Excretion of oxidated cortisol metabolites is markedly lower than previously assumed: An analysis of urinary cortoic acids in healthy children by GC-MS

Discovered about 50 years ago, the four C21 steroidal acids (α-)cortolic acid, β-cortolic acid, (α‑)cortolonic acid and β-cortolonic acid present the oxidative end products of cortisol metabolism. Undergoing renal elimination, these cortoic acids have been assumed to constitute up to 25 % of total urinary cortisol metabolites. However, their analysis has been difficult, only few data has been published in adults, and this class of steroids has become practically forgotten. Since data in children are lacking and nothing is known about their metabolism during human development, we aimed at establishing a more practical analytical method and determined their urinary concentrations in a high number of healthy subjects. In our method, 5-mL-aliquots of 24-hour urine samples were subjected to solid phase extraction (C18 cartridges), followed by strong anion exchange chromatography, and formation of 2-propylester-trimethylsilylether derivatives (2-PR/TMS). The cortoic acids were quantified by targeted gas chromatography-mass spectrometry (GC-MS) using a nonpolar GC column and selected ion monitoring (SIM). Baseline separation of all cortoic acids was achieved. Calibration graphs were linear (R2 > 0.98). Variations in precision and accuracy were less than 15 %, respectively. The detection limit was 100 pg (injected) with a signal-to-noise ratio of 3. 240 specimens from 24-hour urine collections from healthy children (120 boys, 120 girls, aged 3-18 years; DONALD study) were analyzed for cortoic acids and neutral cortisol metabolites to create first reference ranges. The profile of cortoic acids was dominated by α-cortolonic acid with excretion rates up to 70 µg/d. Absolute excretion rates of cortoic acids increased with age, their total excretion rates ranged between 11.0 and 127.3 µg/d (median 45.7 µg/d), but did not show any sexual dimorphism. Since cortoic acids make up only about 1 % of total urinary cortisol metabolites, determination of neutral urinary steroids reliably allows assessment of cortisol production. However, cortoic acids might present potential biomarkers of the body's redox state.

[Perioperative mortality in otorhinolaryngology tumor surgery]

BACKGROUND

Perioperative mortality is an important factor for quality assurance in surgery. For ENT-surgery only sparse data has been published.

PATIENTS AND METHODS

A retrospective analysis of 1054 interventions performed on 775 consecutive patients treated surgically for benign and malignant tumors of the head and neck was conducted during a 3-year period in 1995-1998.

RESULTS

Of these patients, 34.1% were female and 65.9% male. Age ranged from 4-88 years with a mean age of 54.8 years. 489 patients (63.1%) were treated for malignoma and 286 for benign tumors (36.9%). 0.9% (n = 7) of our patients (n = 775) died during the first 30 days after surgery. That means 0.66% of all surgical interventions (n = 1054) were followed by post-operative mortality.

DISCUSSION

In otorhinolaryngological surgery, post-operative mortality seems to be acceptable and low compared to other medical disciplines. The challenge for surgery must be to reach and preserve low perioperative mortality rates in the future. Finding the individually correct indication for surgical treatment must be guaranteed in order to reach this aim.