536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/26/2022] [Accepted: 11/10/2022] [Indexed: 12/02/2022]
Abstract
OBJECTIVE The aim of this study is to develop a LC-MS/MS method for the quantitation of seven cytochrome P450 (CYP450) enzymes. METHODS A high-performance liquid chromatography-tandem mass spectrometry method was developed using multiple reaction monitoring mode with positive electrospray ionization. The method was validated with selectivity, linearity, stability, accuracy and precious. In addition, the abundance of seven CYP450 enzymes in human liver microsomes and CYP3A4 in placenta were determined using the current method. RESULTS The linear range for CYP1A2, CYP2B6 and CYP2C8 was 0.036-3.6 nM and for CYP2C9, CYP2C19, CYP2D6 and CYP3A4 was 0.090-9.0 nM. No interference was found between the blank matrix and each specific peptides. The accuracy and precious results were in accord with the requirement of analytical methods for biological samples in Chinese Pharmacopoeia. In addition, the peptides were stable under current stability conditions. The content of CYP3A4 in placenta and the seven CYP450 enzymes in human liver microsomes were accurately quantified. CONCLUSION The developed method is sensitive and specific and can be applied to the quantification of enzymes abundance in different human derived samples like placenta and liver microsomes.
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Affiliation(s)
- Xuan Guo
- Peking University Third Hospital Institute of Medical Innovation and Research, Beijing, China; School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Lei Zhang
- Peking University Third Hospital Institute of Medical Innovation and Research, Beijing, China; Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China; Medical Metabolomics Center for Reproductive Medicine, Peking University Third Hospital, Beijing, China
| | - Zihan Lei
- Peking University Third Hospital Institute of Medical Innovation and Research, Beijing, China; School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Zhe Hou
- Peking University Third Hospital Institute of Medical Innovation and Research, Beijing, China; School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Hui Li
- Peking University Third Hospital Institute of Medical Innovation and Research, Beijing, China; School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xiaodong Li
- Shimadzu China Innovation Center, Beijing, China
| | - Jing Dong
- Shimadzu China Innovation Center, Beijing, China
| | - Ling Song
- Peking University Third Hospital Institute of Medical Innovation and Research, Beijing, China
| | - Dingding Chen
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China.
| | - Dongyang Liu
- Peking University Third Hospital Institute of Medical Innovation and Research, Beijing, China.
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13
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Trusso Sfrazzetto G, Santonocito R. Nanomaterials for Cortisol Sensing. NANOMATERIALS (BASEL, SWITZERLAND) 2022; 12:3790. [PMID: 36364563 PMCID: PMC9658644 DOI: 10.3390/nano12213790] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
Space represents one of the most dangerous environments for humans, which can be affected by high stress levels. This can lead to severe physiological problems, such as headaches, gastrointestinal disorders, anxiety, hypertension, depression, and coronary heart diseases. During a stress condition, the human body produces specific hormones, such as dopamine, adrenaline, noradrenaline, and cortisol. In particular, the control of cortisol levels can be related to the stress level of an astronaut, particularly during a long-term space mission. The common analytical methods (HPLC, GC-MS) cannot be used in an extreme environment, such as a space station, due to the steric hindrance of the instruments and the absence of gravity. For these reasons, the development of smart sensing devices with a facile and fast analytical protocol can be extremely useful for space applications. This review summarizes the recent (from 2011) miniaturized sensoristic devices based on nanomaterials (gold and carbon nanoparticles, nanotubes, nanowires, nano-electrodes), which allow rapid and real-time analyses of cortisol levels in biological samples (such as saliva, urine, sweat, and plasma), to monitor the health conditions of humans under extreme stress conditions.
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Affiliation(s)
- Giuseppe Trusso Sfrazzetto
- Department of Chemical Sciences, University of Catania, Viale A. Doria 6, 95100 Catania, Italy
- National Interuniversity Consortium for Materials Sciences and Technology (I.N.S.T.M.), Research Unit of Catania, 95100 Catania, Italy
| | - Rossella Santonocito
- Department of Chemical Sciences, University of Catania, Viale A. Doria 6, 95100 Catania, Italy
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14
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Yeasmin S, Wu B, Liu Y, Ullah A, Cheng LJ. Nano gold-doped molecularly imprinted electrochemical sensor for rapid and ultrasensitive cortisol detection. Biosens Bioelectron 2022; 206:114142. [DOI: 10.1016/j.bios.2022.114142] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/27/2022] [Indexed: 12/27/2022]
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15
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van Baal L, Wichert M, Zwanziger D, Dralle H, Weber F, Kreitschmann-Andermahr I, Führer D, Unger N. Distinct Late-Night Salivary Cortisol Cut-Off Values for the Diagnosis of Hypercortisolism. Horm Metab Res 2021; 53:662-671. [PMID: 34607366 DOI: 10.1055/a-1608-1720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Due to high morbidity and mortality of untreated hypercortisolism, a prompt diagnosis is essential. Measurement of late-night salivary cortisol provides a simple and non-invasive method. However, thresholds and reference ranges differ among studies. The goal of this study was to define a threshold of late-night salivary cortisol for the diagnosis of hypercortisolism based on the used assay. Moreover, the influence of different aetiologies of hypercortisolism and individual comorbidities were investigated. Prospective analyses of 217 patients, including 36 patients with proven hypercortisolism were carried out. A sum of 149 patients with suspicion of hypercortisolism but negative endocrine testing and 32 patients with hypercortisolism in remission served as control group. Late-night salivary cortisol was measured using an automated chemiluminescence immunoassay. Cut-off values were calculated by ROC analysis. The calculated cut-off value for the diagnosis of hypercortisolism was 10.1 nmol/l (sensitivity 94%; specificity 84%). Only slightly lower thresholds were obtained in patients with suspected hypercortisolism due to weight gain/obesity (9.1 nmol/l), hypertension or adrenal tumours (both 9.8 nmol/l) or pituitary adenomas (9.5 nmol/l). The late-night salivary cortisol threshold to distinguish between Cushing's disease and Cushing's disease in remission was 9.2 nmol/l. The cut-off value for the diagnosis of ectopic ACTH-production was 109.0 nmol/l (sensitivity 50%, specificity 92%). Late-night salivary cortisol is a convenient and reliable parameter for the diagnosis of hypercortisolism. Except for ectopic ACTH-production, thresholds considering different indications for evaluation of hypercortisolism were only slightly different. Therefore, they might only be useful if late-night salivary cortisol results near the established cut-off value are present.
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Affiliation(s)
- Lukas van Baal
- Department of Endocrinology, Diabetes and Metabolism, University Duisburg-Essen, Essen, Germany
| | - Marc Wichert
- Department of Clinical Chemistry, University Duisburg-Essen, Essen, Germany
| | - Denise Zwanziger
- Department of Endocrinology, Diabetes and Metabolism, University Duisburg-Essen, Essen, Germany
- Department of Clinical Chemistry, University Duisburg-Essen, Essen, Germany
| | - Henning Dralle
- Division of Endocrine Surgery, University Duisburg-Essen, Essen, Germany
| | - Frank Weber
- Division of Endocrine Surgery, University Duisburg-Essen, Essen, Germany
| | | | - Dagmar Führer
- Department of Endocrinology, Diabetes and Metabolism, University Duisburg-Essen, Essen, Germany
| | - Nicole Unger
- Department of Endocrinology, Diabetes and Metabolism, University Duisburg-Essen, Essen, Germany
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16
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17
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Perlman JE, Johnston PC, Hui F, Mulligan G, Weil RJ, Recinos PF, Yogi-Morren D, Salvatori R, Mukherjee D, Gallia G, Kennedy L, Hamrahian AH. Pitfalls in Performing and Interpreting Inferior Petrosal Sinus Sampling: Personal Experience and Literature Review. J Clin Endocrinol Metab 2021; 106:e1953-e1967. [PMID: 33421066 PMCID: PMC8599872 DOI: 10.1210/clinem/dgab012] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Indexed: 02/13/2023]
Abstract
CONTEXT Inferior petrosal sinus sampling (IPSS) helps differentiate the source of ACTH-dependent hypercortisolism in patients with inconclusive biochemical testing and imaging, and is considered the gold standard for distinguishing Cushing disease (CD) from ectopic ACTH syndrome. We present a comprehensive approach to interpreting IPSS results by examining several real cases. EVIDENCE ACQUISITION We performed a comprehensive review of the IPSS literature using PubMed since IPSS was first described in 1977. EVIDENCE SYNTHESIS IPSS cannot be used to confirm the diagnosis of ACTH-dependent Cushing syndrome (CS). It is essential to establish ACTH-dependent hypercortisolism before the procedure. IPSS must be performed by an experienced interventional or neuroradiologist because successful sinus cannulation relies on operator experience. In patients with suspected cyclical CS, it is important to demonstrate the presence of hypercortisolism before IPSS. Concurrent measurement of IPS prolactin levels is useful to confirm adequate IPS venous efflux. This is essential in patients who lack an IPS-to-peripheral (IPS:P) ACTH gradient, suggesting an ectopic source. The prolactin-adjusted IPS:P ACTH ratio can improve differentiation between CD and ectopic ACTH syndrome when there is a lack of proper IPS venous efflux. In patients who have unilateral successful IPS cannulation, a contralateral source cannot be excluded. The value of the intersinus ACTH ratio to predict tumor lateralization may be improved using a prolactin-adjusted ACTH ratio, but this requires further evaluation. CONCLUSION A stepwise approach in performing and interpreting IPSS will provide clinicians with the best information from this important but delicate procedure.
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Affiliation(s)
- Jordan E Perlman
- Johns Hopkins University, Division of Endocrinology, Diabetes and Metabolism, Baltimore, MD, USA
| | - Philip C Johnston
- Regional Center for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, Northern Ireland, UK
| | - Ferdinand Hui
- Johns Hopkins University, Department of Radiology, Baltimore, MD, USA
| | - Guy Mulligan
- Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland, OH, USA
| | - Robert J Weil
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - Pablo F Recinos
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA
| | - Divya Yogi-Morren
- Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland, OH, USA
| | - Roberto Salvatori
- Johns Hopkins University, Division of Endocrinology, Diabetes and Metabolism, Baltimore, MD, USA
| | - Debraj Mukherjee
- Johns Hopkins University, Department of Neurosurgery, Baltimore, MD, USA
| | - Gary Gallia
- Johns Hopkins University, Department of Neurosurgery, Baltimore, MD, USA
| | - Laurence Kennedy
- Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland, OH, USA
| | - Amir H Hamrahian
- Johns Hopkins University, Division of Endocrinology, Diabetes and Metabolism, Baltimore, MD, USA
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18
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Wong MM, Tahir T, Wong MM, Baron A, Finnerty R. Biomarkers of Stress in Music Interventions: A Systematic Review. J Music Ther 2021; 58:241-277. [PMID: 33822108 DOI: 10.1093/jmt/thab003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Psychological stress is a significant public health concern as it is associated with various comorbidities and long-term health implications. Music interventions are emerging therapies for alleviating psychological stress and improving one's physical and mental well-being. We conducted a systematic literature review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement guidelines for reporting to identify all neuroendocrine biomarkers used to evaluate psychological stress in randomized control trials involving music interventions. We identified 18 unique biomarkers of stress from 14 full-text randomized controlled trials studies. Only one of the 14 music studies included a music therapy intervention. The most frequently used biomarkers across the studies were plasma cortisol, salivary cortisol, and salivary α-amylase. Of the 14 studies, 12 included in this review assessed at least one of these three biomarkers. Of these 12 studies, five papers reported p-values for changes in both stress biomarkers and psychological stress outcome measures. Four of the five studies found significant p-values for the reduction of both stress biomarkers and psychological stress in music intervention groups. The variety of stress biomarkers used and the variance in study protocols makes it difficult to assess the magnitude of effect of music interventions on psychological stress. However, our findings suggest that music interventions have the potential for reducing both stress biomarker levels and psychological stress in acute stress situations.
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Affiliation(s)
| | | | | | - Annilee Baron
- McMaster University, Hamilton, ON, Canada.,Music Therapy Academy, Hamilton, ON, Canada
| | - Rachael Finnerty
- McMaster University, Hamilton, ON, Canada.,Music Therapy Academy, Hamilton, ON, Canada
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19
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Ueland GÅ, Kellmann R, Jørstad Davidsen M, Viste K, Husebye ES, Almås B, Storr HL, Sagen JV, Mellgren G, Júlíusson PB, Methlie P. Bedtime Salivary Cortisol as a Screening Test for Cushing Syndrome in Children. J Endocr Soc 2021; 5:bvab033. [PMID: 33928203 PMCID: PMC8064046 DOI: 10.1210/jendso/bvab033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Indexed: 11/19/2022] Open
Abstract
Background Diagnosing Cushing syndrome (CS) can be challenging. The 24-hour urine free cortisol (UFC) measurement is considered gold standard. This is a laborious test, dependent on correct urine collection. Late-night salivary cortisol is easier and is used as a screening test for CS in adults, but has not been validated for use in children. Objective To define liquid chromatography tandem mass spectrometry (LC-MS/MS)-based cutoff values for bedtime and morning salivary cortisol and cortisone in children, and validate the results in children with and without CS. Methods Bedtime and morning salivary samples were collected from 320 healthy children aged 4 to 16 years. Fifty-four patients from the children’s outpatient obesity clinic and 3 children with pituitary CS were used for validation. Steroid hormones were assayed by LC-MS/MS. Cutoff levels for bedtime salivary cortisol and cortisone were defined by the 97.5% percentile in healthy subjects. Results Bedtime cutoff levels for cortisol and cortisone were 2.4 and 12.0 nmol/L, respectively. Applying these cutoff levels on the verification cohort, 1 child from the obesity clinic had bedtime salivary cortisol exceeding the defined cutoff level, but normal salivary cortisone. All 3 children with pituitary CS had salivary cortisol and cortisone far above the defined bedtime cutoff levels. Healthy subjects showed a significant decrease in salivary cortisol from early morning to bedtime. Conclusions We propose that bedtime salivary cortisol measured by LC-MS/MS with a diagnostic threshold above 2.4 nmol/L can be applied as a screening test for CS in children. Age- and gender-specific cutoff levels are not needed.
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Affiliation(s)
- Grethe Å Ueland
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, 5021 Bergen, Norway.,Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway
| | - Ralf Kellmann
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, 5021 Bergen, Norway
| | - Melissa Jørstad Davidsen
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, 5021 Bergen, Norway.,Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
| | - Kristin Viste
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, 5021 Bergen, Norway
| | - Eystein S Husebye
- Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway.,Department of Clinical Science, University of Bergen, 5021 Bergen, Norway.,K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, 5021 Bergen, Norway
| | - Bjørg Almås
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, 5021 Bergen, Norway
| | - Helen L Storr
- K.Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Jørn V Sagen
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, 5021 Bergen, Norway.,Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
| | - Gunnar Mellgren
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, 5021 Bergen, Norway.,Department of Clinical Science, University of Bergen, 5021 Bergen, Norway.,Mohn Nutrition Research Laboratory, University of Bergen, 5021 Bergen, Norway
| | - Petur B Júlíusson
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway.,Department of Pediatrics, Haukeland University Hospital, 5021 Bergen, Norway.,Department of Health Registries, Norwegian Institute of Public Health, 5020 Bergen, Norway
| | - Paal Methlie
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, 5021 Bergen, Norway.,Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway
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20
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Casals G, Hanzu FA. Cortisol Measurements in Cushing's Syndrome: Immunoassay or Mass Spectrometry? Ann Lab Med 2020; 40:285-296. [PMID: 32067427 PMCID: PMC7054699 DOI: 10.3343/alm.2020.40.4.285] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/20/2019] [Accepted: 02/07/2020] [Indexed: 11/19/2022] Open
Abstract
Determination of cortisol levels in the urine (24 hours urine free cortisol), saliva (late-night), or serum (total cortisol after dexamethasone suppression) is recommended to screen for Cushing's syndrome (CS). This review focuses on the differences between the frequently used cortisol-antibody immunoassay-based methods and the highly specific mass-spectrometry-based methods that are progressively being employed in clinical laboratories for CS screening. The particular characteristics of cortisol metabolism and the lack of specificity of the immunoassays cause marked differences between both methods that are in turn highly dependent on the biological matrix, in which the cortisol is measured. Understanding the origin of these differences is essential for the interpretation of these results. Although cross-reactivity with endogenous steroids leads to grossly inaccurate results of immunoassay measurements of cortisol in the saliva and urine, preliminary evidence suggests that the clinical sensitivity of CS screening using immunoassays may be similar to CS screening using mass spectrometry. However, mass spectrometry offers more accurate results and considerably reduced variation across laboratories, while avoiding false-positive results. Moreover, mass spectrometry can overcome some common diagnostic challenges, such as identification of exogenous corticosteroids or simultaneous assessment of appropriate dexamethasone levels in suppression tests. Further, comprehensive mass spectrometry-based profiling of several steroid metabolites may be useful for discriminating among different subtypes of CS. Finally, this review discusses the main preanalytical factors that could cause variations in cortisol measurements and their influence on the reliability of the results.
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Affiliation(s)
- Gregori Casals
- Department of Biochemistry and Molecular Genetics, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centrode Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), ISCIII, Madrid, Spain.
| | - Felicia Alexandra Hanzu
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Endocrinology and Nutrition, Hospital Clínic, Barcelona, Spain.,Department of Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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21
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Ponzetto F, Settanni F, Parasiliti-Caprino M, Rumbolo F, Nonnato A, Ricciardo M, Amante E, Priolo G, Vitali S, Anfossi L, Arvat E, Ghigo E, Giordano R, Mengozzi G. Reference ranges of late-night salivary cortisol and cortisone measured by LC-MS/MS and accuracy for the diagnosis of Cushing's syndrome. J Endocrinol Invest 2020; 43:1797-1806. [PMID: 32772255 DOI: 10.1007/s40618-020-01388-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/02/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE International guidelines recommend salivary cortisol for the diagnosis of Cushing's syndrome. Despite mass spectrometry-based assays are considered the analytical gold-standard, there is still the need to define reference intervals and diagnostic accuracy of such methodology. METHODS 100 healthy volunteers and 50 consecutive patients were enrolled to compare LC-MS/MS and electrochemiluminescence assay for the determination of late-night salivary cortisol and cortisone. Moreover, we aimed to determine reference intervals of salivary steroids in a population of healthy individuals and diagnostic accuracy in patients with suspected hypercortisolism and in a population including also healthy individuals. RESULTS Method comparison highlighted a positive bias (51.8%) of immunoassay over LC-MS/MS. Reference intervals of salivary cortisol (0.17-0.97 µg/L), cortisone (0.84-4.85 µg/L) and ratio (0.08-0.30) were obtained. The most accurate thresholds of salivary cortisol for the diagnosis of hypercortisolism were 1.15 µg/L in the population with suspected hypercortisolism (AUC 1) and 1.30 µg/L in the population including also healthy individuals (AUC 1). Cut-off values of salivary cortisone (7.23 µg/L; Se 92.9%, Sp 97.2%, AUC 0.960 and Se 92.9%, Sp 99.1%, AUC 0.985 in suspected hypercortisolism and in overall population, respectively) and cortisol-to-cortisone ratio (0.20; Se 85.7%, Sp 80.6%, AUC 0.820 and Se 85.7%, Sp 85.5%, AUC 0.855 in suspected hypercortisolism and in overall population, respectively) were accurate and similar in both populations. CONCLUSION LC-MS/MS is the most accurate analytical platform for measuring salivary steroids. Obtained reference intervals are coherent with previously published data and diagnostic accuracy for diagnosis of overt hypercortisolism proved highly satisfactory.
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Affiliation(s)
- F Ponzetto
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - F Settanni
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin, Italy
| | - M Parasiliti-Caprino
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
| | - F Rumbolo
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin, Italy
| | - A Nonnato
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin, Italy
| | - M Ricciardo
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin, Italy
| | - E Amante
- Department of Chemistry, University of Turin, Turin, Italy
| | - G Priolo
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin, Italy
| | - S Vitali
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin, Italy
| | - L Anfossi
- Department of Chemistry, University of Turin, Turin, Italy
| | - E Arvat
- Oncologic Endocrinology, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - E Ghigo
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - R Giordano
- Department of Biological and Clinical Sciences, University of Turin, Turin, Italy
| | - G Mengozzi
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin, Italy
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22
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Zea M, Bellagambi FG, Ben Halima H, Zine N, Jaffrezic-Renault N, Villa R, Gabriel G, Errachid A. Electrochemical sensors for cortisol detections: Almost there. Trends Analyt Chem 2020. [DOI: 10.1016/j.trac.2020.116058] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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23
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Purser JD, Riachy R, Blanton LS, Belalcazar LM. Rapid Development of Iatrogenic Cushing Syndrome In A Patient On Ritonavir: The Adverse Metabolic Consequence of Topical Steroid Use. AACE Clin Case Rep 2020; 6:e346-e348. [DOI: 10.4158/accr-2020-0375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/10/2020] [Indexed: 11/15/2022] Open
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Sauer FJ, Gerber V, Frei S, Bruckmaier RM, Groessl M. Salivary cortisol measurement in horses: immunoassay or LC-MS/MS? Domest Anim Endocrinol 2020; 72:106445. [PMID: 32247992 DOI: 10.1016/j.domaniend.2020.106445] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/18/2019] [Accepted: 01/27/2020] [Indexed: 12/23/2022]
Abstract
The aim of the present study was to measure salivary cortisol concentrations of horses before and after hypothalamic-pituitary-adrenal (HPA) axis stimulation by means of liquid chromatography-tandem-mass spectrometry (LC-MS/MS) and an immunoassay (cELISA) for method comparison. Nine clinically healthy horses participated in the study. An ACTH stimulation test was performed. Saliva samples were collected before (T0) and 60 (T60) min after intravenous injection of 1 μg/kg BW synthetic ACTH1-24. LC-MS/MS was assessed for the determination of equine salivary cortisol. The results of these measurements were then compared to the results obtained by a cELISA, which has previously been validated for use in horses. The Pearson correlation coefficient was calculated and showed no correlation at T0 (r = -0.2452; P = 0.5249) and significantly correlated results at T60 (r = 0.8334; P = 0.0053). Bland-Altman-Plots of T60 revealed that immunoassay measurements led to higher outcome values than LC-MS/MS. On average, immunoassay results were 2.3 times higher. Poor agreement between both methods at T0 is potentially a consequence of inaccuracy in the very low measuring range of the immunoassay, and to a smaller extent, structurally similar cross-reacting agents and matrix effects, which might bias the results. Overestimation of immunoassay results at T60 might be due to different standardization of both methods, non-avoidable matrix effects on the antigen-antibody interaction in the ELISA, and possibly cross-reactions of other steroids. While immunoassay measurements of equine salivary cortisol yielded higher but reasonably correlated results for elevated cortisol concentrations after stimulation of the HPA axis, LC-MS/MS provided more accurate results, particularly for baseline cortisol concentrations close to the limit of detection of the ELISA.
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Affiliation(s)
- F J Sauer
- Swiss Institute of Equine Medicine (ISME), Vetsuisse Faculty, Department of Clinical Veterinary Medicine, University of Bern, and Agroscope, Switzerland, Laenggassstrasse 124, 3012 Bern, Switzerland.
| | - V Gerber
- Swiss Institute of Equine Medicine (ISME), Vetsuisse Faculty, Department of Clinical Veterinary Medicine, University of Bern, and Agroscope, Switzerland, Laenggassstrasse 124, 3012 Bern, Switzerland
| | - S Frei
- Department of Nephrology and Hypertension and Department of BioMedical Research, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - R M Bruckmaier
- Veterinary Physiology, Vetsuisse Faculty, University of Bern, Bremgartenstrasse 109a, 3012 Bern, Switzerland
| | - M Groessl
- Department of Nephrology and Hypertension and Department of BioMedical Research, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
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Saito-Abe M, Yamamoto-Hanada K, Nakayama SF, Hashimoto Y, Natsume O, Fukami M, Hasegawa T, Ohya Y. Reference values for salivary cortisol in healthy young infants by liquid chromatography-tandem mass spectrometry. Pediatr Int 2020; 62:785-788. [PMID: 31976606 DOI: 10.1111/ped.14166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/10/2020] [Accepted: 01/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sampling of salivary cortisol is non-invasive and important for the evaluation of the hypothalamic-pituitary-adrenal axis function and stress levels. However, the reference values for salivary cortisol measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) in healthy infants are unclear. The aim of this study was to establish the reference values for salivary cortisol levels in healthy infants. METHODS This study was a prospective observational cohort study following the participants until the age of 6 months. We analyzed 71 healthy, full-term infants at age 1 month between December 2017 and March 2018. We repeated saliva sampling every month, measured the salivary cortisol levels in the early morning by LC-MS/MS, and took the subjects' medical history by questionnaire. RESULTS The minimum, 25th, 50th, 75th percentile, and maximum salivary cortisol levels were 0.08, 1.11, 2.21, 5.18, and 30.35 nmol/L, respectively. CONCLUSIONS We established the reference values for salivary cortisol in young infants using LC-MS/MS.
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Affiliation(s)
- Mayako Saito-Abe
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | | | - Shoji F Nakayama
- Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan
| | - Yuki Hashimoto
- Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan.,Technical Solution Headquarters, Sumika Chemical Analysis Service, Ltd., Osaka, Japan
| | - Osamu Natsume
- Department of Pediatrics, School of Medicine, Hamamatsu University, Shizuoka, Japan
| | - Maki Fukami
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Tomonobu Hasegawa
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
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Rincon AV, Ostner J, Heistermann M, Deschner T. Measuring urinary cortisol and testosterone levels in male Barbary macaques: A comparison of EIA and LC-MS. Gen Comp Endocrinol 2019; 281:117-125. [PMID: 31145893 DOI: 10.1016/j.ygcen.2019.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/04/2019] [Accepted: 05/26/2019] [Indexed: 01/03/2023]
Abstract
The development of methods to quantify hormones from non-invasively collected samples such as urine or feces has facilitated endocrinology research on wild-living animals. To ensure that hormone measurements are biologically meaningful, method validations are strongly recommended for each new species or sample matrix. Our aim was to validate three commonly used enzyme immunoassays (EIA), one for analysis of cortisol and two for analysis of testosterone, to assess adrenocortical and gonadal endocrine activity, respectively, from the urine of male Barbary macaques. We compared EIA and liquid chromatography-mass spectrometry (LC-MS) results to determine if the EIA measurements truly reflect levels of the target hormone and to determine if antibody cross-reactivities with other steroids were potentially confounding results. Furthermore, we conducted a biological validation of testosterone to ensure that both EIA and LC-MS were able to capture physiologically meaningful differences in hormone levels. We found that cortisol measured by EIA correlated strongly with cortisol measured by LC-MS in both adult and immature males, without the need for deconjugation of steroids in the urine. Both testosterone EIAs correlated strongly with LC-MS in adult males, but only if steroids in the urine were deconjugated by enzymatic hydrolysis prior to analysis. However, in immature males, EIA and LC-MS results did not correlate significantly. Further correlation analyses suggest this is likely due to cross-reactivity of the testosterone antibodies with other adrenal steroids such as cortisol, DHEA, and likely others, which are present at much higher concentrations relative to testosterone in immature males. Testosterone levels were significantly higher in adult compared to immature males as measured by LC-MS but not as measured by EIA. Taken together, our results suggest that the testosterone EIAs are suitable to assess gonadal activity in adult but not immature males, and only if a hydrolysis of the urine is conducted prior to analysis.
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Affiliation(s)
- Alan V Rincon
- Department of Behavioral Ecology, Johann-Friedrich-Blumenbach Institute for Zoology and Anthropology, University of Goettingen, Goettingen, Germany; Leibniz ScienceCampus Primate Cognition, Goettingen, Germany.
| | - Julia Ostner
- Department of Behavioral Ecology, Johann-Friedrich-Blumenbach Institute for Zoology and Anthropology, University of Goettingen, Goettingen, Germany; Leibniz ScienceCampus Primate Cognition, Goettingen, Germany; Research Group Social Evolution in Primates, German Primate Center, Leibniz Institute for Primate Research, Goettingen, Germany
| | - Michael Heistermann
- Endocrinology Laboratory, German Primate Center, Leibniz Institute for Primate Research, Goettingen, Germany
| | - Tobias Deschner
- Department of Primatology, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
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Araujo-Castro M, Sampedro Núñez MA, Marazuela M. Autonomous cortisol secretion in adrenal incidentalomas. Endocrine 2019; 64:1-13. [PMID: 30847651 DOI: 10.1007/s12020-019-01888-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 02/28/2019] [Indexed: 02/06/2023]
Abstract
Adrenal incidentalomas (AI) are one of the most frequent reasons for consultation in Endocrinology, as they are present in 3-10% of the general population. Up to 20% of them may have autonomous cortisol secretion (ACS), a term that refers to AI carriers with biochemical evidence of excess cortisol, but without the "specific" clinical signs of Cushing's syndrome. As ACS is associated with an increased risk of diabetes, obesity, high blood pressure (HBP), osteoporosis, cardiovascular events, and global mortality; its correct identification is of great importance. There are different laboratory assays to detect ACS, but all of them have some limitations. The dexamethasone suppression test is the most accepted for screening. However, there is no consensus on the cutoff point that should be used. Low levels of ACTH and DHEA-S and high urinary free cortisol are also associated with ACS, but in isolation they are of little value to establish the diagnosis. Considering its clinical implications and the lack of consensus in the diagnosis and in which is the most appropriate management of these patients, this review offers a quick reference guide of ACS, presenting an exhaustive review of the topic: its definition, epidemiology, diagnosis, clinical implications, treatment, and follow-up.
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Affiliation(s)
- Marta Araujo-Castro
- Department of Endocrinology, Hospital Universitario La Princesa, Instituto de Investigación Princesa, Madrid, Spain.
| | - Miguel Antonio Sampedro Núñez
- Department of Endocrinology, Hospital Universitario La Princesa, Instituto de Investigación Princesa, Madrid, Spain.
| | - Mónica Marazuela
- Department of Endocrinology, Hospital Universitario La Princesa, Instituto de Investigación Princesa, Madrid, Spain.
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Ceccato F, Marcelli G, Martino M, Concettoni C, Brugia M, Trementino L, Michetti G, Arnaldi G. The diagnostic accuracy of increased late night salivary cortisol for Cushing's syndrome: a real-life prospective study. J Endocrinol Invest 2019; 42:327-335. [PMID: 29987756 DOI: 10.1007/s40618-018-0921-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 06/26/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND AIM A prompt diagnosis of Cushing's Syndrome (CS) in high-risk populations is mandatory: 1-mg dexamethasone suppression test (1-mg DST), late night salivary cortisol (LNSC), and urinary-free cortisol (UFC) are recommended, despite thresholds calculated in retrospective studies. Our aim was to study the diagnostic accuracy of LNSC measured with chemiluminescence assay in a prospective study, confirming discrepancies with mass spectrometry (MS). MATERIALS AND METHODS We enrolled 117 controls and 164 suspected CS (CS = 47, non-CS = 117). In case of increased LNSC, high clinical suspicion of CS or adrenal incidentaloma, patients were hospitalized to exclude/confirm CS. RESULTS LNSC levels were higher in patients with suspected CS, CS, and non-CS than controls. Considering 16 nmol/L as threshold for CS, overall LNSC revealed SE 97% and SP 84% in the whole group of subjects considered, achieving positive/negative likelihood ratio of 5.56/0.045, respectively. 35 out of 81 subjects with increased LNSC were non-CS (15 diabetic and 20 obese): considering only those patients with increased likelihood to have a CS (the non-CS patients) SP decreased to 70%, and further reduced to 60% if we discharged subjects with adrenal incidentaloma. MS analyses reduced partially the number of false-positive LNSC. CONCLUSIONS LNSC measured in automated chemiluminescence is reliable in clinical practice: it present a high diagnostic accuracy to exclude hypercortisolism in patients with normal cortisol levels. MS could be used to reduce the number of false-positive results; nevertheless, some non-CS subjects with functional hypercortisolism could have a mild impairment of cortisol rhythm.
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Affiliation(s)
- F Ceccato
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Via Ospedale Civile, 105, 35128, Padua, PD, Italy.
| | - G Marcelli
- Division of Endocrinology, Department of Clinical and Molecular Sciences (DISCLIMO), Umberto I Hospital, Polytechnic University of Marche, Via Tronto 10B, 60020, Torrette, AN, Italy
| | - M Martino
- Division of Endocrinology, Department of Clinical and Molecular Sciences (DISCLIMO), Umberto I Hospital, Polytechnic University of Marche, Via Tronto 10B, 60020, Torrette, AN, Italy
| | - C Concettoni
- Division of Endocrinology, Department of Clinical and Molecular Sciences (DISCLIMO), Umberto I Hospital, Polytechnic University of Marche, Via Tronto 10B, 60020, Torrette, AN, Italy
| | - M Brugia
- Division of Endocrinology, Department of Clinical and Molecular Sciences (DISCLIMO), Umberto I Hospital, Polytechnic University of Marche, Via Tronto 10B, 60020, Torrette, AN, Italy
| | - L Trementino
- Division of Endocrinology, Department of Clinical and Molecular Sciences (DISCLIMO), Umberto I Hospital, Polytechnic University of Marche, Via Tronto 10B, 60020, Torrette, AN, Italy
| | - G Michetti
- Division of Endocrinology, Department of Clinical and Molecular Sciences (DISCLIMO), Umberto I Hospital, Polytechnic University of Marche, Via Tronto 10B, 60020, Torrette, AN, Italy
| | - G Arnaldi
- Division of Endocrinology, Department of Clinical and Molecular Sciences (DISCLIMO), Umberto I Hospital, Polytechnic University of Marche, Via Tronto 10B, 60020, Torrette, AN, Italy
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Hogenelst K, Soeter M, Kallen V. Ambulatory measurement of cortisol: Where do we stand, and which way to follow? SENSING AND BIO-SENSING RESEARCH 2019. [DOI: 10.1016/j.sbsr.2018.100249] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Trends in Analysis of Cortisol and Its Derivatives. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1140:649-664. [DOI: 10.1007/978-3-030-15950-4_39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Braun LT, Riester A, Oßwald-Kopp A, Fazel J, Rubinstein G, Bidlingmaier M, Beuschlein F, Reincke M. Toward a Diagnostic Score in Cushing's Syndrome. Front Endocrinol (Lausanne) 2019; 10:766. [PMID: 31787931 PMCID: PMC6856055 DOI: 10.3389/fendo.2019.00766] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/21/2019] [Indexed: 12/26/2022] Open
Abstract
Cushing's syndrome (CS) is a classical rare disease: it is often suspected in patients who do not have the disease; at the same time, it takes a mean of 3 years to diagnose CS in affected individuals. The main reason is the extreme rarity (1-3/million/year) in combination with the lack of a single lead symptom. CS has to be suspected when a combination of signs and symptoms is present, which together make up the characteristic phenotype of cortisol excess. Unusual fat distribution affecting the face, neck, and trunk; skin changes including plethora, acne, hirsutism, livid striae, and easy bruising; and signs of protein catabolism such as thinned and vulnerable skin, osteoporotic fractures, and proximal myopathy indicate the need for biochemical screening for CS. In contrast, common symptoms like hypertension, weight gain, or diabetes also occur quite frequently in the general population and per se do not justify biochemical testing. First-line screening tests include urinary free cortisol excretion, dexamethasone suppression testing, and late-night salivary cortisol measurements. All three tests have overall reasonable sensitivity and specificity, and first-line testing should be selected on the basis of the physiologic conditions of the patient, drug intake, and available laboratory quality control measures. Two normal test results usually exclude the presence of CS. Other tests and laboratory parameters like the high-dose dexamethasone suppression test, plasma ACTH, the CRH test, and the bilateral inferior petrosal sinus sampling are not part of the initial biochemical screening. As a general rule, biochemical screening should only be performed if the pre-test probability for CS is reasonably high. This article provides an overview about the current standard in the diagnosis of CS starting with clinical scores and screenings, the clinical signs, relevant differential diagnoses, the first-line biochemical screening, and ending with a few exceptional cases.
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Affiliation(s)
- Leah T. Braun
- Department for Endocrinology, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany
| | - Anna Riester
- Department for Endocrinology, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany
| | - Andrea Oßwald-Kopp
- Department for Endocrinology, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany
| | - Julia Fazel
- Department for Endocrinology, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany
| | - German Rubinstein
- Department for Endocrinology, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany
| | - Martin Bidlingmaier
- Department for Endocrinology, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany
| | - Felix Beuschlein
- Department for Endocrinology, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Zurich, Switzerland
| | - Martin Reincke
- Department for Endocrinology, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany
- *Correspondence: Martin Reincke
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Fujisawa A, Ota A, Matsunaga M, Li Y, Kakizaki M, Naito H, Yatsuya H. Effect of laughter yoga on salivary cortisol and dehydroepiandrosterone among healthy university students: A randomized controlled trial. Complement Ther Clin Pract 2018; 32:6-11. [DOI: 10.1016/j.ctcp.2018.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 03/19/2018] [Accepted: 04/12/2018] [Indexed: 01/13/2023]
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Sturmer LR, Dodd D, Chao CS, Shi RZ. Clinical utility of an ultrasensitive late night salivary cortisol assay by tandem mass spectrometry. Steroids 2018; 129:35-40. [PMID: 29197558 DOI: 10.1016/j.steroids.2017.11.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 11/24/2017] [Accepted: 11/27/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Late night salivary cortisol measurement is a clinically important and convenient screening test for Cushing's syndrome. Tandem mass spectrometry (LC-MS/MS) assays have superior sensitivity and specificity compared to immunoassays. Our goal was to improve a LC-MS/MS method to measure salivary cortisol in both adult and pediatric patients and to characterize its analytical performance by method validation and clinical performance by chart review. METHODS We improved a LC-MS/MS method originally developed for urine cortisol to measure low level salivary cortisol. The sample preparation was by liquid-liquid extraction using dichloromethane followed by stepwise washing with acidic, basic and neutral solutions. The assay's analytical performance was characterized and retrospective patient chart review was conducted to evaluate the assay's clinical diagnostic performance. RESULTS The LC-MS/MS assay showed enhanced functional sensitivity of 10 ng/dL for salivary cortisol and was linear within an analytical measurement range of 10-10,000 ng/dL. Assay accuracy was within 84-120% as determined by recovery studies and correlation with a reference method. Data from healthy adult volunteers was compiled to establish the reference interval for late night salivary cortisol. Patient chart review determined subjects with diagnosis of Cushing's syndrome or disease, and assay's clinical diagnostic sensitivity of 100% and specificity of 92% when the cutoff value was 70 ng/dL. CONCLUSIONS The improved LC-MS/MS method is sensitive and specific with enhanced analytical performance and clinical diagnostic utility for screening Cushing's syndrome. The assay may have broad clinical application due to its high sensitivity and wide dynamic range.
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Affiliation(s)
- Lillian R Sturmer
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Dylan Dodd
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Christina S Chao
- Pediatric Endocrinology, Kaiser Permanente Roseville Medical Center, Roseville, CA, United States
| | - Run-Zhang Shi
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, United States.
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Cushing Syndrome: Diagnostic Workup and Imaging Features, With Clinical and Pathologic Correlation. AJR Am J Roentgenol 2017. [PMID: 28639924 DOI: 10.2214/ajr.16.17290] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Cushing syndrome (CS) is a constellation of clinical signs and symptoms resulting from chronic exposure to excess cortisol, either exogenous or endogenous. Exogenous CS is most commonly caused by administration of glucocorticoids. Endogenous CS is subdivided into two types: adrenocorticotropic hormone (ACTH) dependent and ACTH independent. CONCLUSION Cushing disease, which is caused by a pituitary adenoma, is the most common cause of ACTH-dependent CS for which pituitary MRI can be diagnostic, with bilateral inferior petrosal sinus sampling useful in equivocal cases. In ectopic ACTH production, which is usually caused by a tumor in the thorax (e.g., small cell lung carcinoma, bronchial and thymic carcinoids, or medullary thyroid carcinoma) or abdomen (e.g., gastroenteropancreatic neuroendocrine tumors or pheochromocytoma), CT, MRI, and nuclear medicine tests are used for localizing the source of ACTH. In ACTH-independent CS, which is caused by various adrenal abnormalities, adrenal protocol CT or MRI is usually diagnostic.
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El-Farhan N, Rees DA, Evans C. Measuring cortisol in serum, urine and saliva - are our assays good enough? Ann Clin Biochem 2017; 54:308-322. [PMID: 28068807 DOI: 10.1177/0004563216687335] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Cortisol is a steroid hormone produced in response to stress. It is essential for maintaining health and wellbeing and leads to significant morbidity when deficient or present in excess. It is lipophilic and is transported bound to cortisol-binding globulin (CBG) and albumin; a small fraction (∼10%) of total serum cortisol is unbound and biologically active. Serum cortisol assays measure total cortisol and their results can be misleading in patients with altered serum protein concentrations. Automated immunoassays are used to measure cortisol but lack specificity and show significant inter-assay differences. Liquid chromatography - tandem mass spectrometry (LC-MS/MS) offers improved specificity and sensitivity; however, cortisol cut-offs used in the short Synacthen and Dexamethasone suppression tests are yet to be validated for these assays. Urine free cortisol is used to screen for Cushing's syndrome. Unbound cortisol is excreted unchanged in the urine and 24-h urine free cortisol correlates well with mean serum-free cortisol in conditions of cortisol excess. Urine free cortisol is measured predominantly by immunoassay or LC-MS/MS. Salivary cortisol also reflects changes in unbound serum cortisol and offers a reliable alternative to measuring free cortisol in serum. LC-MS/MS is the method of choice for measuring salivary cortisol; however, its use is limited by the lack of a single, validated reference range and poorly standardized assays. This review examines the methods available for measuring cortisol in serum, urine and saliva, explores cortisol in disease and considers the difficulties of measuring cortisol in acutely unwell patients and in neonates.
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Affiliation(s)
- Nadia El-Farhan
- 1 Biochemistry Department, Royal Gwent Hospital, Newport, UK
| | - D Aled Rees
- 2 Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - Carol Evans
- 3 Department of Medical Biochemistry and Immunology, University Hospital of Wales, Cardiff, UK
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Coelli S, Farias CB, Soares AA, Crescente GM, Hirakata VN, Souza LB, Czepielewski MA, Camargo JL, Silveiro SP. Influence of age, gender and body mass index on late-night salivary cortisol in healthy adults. ACTA ACUST UNITED AC 2017; 55:1954-1961. [DOI: 10.1515/cclm-2016-1100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 03/28/2017] [Indexed: 11/15/2022]
Abstract
AbstractBackground:Late-night salivary cortisol (LNSC) is one of the most reliable tests to screen for endogenous Cushing syndrome. This test is simple, inexpensive and noninvasive and has high sensitivity and specificity. The aim of our study was to analyze the putative influence of age, gender and body mass index (BMI) on LNSC levels in a healthy population.Methods:Cross-sectional study conducted in healthy adults. Midnight saliva samples were collected at home. Participants refrained from teeth brushing, eating or drinking for 2 h prior to collection. Salivary cortisol measured by electrochemiluminescence immunoassay (ECLIA). The study was approved by the Ethics Committee of the hospital (number 140073).Results:We evaluated 122 nonsmoking healthy volunteers. Mean age was 35±14 years (range, 18–74 years); 63% were women. Mean BMI was 24±3 kg/mConclusions:The maximum reference value (P97.5) of LNSC was set at 8.3 nmol/L (0.3 μg/dL) using ECLIA. Advanced age was associated with higher LNSC levels, with no evident influence of gender or BMI.
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Jia M, Chew WM, Feinstein Y, Skeath P, Sternberg EM. Quantification of cortisol in human eccrine sweat by liquid chromatography - tandem mass spectrometry. Analyst 2017; 141:2053-60. [PMID: 26858998 DOI: 10.1039/c5an02387d] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cortisol has long been recognized as the "stress biomarker" in evaluating stress related disorders. Plasma, urine or saliva are the current source for cortisol analysis. The sampling of these biofluids is either invasive or has reliability problems that could lead to inaccurate results. Sweat has drawn increasing attention as a promising source for non-invasive stress analysis. A sensitive HPLC-MS/MS method was developed for the quantitation of cortisol ((11β)-11,17,21-trihydroxypregn-4-ene-3,20-dione) in human eccrine sweat. At least one unknown isomer that has previously not been reported and could potentially interfere with quantification was separated from cortisol with mixed mode RP HPLC. Detection of cortisol was carried out using atmospheric pressure chemical ionization (APCI) and selected reaction monitoring (SRM) in positive ion mode, using cortisol-9,11,12,12-D4 as internal standard. LOD and LOQ were estimated to be 0.04 ng ml(-1) and 0.1 ng ml(-1), respectively. Linear range of 0.10-25.00 ng ml(-1) was obtained. Intraday precision (2.5%-9.7%) and accuracy (0.5%-2.1%), interday precision (12.3%-18.7%) and accuracy (7.1%-15.1%) were achieved. This method has been successfully applied to the cortisol analysis of human eccrine sweat samples. This is the first demonstration that HPLC-MS/MS can be used for the sensitive and highly specific determination of cortisol in human eccrine sweat in the presence of at least one isomer that has similar hydrophobicity as cortisol. This study demonstrated that human eccrine sweat could be used as a promising source for non-invasive assessment of stress biomarkers such as cortisol and other steroid hormones.
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Affiliation(s)
- Min Jia
- Arizona Center for Integrative Medicine, College of Medicine, the University of Arizona, Tucson, AZ 85724, USA.
| | - Wade M Chew
- Arizona Cancer Center, The University of Arizona, Tucson, AZ 85724, USA
| | - Yelena Feinstein
- Center for Toxicology, College of Pharmacy, The University of Arizona, Tucson, AZ 85724, USA
| | - Perry Skeath
- Arizona Center for Integrative Medicine, College of Medicine, the University of Arizona, Tucson, AZ 85724, USA.
| | - Esther M Sternberg
- Arizona Center for Integrative Medicine, College of Medicine, the University of Arizona, Tucson, AZ 85724, USA.
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Lopes LML, Francisco RPV, Galletta MAK, Bronstein MD. Determination of nighttime salivary cortisol during pregnancy: comparison with values in non-pregnancy and Cushing's disease. Pituitary 2016; 19:30-8. [PMID: 26346684 DOI: 10.1007/s11102-015-0680-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Nighttime salivary cortisol (NSC) has been proposed for the diagnosis of Cushing's syndrome during pregnancy. However, reference values for NCS in pregnant women have not been adequately determined. The aim of this study was to determine the reference values of NSC in the three gestational trimesters in order to help distinguish physiological from pathological hypercortisolism during pregnancy. METHODS This prospective and retrospective study evaluated 85 pregnant women in whom samples were collected in the first, second and/or third gestational trimester (pregnancy group), 33 non-pregnant women (control group), and 25 non-pregnant women with Cushing's disease (CD group). NSC was measured by enzyme-linked immunosorbent assay. RESULTS NSC increased progressively during pregnancy, reaching maximum levels on the third trimester (median 2.1-fold increase compared with controls, p < 0.001). Reference values for NSC were determined and the upper limits on each gestational trimester were: first trimester 0.25 µg/dL (6.9 nmol/L), second trimester 0.26 µg/dL (7.2 nmol/L), and third trimester 0.33 µg/dL (9.1 nmol/L). Cutoff values that separated the CD group from the three trimesters in the pregnancy groups were, respectively, 0.255 µg/dL (7.0 nmol/L), 0.260 µg/dL (7.2 nmol/L), and 0.285 µg/dL (7.9 nmol/L). Comparison of NSC cutoff values in pregnant women with CD patients showed high sensitivity and specificity in all three trimesters. CONCLUSIONS We established cutoff values for determination of NSC which can be useful for pregnant women with a diagnostic suspicion of CD.
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Affiliation(s)
- Ludmilla Malveira Lima Lopes
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, Brazil.
| | | | - Marco Aurélio Knippel Galletta
- Department of Obstetrics and Gynecology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, Brazil.
| | - Marcello Delano Bronstein
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, Brazil.
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Wang H, Bussy U, Chung-Davidson YW, Li W. Ultra-performance liquid chromatography tandem mass spectrometry for simultaneous determination of natural steroid hormones in sea lamprey ( Petromyzon marinus ) plasma and tissues. J Chromatogr B Analyt Technol Biomed Life Sci 2016; 1009-1010:170-8. [DOI: 10.1016/j.jchromb.2015.12.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/21/2015] [Accepted: 12/17/2015] [Indexed: 01/17/2023]
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Salivary cortisol and cortisone by LC–MS/MS: validation, reference intervals and diagnostic accuracy in Cushing's syndrome. Clin Chim Acta 2015; 451:247-51. [DOI: 10.1016/j.cca.2015.10.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/08/2015] [Accepted: 10/05/2015] [Indexed: 01/17/2023]
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Pecori Giraldi F, Ambrogio AG. Variability in laboratory parameters used for management of Cushing's syndrome. Endocrine 2015; 50:580-9. [PMID: 26160393 PMCID: PMC4662716 DOI: 10.1007/s12020-015-0676-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/24/2015] [Indexed: 12/21/2022]
Abstract
The progress in assay methodology, from the use of radioactive tracers to chemiluminescent signals, from competitive to chromatographic techniques and from serum or urine to saliva has considerably impacted on hormonal measurements. The clinician now may choose among multiple tests but the inherent variability in cortisol and ACTH secretion, coupled to lack of harmonization among assay procedures and normal ranges mandates careful interpretation of any result. The present review will examine factors which affect interpretation of cortisol and ACTH measurements and their impact on tests used for management of Cushing's syndrome.
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Affiliation(s)
- Francesca Pecori Giraldi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
- Neuroendocrinology Research Laboratory, Istituto Auxologico Italiano, Via Zucchi 18, 20095, Milan, MI, Italy.
| | - Alberto G Ambrogio
- Neuroendocrinology Research Laboratory, Istituto Auxologico Italiano, Via Zucchi 18, 20095, Milan, MI, Italy
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Ota A, Yatsuya H, Mase J, Ono Y. Psychological job strain, social support at work and daytime secretion of dehydroepiandrosterone (DHEA) in healthy female employees: cross-sectional analyses. Sci Rep 2015; 5:15844. [PMID: 26552586 PMCID: PMC4639848 DOI: 10.1038/srep15844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 10/01/2015] [Indexed: 11/18/2022] Open
Abstract
Evidence is limited concerning the influences of high psychological job strain and low social support at work on daytime secretion of dehydroepiandrosterone (DHEA), which demonstrates anti-cortisol effects. We carried out a cross-sectional study to examine the associations of job strain and social support with daytime secretion amounts of DHEA and cortisol and daytime variation of the cortisol-to-DHEA ratio (C/D ratio) in healthy female workers. Study subjects comprised 115 healthy female nursery school teachers. Area under the curve with respect to ground (AUCG) of salivary DHEA, cortisol and C/D ratio was calculated for estimation of daytime secretion and variation. Social support scores were negatively associated with daytime DHEA secretion (standardized partial regression coefficient = -0.343, P < 0.001 by multiple linear regression analysis). This association remained significant when daytime cortisol secretion was additionally adjusted. Social support was not associated with daytime variation of the C/D ratio. Significant association between social support and daytime cortisol secretion was not confirmed. Job strain was not associated with DHEA, cortisol or the C/D ratio. In summary, we found that daytime DHEA secretion was increased in healthy workers with low social support, perhaps independent of daytime cortisol secretion.
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Affiliation(s)
- Atsuhiko Ota
- Department of Public Health, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroshi Yatsuya
- Department of Public Health, Fujita Health University School of Medicine, Toyoake, Japan
| | - Junji Mase
- Department of Public Health, Fujita Health University School of Medicine, Toyoake, Japan
- Division of Dentistry, Aichi Cancer Centre Hospital, Nagoya, Japan
| | - Yuichiro Ono
- Department of Public Health, Fujita Health University School of Medicine, Toyoake, Japan
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Fahlbusch FB, Heussner K, Schmid M, Schild R, Ruebner M, Huebner H, Rascher W, Doerr HG, Rauh M. Measurement of amniotic fluid steroids of midgestation via LC-MS/MS. J Steroid Biochem Mol Biol 2015; 152:155-60. [PMID: 26047555 DOI: 10.1016/j.jsbmb.2015.05.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 05/02/2015] [Accepted: 05/31/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Analysis of steroids by mass spectrometry (MS) has evolved into a reliable tool for the simultaneous detection of multiple steroids. As amniotic fluid (AF) and fetal serum composition of early pregnancy are closely related, the analysis of AF can yield information on the physiological status of the developing fetus. We evaluated the use of liquid-chromatography tandem mass spectrometry (LC-MS/MS) for AF steroid analysis, including the analysis of its sensitivity and accuracy for gender verification in healthy subjects. MATERIALS AND METHODS AF of 78 male and 94 female healthy newborns was analyzed by LC-MS/MS at 16 weeks of gestation. The levels of androstenedione, corticosterone, cortisol, cortisone, deoxycorticosterone, 11-deoxycortisol, dehydroepiandrosterone (DHEA), dehydroepiandrosterone-sulfate (DHEA-S), 17-hydroxyprogesterone, progesterone (17-OHP) and testosterone were measured. Steroid levels were compared to RIA and GC-MS levels of midgestation from the literature. Cross-validated logistic regression was used to obtain statistical predictions of gender at birth from testosterone and the above steroids. RESULTS LC-MS/MS analysis of AF steroids yielded comparable results with published GC-MS data. Gender specific differences were found for androstenedione and testosterone concentrations with higher levels in the male fetus. In contrast to published RIA data no gender specific differences were observed for 17-hydroxyprogesterone and dehydroepiandrosterone AF concentrations. Testosterone concentrations yielded highly accurate predictions for male gender at birth. Additional analysis of further steroids did neither increase the accuracy, sensitivity nor specificity of this prediction. The estimated optimal cut-off value for amniotic testosterone level was 0.074 μg/L for healthy male newborns. CONCLUSIONS LC-MS/MS is a reliable method for the determination of steroids in amniotic fluid. The determination of testosterone in amniotic fluid by LC-MS/MS in early pregnancy of healthy subjects can be used to offer a reliable prediction of fetal gender at birth.
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Affiliation(s)
- Fabian B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany.
| | - Kirsten Heussner
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Schmid
- Institute of Medical Biometry, Informatics and Epidemiology (IMBIE), Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Ralf Schild
- Department of Obstetrics and Perinatal Medicine, Diakoniekrankenhaus Friederikenstift, Hannover, Germany
| | - Matthias Ruebner
- Department of Gynecology and Obstetrics, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Hanna Huebner
- Department of Gynecology and Obstetrics, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Wolfgang Rascher
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Helmuth-Guenther Doerr
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Manfred Rauh
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
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Cushing's syndrome: update on signs, symptoms and biochemical screening. Eur J Endocrinol 2015; 173:M33-8. [PMID: 26156970 DOI: 10.1530/eje-15-0464] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 06/10/2015] [Indexed: 01/01/2023]
Abstract
Endogenous pathologic hypercortisolism, or Cushing's syndrome, is associated with poor quality of life, morbidity, and increased mortality. Early diagnosis may mitigate against this natural history of the disorder. The clinical presentation of Cushing's syndrome varies, in part related to the extent and duration of cortisol excess. When hypercortisolism is severe, its signs and symptoms are unmistakable. However, most of the signs and symptoms of Cushing's syndrome are common in the general population (e.g., hypertension and weight gain) and not all are present in every patient. In addition to classical features of glucocorticoid excess, such as proximal muscle weakness and wide purple striae, patients may present with the associated comorbidities that are caused by hypercortisolism. These include cardiovascular disease, thromboembolic disease, psychiatric and cognitive deficits, and infections. As a result, internists and generalists must consider Cushing's syndrome as a cause, and endocrinologists should search for and treat these comorbidities. Recommended tests to screen for Cushing's syndrome include 1 mg dexamethasone suppression, urine free cortisol, and late night salivary cortisol. These may be slightly elevated in patients with physiologic hypercortisolism, which should be excluded, along with exogenous glucocorticoid use. Each screening test has caveats and the choice of tests should be individualized based on each patient's characteristics and lifestyle. The objective of this review is to update the readership on the clinical and biochemical features of Cushing's syndrome that are useful when evaluating patients for this diagnosis.
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Johnston PC, Lansang MC, Chatterjee S, Kennedy L. Intra-articular glucocorticoid injections and their effect on hypothalamic-pituitary-adrenal (HPA)-axis function. Endocrine 2015; 48:410-6. [PMID: 25182149 DOI: 10.1007/s12020-014-0409-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 08/26/2014] [Indexed: 12/27/2022]
Abstract
The use of intra-articular (IA) glucocorticoids for reducing pain and inflammation in patients with osteoarthritis, rheumatoid arthritis, and other inflammatory arthropathies is widespread among primary care physicians, specialists, and non-specialists in the United States. Injectable glucocorticoids have anti-inflammatory and analgesic properties which can be effective in improving clinical parameters such as pain, range of motion, and quality of life. After injection into the IA space, glucocorticoids may be systemically absorbed; the degree of absorption can depend on the size of the joint injected, the injectable glucocorticoid preparation used, the dosage, and the frequency of the injection. The adverse effects of intra-articular glucocorticoid injections (IAGC) can often be overlooked by both the patient and physicians who administer them, in particular the potential deleterious effect on the hypothalamic-pituitary-adrenal (HPA)-axis which can result in adrenal suppression and/or iatrogenic Cushing syndrome. In this paper we provide an overview on the often under-recognized effects of IAGC on HPA-axis function.
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Affiliation(s)
- Philip C Johnston
- Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic Foundation, 9500 Euclid Avenue Desk F20, Cleveland, OH, 44195, USA,
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Danet-Lamasou M, Asselineau J, Perez P, Vivot A, Nunes ML, Loiseau H, San-Galli F, Cherifi-Gatta B, Corcuff JB, Tabarin A. Accuracy of repeated measurements of late-night salivary cortisol to screen for early-stage recurrence of Cushing's disease following pituitary surgery. Clin Endocrinol (Oxf) 2015; 82:260-6. [PMID: 24975391 DOI: 10.1111/cen.12534] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 03/23/2014] [Accepted: 06/18/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The performance of late-night salivary cortisol (LNSC) to accurately screen for postoperative recurrence of Cushing's disease (CD) at an early stage is unknown. The aim of this study was to compare the accuracy of multiple sampling strategies to suggest the optimal number of LNSC samples needed for diagnosing post-surgical recurrences of CD at an early stage. DESIGN Retrospective analysis in a single centre. PATIENTS AND MEASUREMENTS Thirty-six patients in surgical remission of CD had successive measurements of LNSC, defined as 'sequences', using a locally modified RIA assay as part of long-term follow-up (69·2 ± 10·6 months). Patients underwent an extensive biochemical evaluation within 3 months before or after a sequence of saliva sampling and were classified as being in remission or in early-stage recurrence. The accuracy of three diagnostic strategies combining two, three or four LNSC results from a sequence was estimated using areas under the ROC curves (AUC), sensitivity, specificity and predictive values. RESULTS Forty-four sequences of LNSC measurements were available. Fifty-two percent of sequences were performed during early-stage recurrence. The intrasequence variability of LNSC was higher during recurrence than during remission (medians of SDs: 2·1 vs 0·5 nm; P < 0·0001). AUCs from ROC curves ranged from 0·93 to 0·96 depending on the strategy. For 90% sensitivities, the best specificities (92·9% and 90·9%) were achieved by strategies taking into account three or four measurements summarized either by their mean or their maximum value. CONCLUSIONS Increase in LNSC concentration is an early abnormality during post-surgical recurrence of CD. However, due to a major within-patient variability of LNSC from 1 day to another, a screening strategy using three or four samples collected on successive days may be recommended to detect early-stage recurrence of CD with a high accuracy.
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Affiliation(s)
- Marie Danet-Lamasou
- Departement d'Endocrinologie et Maladies Metaboliques, CHU de Bordeaux, Hopital du Haut Leveque, Pessac, France
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Vieira JGH, Nakamura OH, Carvalho VM. Determination of cortisol and cortisone in human saliva by a liquid chromatography-tandem mass spectrometry method. ACTA ACUST UNITED AC 2014; 58:844-50. [DOI: 10.1590/0004-2730000003347] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 08/21/2014] [Indexed: 12/27/2022]
Abstract
Objective Salivary cortisol measurement plays an important role in the evaluation of adrenal function. Its high correlation with free serum cortisol, the easy of sampling and the limited presence of interfering steroids, generated multiple recent studies of its application, in special in the screening of adrenal hyperfunction. In this paper we present our experience in the development of a high pressure liquid chromatography tandem mass spectrometry (HPLC-MS/MS) method for salivary cortisol and cortisone measurement. Materials and methods For this study we used 181 saliva samples from our routine diagnostic laboratory. The HPLC-MS/MS method was based on a Waters Quattro Premier tandem mass spectrometer with an electrospray probe. After derivatization with hydroxylamine transitions monitored included cortisol and cortisone. An in-house radioimmunoassay (RIA) was used for salivary cortisol results comparison. Results Functional sensitivity was 24 ng/dL for cortisol and linearity from 24 to 1929 ng/dL. Saliva cortisol values obtained in the 181 samples presented a median of 52 ng/dL with 5‐95% percentile of 24 and 374 ng/dL. With the RIA the results were 86, 25 and 436 ng/dL, respectively, with values for RIA being significantly higher (P<0.0001) and high correlation (r=0.8312, P<0.0001). Cortisone measured in 159 samples showed a median of 278 ng/dL, with 5‐95% percentile of 100 and 1,133 ng/dL. Correlation with cortisol values was significant (r=0.820, P<0.0001). Conclusion We conclude that the HPLC-MS/MS method compares favorably with the RIA for salivary cortisol measurement, with the additional possibility of concomitant cortisone measurement and the evaluation of 11βHSD2 activity.
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Abstract
The peptide hormone glucagon plays an important role in homeostasis of glucose concentrations in the blood. Its biological importance is evidenced through the conservation of its peptide sequence between species. Reliable assays for glucagon in biological samples are important for gaining a better understanding of the pathology and treatment of diabetes. Numerous assays are available for the analysis of glucagon in biological samples, the majority of which employ an immunochemical approach and have been available for many years. However, recent advances in MS instrumentation and the amenability of glucagon for analysis by LC–MS/MS has brought these new methods to the forefront. Concentrations of glucagon determined from different methods are not always consistent and this review provides suggestions of how to improve the reliability of methods for glucagon analysis.
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Abstract
Cortisol is quantitatively the major glucocorticoid product of the adrenal cortex. The main reason to measure cortisol is to diagnose human diseases characterised by deficiency of adrenal steroid excretion in Addison's disease or overproduction in Cushing's syndrome (CS). In both cases a sensitive, accurate and reproducible assay of cortisol is required. Several methods have been described for the quantitative measurement of cortisol in both serum and urine. The most widely used methods in routine clinical laboratories are immunoassays (IA) and enzyme immunoassays (EIA), luminescence and fluorescence assays, which are available in numerous commercial kits and on automated platforms. However, there remains a number of problems in the so-called direct immunoassays if extraction and prepurification are not carried out before the assay. Recently, more specific chromatographic methods have been introduced, such as high pressure liquid chromatographic (HPLC) or liquid chromatography tandem mass spectrometric assays (LC-MS/MS). The high specificity especially of LC-MS/MS facilitates reliable measurement of cortisol both in plasma, urine and saliva samples.
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Affiliation(s)
- Ursula Turpeinen
- HUSLAB, Laboratory of Women's Clinic, Haartmaninkatu 2, 00290 Helsinki, Finland.
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Mert M, Tanakol R, Karpuzoglu H, Abbasoglu S, Yarman S, Boztepe H, Alagol F. Spectral effect: each population must have its own normal midnight salivary cortisol reference values determined. Arch Med Sci 2013; 9:872-6. [PMID: 24273572 PMCID: PMC3832833 DOI: 10.5114/aoms.2013.38681] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 05/21/2011] [Accepted: 07/11/2011] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION The mesurement of midnight salivary cortisol provides the most sensitive method for screening of Cushing's sendrome. However the clinical significance of spectral error is the requirement for determination of normal reference values in each population for each test, which will be used as the diagnostic method. Salivary cortisol levels may be affected by individual factors such as nutrition, sleep, medication, activity, and gender. Being a non-invasive method, midnight salivary cortisol (MSC) has been used as a valuable indicator of free plasma cortisol. MATERIAL AND METHODS Midnight salivary cortisol was assessed in randomly selected 100 Turkish patents who underwent to a detailed physical examination. Saliva samples were collected at 00:00 to plastic tubes with the help of plastic pipettes, without brushing their teeth, but after rinsing their mouth. Salivary cortisol was measured with luminescense immunoassay kit. Differences and correlations were analysed. RESULTS The mean midnight salivary cortisol of the healthy population was 0.21 ±0.03 µg/dl. Body mass index, age, sex, smoking, exercise, educational status alcohol, had no effect on the MSC. CONCLUSIONS Consequently, normal salivary cortisol reference ranges must be used for different assays and different populations in order to evaluate more accurately pituitary-adrenal axis pathology in clinical practice.
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Affiliation(s)
- Meral Mert
- Bakırkoy Dr. Sadi Konuk Training Hospital, Endocrinology and Metabolism, Istanbul, Turkey
| | - Refik Tanakol
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Hande Karpuzoglu
- Department of Biochemistry, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Semra Abbasoglu
- Department of Biochemistry, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Sema Yarman
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Harika Boztepe
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Faruk Alagol
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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