Some aspects of the measurement of cortisol production in patients with breast cancer

Cortisol production rates measured by liquid chromatography/mass spectrometry

Cortisol production rates (FPRs) in physiologic and pathologic states in humans have been investigated over the past 30 years. However, there has been conflicting evidence concerning the validity of the currently accepted value of FPRs in humans (12 to 15 mg/m2/d) as determined by radiotracer methodology. The present study reviews previous methods proposed for the measurement of FPRs in humans and discusses the applications of the first method for the direct determination of 24-hour plasma FPRs during continuous administration of a stable isotope, using a thermospray high-pressure liquid chromatography-mass spectrometry technique. The technique is fast, sensitive, and, unlike gas chromatography-mass spectrometry methods, does not require derivatization, allowing on-line detection and quantification of plasma cortisol after a simple extraction procedure. The results of determination of plasma FPRs by stable tracer/mass spectrometry are directly in units of mass/time and, unlike radiotracer methods, are independent of any determination of volume of distribution or cortisol concentration. Our methodology offers distinct advantages over radiotracer techniques in simplicity and reliability since only single measurements of isotope ratios are required. The technique was validated in adrenalectomized patients. Circadian variations in daily FRPs were observed in normal volunteers, and, to date, results suggest a lower FRP in normal children and adults than previously believed.

Salivary cortisol and dehydroepiandrosterone sulphate levels in postmenopausal women with primary breast cancer

Cortisol and dehydroepiandrosterone sulphate (DHAS) were measured in saliva from postmenopausal women with primary breast cancer and a control group of comparable age. Specimens were collected at 2-hr intervals during wake-span for two consecutive days, and circadian rhythmicity was demonstrated for each of the hormones in both populations. The marginally elevated levels of cortisol and lower levels of DHAS associated with the cancer group, and the larger inter-subject variation, make it unlikely that these hormone measurements would be of value in identifying women at risk of developing breast cancer.

Correlation of pre-treatment serum 17-hydroxycorticosteroid values with survival in patients with prostatic cancer

Total 17-OHCS values were determined before and after treatment in 715 patients with all stages of prostatic cancer. The pre-treatment 17-OHCS level was an important variable in predicting survival and appeared to be a better prognostic indicator of death in the first year than the patient's age, treatment or stage of disease. Generally, the higher the initial value of serum 17-OHCS the greater the probability of death in the first year of treatment. There was no preponderance of one type of death over another when patients with initial high and low values were compared.

The effect of hypophysectomy on the cortisol secretion in 4 patients with advanced metastatic breast cancer

A raised cortisol production rate is found in patients with advanced breast cancer. The cortisol production rate was estimated before and after hypophysectomy in 4 patients with metastatic disease and was found to fall to one-sixth of the original level. It is concluded that the high preoperative cortisol production rate was dependent on pituitary function and was not due to the production of corticotrophin by the tumour cells.