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Vierbaum L, Weiss N, Kaiser P, Kremser M, Wenzel F, Thevis M, Schellenberg I, Luppa PB. Longitudinal analysis of external quality assessment of immunoassay-based steroid hormone measurement indicates potential for improvement in standardization. Front Mol Biosci 2024; 11:1345356. [PMID: 38357630 PMCID: PMC10865096 DOI: 10.3389/fmolb.2024.1345356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/02/2024] [Indexed: 02/16/2024] Open
Abstract
As hormonal disorders are linked to several diseases, the accurate quantitation of steroid hormone levels in serum is crucial in order to provide patients with a reliable diagnosis. Mass spectrometry-based methods are regarded as having the highest level of specificity and sensitivity. However, immunoassays are more commonly used in routine diagnostics to measure steroid levels as they are more cost effective and straightforward to conduct. This study analyzes the external quality assessment results for the measurement of testosterone, progesterone and 17β-estradiol in serum using immunoassays between early 2020 and May 2022. As reference measurement procedures are available for the three steroid hormones, the manufacturer-specific biases were normalized to the reference measurement values. The manufacturer-specific coefficients of variation were predominantly inconspicuous, below 20% for the three hormones when outliers are disregarded, however there were large differences between the various manufacturer collectives. For some collectives, the median bias to the respective reference measurement value was repeatedly greater than ±35%, which is the acceptance limit defined by the German Medical Association. In the case of testosterone and progesterone determination, some collectives tended to consistently over- or underestimate analyte concentrations compared to the reference measurement value, however, for 17β-estradiol determination, both positive and negative biases were observed. This insufficient level of accuracy suggests that cross-reactivity continues to be a fundamental challenge when antibody detection is used to quantify steroids with a high structural similarity. Distinct improvements in standardization are required to provide accurate analysis and thus, reliable clinical interpretations. The increased accuracy of the AX immunoassay for testosterone measurement, as observed in the INSTAND EQAs between 2020 and 2022, could be the result of a recalibration of the assay and raises hope for further improvement of standardization of immunoassay-based steroid hormone analyses in the coming years.
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Affiliation(s)
- Laura Vierbaum
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
| | - Nathalie Weiss
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
| | - Patricia Kaiser
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
| | - Marcel Kremser
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
| | - Folker Wenzel
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
- Faculty of Medical and Life Sciences, Furtwangen University, Villingen-Schwenningen, Germany
| | - Mario Thevis
- Institute of Biochemistry/Center for Preventive Doping Research, German Sport University Cologne, Cologne, Germany
| | - Ingo Schellenberg
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
- Institute of Bioanalytical Sciences (IBAS), Center of Life Sciences, Anhalt University of Applied Sciences, Bernburg, Germany
| | - Peter B. Luppa
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
- Institute of Clinical Chemistry and Pathobiochemistry, University Hospital Rechts der Isar, Technische Universität München, Munich, Germany
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Casals G, Costa RF, Rull EU, Escobar-Morreale HF, Argente J, Sesmilo G, Biagetti B. Recommendations for the measurement of sexual steroids in clinical practice. A position statement of SEQC ML/SEEN/SEEP. ADVANCES IN LABORATORY MEDICINE 2023; 4:52-69. [PMID: 37359897 PMCID: PMC10197192 DOI: 10.1515/almed-2023-0020] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/19/2023] [Indexed: 06/28/2023]
Abstract
The proper clinical approach to a wide range of disorders relies on the availability of accurate, reproducible laboratory results for sexual steroids measured using methods with a high specificity and sensitivity. The chemiluminescent immunoassays currently available have analytical limitations with significant clinical implications. This position statement reviews the current limitations of laboratory techniques for the measurement of estradiol and testosterone and their impact on diverse clinical scenarios. A set of recommendations are provided to incorporate steroid hormone analysis by mass spectrometry in national health systems. International societies have recommended this methodology for a decade.
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Affiliation(s)
- Gregori Casals
- Servicio de Bioquímica y Genética Molecular, Hospital Clínic, IDIBAPS, CIBEREHD Universidad de Barcelona, Barcelona, Spain
| | - Roser Ferrer Costa
- Servicio de Bioquímica, Laboratoris Clínics, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eulàlia Urgell Rull
- Servicio de Bioquímica, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Héctor F. Escobar-Morreale
- Servicio de Endocrinología y Nutrición, Hospital Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS y CIBER Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM, Madrid, Spain
| | - Jesús Argente
- Departamento de Pediatría y Endocrinología Pediátrica, Hospital Infantil Universitario Niño Jesús, Universidad Autonoma de Madrid, CIBEROBN, Instituto de Salud Carlos III, Madrid, Spain
| | - Gemma Sesmilo
- Servicio de Endocrinología y Nutrición, Hospital Universitari Dexeus, Barcelona, Spain
| | - Betina Biagetti
- Servicio de Endocrinología y Nutrición, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Casals G, Ferrer Costa R, Urgell Rull E, Escobar-Morreale HF, Argente J, Sesmilo G, Biagetti B. Executive summary of the position statement of the Spanish Societies SEQC ML/SEEN/SEEP. Recommendations for the measurement of sex steroids in clinical practice. ENDOCRINOL DIAB NUTR 2023; 70 Suppl 1:103-109. [PMID: 36894451 DOI: 10.1016/j.endien.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 03/09/2023]
Abstract
Accurate measurement of sex steroids, particularly testosterone and estradiol, is relevant for the diagnosis and treatment of a wide range of conditions. Unfortunately, current chemiluminescent immunoassays have analytical limitations with important clinical consequences. This document reviews the current state of clinical assays for estradiol and testosterone measurements and their potential impact in different clinical situations. It also includes a series of recommendations and necessary steps to introduce steroid analysis by mass spectrometry into national health systems, a methodology recommended for more than a decade by international societies.
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Affiliation(s)
- Gregori Casals
- Servicio de Bioquímica y Genética Molecular, Hospital Clínic, IDIBAPS, CIBERHD, Universitat de Barcelona, Barcelona, Spain.
| | - Roser Ferrer Costa
- Servicio de Bioquímica, Laboratoris Clínics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eulàlia Urgell Rull
- Servicio de Bioquímica, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Héctor F Escobar-Morreale
- Servicio de Endocrinología y Nutrición, Hospital Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, CIBER Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM, Madrid, Spain
| | - Jesús Argente
- Departamento de Pediatría y Endocrinología Pediátrica, Hospital Infantil Universitario Niño Jesús, Universidad Autónoma de Madrid, CIBEROBN, Instituto de Salud Carlos III, Madrid, Spain
| | - Gemma Sesmilo
- Servicio de Endocrinología y Nutrición, Hospital Universitari Dexeus, Barcelona, Spain
| | - Betina Biagetti
- Servicio de Endocrinología y Nutrición, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Cho SE, Han J, Park JH, Park E, Kim GY, Lee JH, Yi A, Lee SG, Lee EH, Yun YM. Clinical Usefulness of Ultraperformance Liquid Chromatography-Tandem Mass Spectrometry Method for Low Serum Testosterone Measurement. Ann Lab Med 2023; 43:19-28. [PMID: 36045053 PMCID: PMC9467846 DOI: 10.3343/alm.2023.43.1.19] [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: 11/13/2021] [Revised: 05/27/2022] [Accepted: 08/03/2022] [Indexed: 12/27/2022] Open
Abstract
Background Mass spectrometry methods exhibit higher accuracy and lower variability than immunoassays at low testosterone concentrations. We developed and validated an ultraperformance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) assay for quantifying serum total testosterone. Methods We used an ExionLC UPLC (Sciex, Framingham, MA, USA) system and a Sciex Triple Quad 6500+ (Sciex) MS/MS system in electrospray ionization and positive ion modes with multiple reaction monitoring transitions to evaluate precision, accuracy, linearity, lower limit of quantitation (LLOQ), carryover, ion suppression, stability, and reference intervals. For method comparison, we measured serum testosterone concentrations using this method in 40 subjects whose testosterone concentrations ranged from 0.14 to 55.48 nmol/L as determined using the Architect i2000 immunoassay (Abbott Diagnostics, Abbott Park, IL, USA) and in an additional 160 sera with testosterone concentrations <1.67 nmol/L. Results The intra- and inter-run precision CVs were <2.81%, and the accuracy bias values were <3.85%, which were all acceptable. The verified linear interval was 0.03-180.84 nmol/L; the LLOQ was 0.03 nmol/L. No significant carryover and ion suppression were observed. The testosterone in serum was stable at 4°C, at -20°C, and after three freeze-thaw cycles. The reference intervals were successfully verified. The correlation was good at testosterone concentrations of 0.14-55.48 nmol/L; however, the Architect assay showed positive percent bias at concentrations <1.67 nmol/L. Conclusions The UPLC-MS/MS assay shows acceptable performance, with a lower LLOQ than the immunoassay. This method will enable the quantitation of low testosterone concentrations.
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Affiliation(s)
- Sung-Eun Cho
- Department of Laboratory Medicine, GCLabs, Yongin, Korea
| | - Jungsun Han
- Department of Laboratory Medicine, GCLabs, Yongin, Korea
| | - Ju-Hee Park
- Department of Laboratory Medicine, GCLabs, Yongin, Korea
| | - Euna Park
- Department of Laboratory Medicine, GCLabs, Yongin, Korea
| | - Geun Young Kim
- Department of Laboratory Medicine, GCLabs, Yongin, Korea
| | - Jun Hyung Lee
- Department of Laboratory Medicine, GCLabs, Yongin, Korea
| | - Ahram Yi
- Department of Laboratory Medicine, GCLabs, Yongin, Korea
| | - Sang Gon Lee
- Department of Laboratory Medicine, GCLabs, Yongin, Korea
| | - Eun Hee Lee
- Department of Laboratory Medicine, GCLabs, Yongin, Korea
| | - Yeo-Min Yun
- Department of Laboratory Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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Casals G, Ferrer Costa R, Urgell Rull E, Escobar-Morreale HF, Argente J, Sesmilo G, Biagetti B. Resumen ejecutivo del documento de posicionamiento SEQCML/SEEN/SEEP. Recomendaciones para la medición de esteroides sexuales en la práctica clínica. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Karashima S, Osaka I. Rapidity and Precision of Steroid Hormone Measurement. J Clin Med 2022; 11:jcm11040956. [PMID: 35207229 PMCID: PMC8879901 DOI: 10.3390/jcm11040956] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 11/16/2022] Open
Abstract
Steroids are present in all animals and plants, from mammals to prokaryotes. In the medical field, steroids are commonly classified as glucocorticoids, mineralocorticoids, and gonadal steroid hormones. Monitoring of hormones is useful in clinical and research fields for the assessment of physiological changes associated with aging, disease risk, and the diagnostic and therapeutic effects of various diseases. Since the discovery and isolation of steroid hormones, measurement methods for steroid hormones in biological samples have advanced substantially. Although immunoassays (IAs) are widely used in daily practice, mass spectrometry (MS)-based methods have been reported to be more specific. Steroid hormone measurement based on MS is desirable in clinical practice; however, there are several drawbacks, including the purchase and maintenance costs of the MS instrument and the need for specialized training of technicians. In this review, we discuss IA- and MS-based methods currently in use and briefly present the history of steroid hormone measurement. In addition, we describe recent advances in IA- and MS-based methods and future applications and considerations.
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Affiliation(s)
- Shigehiro Karashima
- Institute of Liberal Arts and Science, Kanazawa University, Kanazawa 921-1192, Japan
- Correspondence: (S.K.); (I.O.)
| | - Issey Osaka
- Department of Pharmaceutical Engineering, Faculty of Engineering, Toyama Prefectural University, Imizu 939-0398, Japan
- Correspondence: (S.K.); (I.O.)
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7
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Bohn MK, Horn P, League D, Steele P, Hall A, Adeli K. Pediatric reference intervals for endocrine markers and fertility hormones in healthy children and adolescents on the Siemens Healthineers Atellica immunoassay system. Clin Chem Lab Med 2021; 59:1421-1430. [PMID: 33957708 DOI: 10.1515/cclm-2021-0050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/25/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Rapid development in childhood and adolescence combined with lack of immunoassay standardization necessitates the establishment of age-, sex-, and assay-specific reference intervals for immunochemical markers. This study established reference intervals for 11 immunoassays on the new Siemens Healthineers Atellica® IM Analyzer in the healthy CALIPER cohort. METHODS A total of 600 healthy participants (birth to 18 years) were recruited from the community, and serum samples were collected with informed consent. After sample analysis, age- and sex-specific differences were assessed, and outliers were removed. Reference intervals were established using the robust method (40-<120 participants) or nonparametric method (≥120 participants). RESULTS Of the 11 immunoassays studied, nine required age partitioning (i.e., dehydroepiandrosterone-sulfate, estradiol, ferritin, folate, follicle-stimulating hormone, luteinizing hormone, progesterone, testosterone, vitamin B12), and seven required sex partitioning. Free thyroxine and thyroid-stimulating hormone demonstrated no significant age- and/or sex-specific differences. CONCLUSIONS Overall, the age- and sex-specific trends observed closely mirrored those previously reported by CALIPER on other platforms as well as other internationally recognized studies. However, established lower and upper limits demonstrated some discrepancies between published values from healthy cohorts on alternate analytical systems, highlighting differences between manufacturers and the need for platform-specific reference intervals for informed pediatric clinical decision-making.
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Affiliation(s)
- Mary Kathryn Bohn
- CALIPER Program, Department of Pediatric Laboratory Medicine, Hospital for Sick Children, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Paul Horn
- Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Donna League
- Siemens Healthcare Diagnostics Inc., Tarrytown, NY, USA
| | - Paul Steele
- Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Alexandra Hall
- CALIPER Program, Department of Pediatric Laboratory Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Khosrow Adeli
- CALIPER Program, Department of Pediatric Laboratory Medicine, Hospital for Sick Children, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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8
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Hillebrand JJ, Wickenhagen WV, Heijboer AC. Improving Science by Overcoming Laboratory Pitfalls With Hormone Measurements. J Clin Endocrinol Metab 2021; 106:e1504-e1512. [PMID: 33382880 PMCID: PMC7993596 DOI: 10.1210/clinem/dgaa923] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Indexed: 12/12/2022]
Abstract
Despite all the effort taken, there is often surprisingly little attention paid to the hormone analyses involved in research studies. Thinking carefully about the quality of the hormone measurements in these studies is, however, of major importance, as this attention to methods may prevent false conclusions and inappropriate follow-up studies. We discuss issues regarding hormone measurements that one should consider, ideally prior to starting, or otherwise, as they arise during a scientific study: quality of the technique, expertise, matrices, timing and storage conditions, freeze-thaw cycles, lot-to-lot and day-to-day variation, analyses per batch or sample-wise, singlicate or duplicate measurements, combining methods, and standardization. This article and the examples mentioned herein aim to clarify the need to pay attention to the hormone analyses, and to help in making decisions. In addition, these examples help editors and reviewers of scientific journals to pay attention to the methods section in the submitted manuscripts and ask the right critical questions when needed.
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Affiliation(s)
- Jacquelien J Hillebrand
- Amsterdam UMC, Vrije Universiteit Amsterdam and University of Amsterdam, Endocrine Laboratory, Department of Clinical Chemistry, Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands
| | - Wjera V Wickenhagen
- Amsterdam UMC, Vrije Universiteit Amsterdam and University of Amsterdam, Endocrine Laboratory, Department of Clinical Chemistry, Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands
| | - Annemieke C Heijboer
- Amsterdam UMC, Vrije Universiteit Amsterdam and University of Amsterdam, Endocrine Laboratory, Department of Clinical Chemistry, Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands
- Correspondence: Annemieke C. Heijboer, Amsterdam UMC, Endocrine Laboratory (K2-283), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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9
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Faqehi AM, Denham SG, Naredo G, Cobice DF, Khan S, Simpson JP, Sabil G, Upreti R, Gibb F, Homer NZ, Andrew R. Derivatization with 2-hydrazino-1-methylpyridine enhances sensitivity of analysis of 5α-dihydrotestosterone in human plasma by liquid chromatography tandem mass spectrometry. J Chromatogr A 2021; 1640:461933. [PMID: 33588275 PMCID: PMC7938423 DOI: 10.1016/j.chroma.2021.461933] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/19/2022]
Abstract
Quantitative analysis of low abundance androgens in human plasma. Quantitation of androgens over physiological range in men and post-menopausal women. Use of hydrazine derivatives improves analytical sensitivity.
Liquid Chromatography tandem mass spectrometry (LC-MS/MS) is the gold-standard approach for androgen analysis in biological fluids, superseding immunoassays in selectivity, particularly at low concentrations. While LC-MS/MS is established for analysis of testosterone and androstenedione, 5α-dihydrotestosterone (DHT) presents greater analytical challenges. DHT circulates at low nanomolar concentrations in men and lower in women, ionizing inefficiently and suffering from isobaric interference from other androgens. Even using current LC-MS/MS technology, large plasma volumes (>0.5 mL) are required for detection, undesirable clinically and unsuitable for animals. This study investigated derivatization approaches using hydrazine-based reagents to enhance ionization efficiency and sensitivity of analysis of DHT by LC-MS/MS. Derivatization of DHT using 2-hydrazino-1-methylpyridine (HMP) and 2-hydrazino-4-(trifluoromethyl)-pyrimidine (HTP) were compared. A method was validated using an UHPLC interfaced by electrospray with a triple quadruple mass spectrometer , analyzing human plasma (male and post-menopausal women) following solid-phase extraction. HMP derivatives were selected for validation affording greater sensitivity than those formed with HTP. HMP derivatives were detected by selected reaction monitoring (DHT-HMP m/z 396→108; testosterone-HMP m/z 394→108; androstenedione-HMP m/z 392→108). Chromatographic separation of androgen derivatives was optimized, carefully separating isobaric interferents and acceptable outputs for precision and trueness achieved following injection of 0.4 pg on column (approximately 34 pmol/L). HMP derivatives of all androgens tested could be detected in low plasma volumes: male (100 µL) and post-menopausal female (200 µL), and derivatives were stable over 30 days at -20°C. In conclusion, HMP derivatization, in conjunction with LC-MS/MS, is suitable for quantitative analysis of DHT, testosterone and androstenedione in low plasma volumes, offering advantages in sensitivity over current methodologies.
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Affiliation(s)
- Abdullah Mm Faqehi
- University/British Heart Foundation Centre for Cardiovascular Science, United Kingdom.
| | - Scott G Denham
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom.
| | - Gregorio Naredo
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom
| | - Diego F Cobice
- University/British Heart Foundation Centre for Cardiovascular Science, United Kingdom.
| | - Shazia Khan
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom.
| | - Joanna P Simpson
- University/British Heart Foundation Centre for Cardiovascular Science, United Kingdom.
| | - Ghazali Sabil
- University/British Heart Foundation Centre for Cardiovascular Science, United Kingdom
| | - Rita Upreti
- University/British Heart Foundation Centre for Cardiovascular Science, United Kingdom
| | - Fraser Gibb
- University/British Heart Foundation Centre for Cardiovascular Science, United Kingdom.
| | - Natalie Zm Homer
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom.
| | - Ruth Andrew
- University/British Heart Foundation Centre for Cardiovascular Science, United Kingdom; Mass Spectrometry Core, Edinburgh Clinical Research Facility, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom.
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10
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After another decade: LC-MS/MS became routine in clinical diagnostics. Clin Biochem 2020; 82:2-11. [PMID: 32188572 DOI: 10.1016/j.clinbiochem.2020.03.004] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/09/2020] [Accepted: 03/12/2020] [Indexed: 01/01/2023]
Abstract
Tandem mass spectrometry - especially in combination with liquid chromatography (LC-MS/MS) - is applied in a multitude of important diagnostic niches of laboratory medicine. It is unquestioned in its routine use and is often unreplaceable by alternative technologies. This overview illustrates the development in the past decade (2009-2019) and intends to provide insight into the current standing and future directions of the field. The instrumentation matured significantly, the applications are well understood, and the in vitro diagnostics (IVD) industry is shaping the market by providing assay kits, certified instruments, and the first laboratory automated LC-MS/MS instruments as an analytical core. In many settings the application of LC-MS/MS is still burdensome with locally lab developed test (LDT) designs relying on highly specialized staff. The current routine applications cover a wide range of analytes in therapeutic drug monitoring, endocrinology including newborn screening, and toxicology. The tasks that remain to be mastered are, for example, the quantification of proteins by means of LC-MS/MS and the transition from targeted to untargeted omics approaches relying on pattern recognition/pattern discrimination as a key technology for the establishment of diagnostic decisions.
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Anh NH, Long NP, Kim SJ, Min JE, Yoon SJ, Kim HM, Yang E, Hwang ES, Park JH, Hong SS, Kwon SW. Steroidomics for the Prevention, Assessment, and Management of Cancers: A Systematic Review and Functional Analysis. Metabolites 2019; 9:E199. [PMID: 31546652 PMCID: PMC6835899 DOI: 10.3390/metabo9100199] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/09/2019] [Accepted: 09/17/2019] [Indexed: 02/07/2023] Open
Abstract
Steroidomics, an analytical technique for steroid biomarker mining, has received much attention in recent years. This systematic review and functional analysis, following the PRISMA statement, aims to provide a comprehensive review and an appraisal of the developments and fundamental issues in steroid high-throughput analysis, with a focus on cancer research. We also discuss potential pitfalls and proposed recommendations for steroidomics-based clinical research. Forty-five studies met our inclusion criteria, with a focus on 12 types of cancer. Most studies focused on cancer risk prediction, followed by diagnosis, prognosis, and therapy monitoring. Prostate cancer was the most frequently studied cancer. Estradiol, dehydroepiandrosterone, and cortisol were mostly reported and altered in at least four types of cancer. Estrogen and estrogen metabolites were highly reported to associate with women-related cancers. Pathway enrichment analysis revealed that steroidogenesis; androgen and estrogen metabolism; and androstenedione metabolism were significantly altered in cancers. Our findings indicated that estradiol, dehydroepiandrosterone, cortisol, and estrogen metabolites, among others, could be considered oncosteroids. Despite noble achievements, significant shortcomings among the investigated studies were small sample sizes, cross-sectional designs, potential confounding factors, and problematic statistical approaches. More efforts are required to establish standardized procedures regarding study design, analytical procedures, and statistical inference.
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Affiliation(s)
- Nguyen Hoang Anh
- College of Pharmacy, Seoul National University, Seoul 08826, Korea.
| | | | - Sun Jo Kim
- College of Pharmacy, Seoul National University, Seoul 08826, Korea.
| | - Jung Eun Min
- College of Pharmacy, Seoul National University, Seoul 08826, Korea.
| | - Sang Jun Yoon
- College of Pharmacy, Seoul National University, Seoul 08826, Korea.
| | - Hyung Min Kim
- College of Pharmacy, Seoul National University, Seoul 08826, Korea.
| | - Eugine Yang
- College of Pharmacy, Ewha Womans University, Seoul 03760, Korea.
| | - Eun Sook Hwang
- College of Pharmacy, Ewha Womans University, Seoul 03760, Korea.
| | - Jeong Hill Park
- College of Pharmacy, Seoul National University, Seoul 08826, Korea.
| | - Soon-Sun Hong
- Department of Biomedical Sciences, College of Medicine, Inha University, Incheon 22212, Korea.
| | - Sung Won Kwon
- College of Pharmacy, Seoul National University, Seoul 08826, Korea.
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12
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Zhou Y, Wang S. A robust LC-MS/MS assay with online cleanup for measurement of serum testosterone. J Sep Sci 2019; 42:2561-2568. [PMID: 31106475 DOI: 10.1002/jssc.201801189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 04/19/2019] [Accepted: 05/16/2019] [Indexed: 11/12/2022]
Abstract
Accurate measurement of low levels of testosterone is critical for diagnosis and treatment of androgen disorders. The very low concentrations of testosterone in children, females, and males with androgen suppression therapies necessitate the use of mass spectrometry-based methods. We aimed to develop a liquid chromatography with tandem mass spectrometry method with simplified sample preparation and online solid-phase extraction cleanup to achieve enhanced precision, accuracy, robustness, and cost-effectiveness. The assay was linear from 10 to 20 000 pg/mL with an analytical recovery of 93-104%. The total coefficient of variation was 2.5, 1.9, and 1.7% at concentration levels of 348, 5432, and 10 848 pg/mL, respectively. No significant carryover was observed from samples with concentrations up to 20 000 pg/mL. No significant interference was observed from androstenedione, dehydroepiandrosterone, epi-testosterone, and estriol. Comparison with CDC Hormone Standardization program (HoSt) reference samples with defined values (n = 40) showed a Deming regression slope of 0.963, intercept of 28.06 pg/mL, standard error of estimate was 66.9, a correlation coefficient of 0.9996, and a mean bias of -0.6%. The method met the accuracy criteria by the CDC HoSt program. In addition, we achieved >12 000 injections on a single analytical column without significant performance deterioration due to the specific online solid-phase extraction settings.
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Affiliation(s)
- Yu Zhou
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Sihe Wang
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA.,Pathology and Laboratory Medicine, Akron Children's Hospital, Akron, OH, USA
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Dowis J, Woroniecki W, French D. Development and validation of a LC-MS/MS assay for quantification of serum estradiol using calibrators with values assigned by the CDC reference measurement procedure. Clin Chim Acta 2019; 492:45-49. [DOI: 10.1016/j.cca.2019.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 01/31/2019] [Accepted: 02/02/2019] [Indexed: 12/11/2022]
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14
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Ceponis J, Swerdloff R, Leung A, Hull L, Bai F, Longstreth J, Dudley R, Danoff T, Wang C. Accurate measurement of androgen after androgen esters: problems created by ex vivo esterase effects and LC-MS/MS interference. Andrology 2019; 7:42-52. [PMID: 30345711 PMCID: PMC6519384 DOI: 10.1111/andr.12554] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/16/2018] [Accepted: 09/10/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Ex vivo androgen prodrug conversion by blood esterases after oral androgen ester administration may result in an overestimation of the measured blood androgens. OBJECTIVE We investigated whether blood collection tubes with esterase inhibitors decreased the conversion of testosterone undecanoate (TU) and dimethandrolone undecanoate (DMAU) to their active metabolites, testosterone (T), and dimethandrolone (DMA), providing a more accurate assessment of circulating T/DMA levels. METHODS Blood was collected in tubes with/without esterase inhibitors from: (i) four healthy and four hypogonadal men receiving no androgens and spiked ex vivo with TU/DMAU; (ii) four men taking oral TU (Andriol® ); and (iii) eight hypogonadal men dosed with oral 316 mg TU and 15 healthy men with 200 mg DMAU. T/DMA levels were measured by LC-MS/MS. RESULTS Sodium fluoride (NaF, an esterase inhibitor) decreased measured T levels by 14.2% in men not receiving TU. Increasing amounts of TU/DMAU added to blood collected into plain tubes resulted in a concentration-dependent overestimation of T/DMA that was reduced by collecting blood into NaF tubes (by 30-85%), and keeping samples at 4 °C and minimizing time prior to centrifugation. After oral TU/DMAU administration to men, when TU/DMAU levels were >15/10 ng/mL, respectively, blood collected in NaF tubes yielded lower measured T concentrations by 15-30% and DMA by 22% due to an additional inhibitory effect of NaF on blood esterases. CONCLUSION NaF directly lowers plasma T/DMA levels measured by LC-MS/MS and also inhibits blood esterase activity. Overestimation of T/DMA in blood collected in tubes without NaF after oral TU/DMAU administration is important for pharmacokinetics studies in drug development clinical trials but may have limited impact in clinical practice/utilization because the differences between measured and true androgen values are modest and the wide therapeutic androgen efficacy ranges obviate the need for highly accurate androgen measurements during therapy.
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Affiliation(s)
- J. Ceponis
- Division of EndocrinologyDepartment of MedicineLos Angeles Biomedical Research Institute and Harbor UCLA Medical CenterTorranceCAUSA
- Institute of EndocrinologyLithuanian University of Health SciencesKaunasLithuania
| | - R. Swerdloff
- Division of EndocrinologyDepartment of MedicineLos Angeles Biomedical Research Institute and Harbor UCLA Medical CenterTorranceCAUSA
| | - A. Leung
- Division of EndocrinologyDepartment of MedicineLos Angeles Biomedical Research Institute and Harbor UCLA Medical CenterTorranceCAUSA
| | - L. Hull
- Division of EndocrinologyDepartment of MedicineLos Angeles Biomedical Research Institute and Harbor UCLA Medical CenterTorranceCAUSA
| | - F. Bai
- Division of EndocrinologyDepartment of MedicineLos Angeles Biomedical Research Institute and Harbor UCLA Medical CenterTorranceCAUSA
| | | | - R. Dudley
- Clarus Therapeutics, Inc.NorthbrookILUSA
| | - T. Danoff
- Clarus Therapeutics, Inc.NorthbrookILUSA
| | - C. Wang
- Division of EndocrinologyDepartment of MedicineLos Angeles Biomedical Research Institute and Harbor UCLA Medical CenterTorranceCAUSA
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Vijayakumar N, Op de Macks Z, Shirtcliff EA, Pfeifer JH. Puberty and the human brain: Insights into adolescent development. Neurosci Biobehav Rev 2018; 92:417-436. [PMID: 29972766 PMCID: PMC6234123 DOI: 10.1016/j.neubiorev.2018.06.004] [Citation(s) in RCA: 190] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 06/03/2018] [Accepted: 06/06/2018] [Indexed: 12/24/2022]
Abstract
Alongside the exponential flourish of research on age-related trajectories of human brain development during childhood and adolescence in the past two decades, there has been an increase in the body of work examining the association between pubertal development and brain maturation. This review systematically examines empirical research on puberty-related structural and functional brain development in humans, with the aim of identifying convergent patterns of associations. We emphasize longitudinal studies, and discuss pervasive but oft-overlooked methodological issues that may be contributing to inconsistent findings and hindering progress (e.g., conflating distinct pubertal indices and different measurement instruments). We also briefly evaluate support for prominent models of adolescent neurodevelopment that hypothesize puberty-related changes in brain regions involved in affective and motivational processes. For the field to progress, replication studies are needed to help resolve current inconsistencies and gain a clearer understanding of pubertal associations with brain development in humans, knowledge that is crucial to make sense of the changes in psychosocial functioning, risk behavior, and mental health during adolescence.
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Drotleff B, Hallschmid M, Lämmerhofer M. Quantification of steroid hormones in plasma using a surrogate calibrant approach and UHPLC-ESI-QTOF-MS/MS with SWATH-acquisition combined with untargeted profiling. Anal Chim Acta 2018; 1022:70-80. [DOI: 10.1016/j.aca.2018.03.040] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/16/2018] [Accepted: 03/20/2018] [Indexed: 11/16/2022]
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17
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Abstract
OBJECTIVE The decrease in testosterone levels that occurs with aging has become an important clinical issue both due to the growth of the geriatric population and patient interest in testosterone therapy. The decision to assess for testosterone deficiency and the ability to determine whether the benefits exceed the risks require a comprehensive evaluation of the aging patient. This article is part of a series of papers focused on the endocrinology of aging. This review addresses common issues needed for clinical decision making, including how to interpret test results, differential diagnosis, potential impact of testosterone treatment on insulin resistance and cardiovascular disease, and options for therapy. METHODS Papers reviewed were identified through literature searches conducted on PubMed. RESULTS Assessment of testosterone levels in the geriatric male requires an understanding of the limitations of the assay that is used, the symptoms associated with low testosterone, the impact of comorbid conditions on levels, and risks of therapy. Successful treatment requires setting realistic expectations of the benefits of replacement therapy. CONCLUSION While the prevalence of low testosterone concentrations is increased with aging, the common comorbidities such as obesity and diabetes may contribute to changes in testosterone levels. Clinical trial evidence shows modest benefit for treatment of low testosterone in the presence of symptoms. Assessment of the geriatric male should include evaluation of their testosterone level in the context of their functional status and comorbidities. ABBREVIATIONS CDC = Centers for Disease Control and Prevention; CI = confidence interval; CVD = cardiovascular disease; DXA = dual-energy X-ray absorptiometry; EMAS = European Male Aging Study; FDA = U.S. Food and Drug Administration; FHS = Framingham Heart Study; HDL = high-density lipoprotein; HOMA-IR = homeostasis model assessment of insulin resistance; LH = luteinizing hormone; OR = odds ratio; PSA = prostate-specific antigen; SHBG = sex hormone-binding globulin; T2DM = type 2 diabetes mellitus; vBMD = volumetric bone mineral density.
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Klotz L, Shayegan B, Guillemette C, Collins LL, Gotto G, Guérette D, Jammal MP, Pickles T, Richard PO, Saad F. Testosterone suppression in the treatment of recurrent or metastatic prostate cancer - A Canadian consensus statement. Can Urol Assoc J 2018; 12:30-37. [PMID: 29680011 PMCID: PMC5937399 DOI: 10.5489/cuaj.5116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Testosterone suppression, achieved through orchiectomy or medically induced androgen-deprivation therapy (ADT), is a standard treatment for men with recurrent and metastatic prostate cancer. Current assay methods demonstrate the capacity for testosterone suppression to <0.7 nmol/l, and clinical data support improved outcomes from ADT when lower levels are achieved. Practical clinical guidelines are warranted to facilitate adoption of 0.7 nmol/l as the new standard castrate testosterone level.A pan-Canadian group of experts, representing diverse clinical specialties, identified key clinical issues, searched and reviewed relevant literature, and developed consensus statements on testosterone suppression for the treatment of prostate cancer. The expert panel found that current evidence supports the clinical benefit of achieving low testosterone levels during ADT, and encourage adoption of ≤0.7 nmol/l as a new castrate level threshold. The panel recommends regular monitoring of testosterone (e.g., every 3-6 months) and prostate-specific antigen (PSA) levels as clinically appropriate (e.g., every 3-6 months) during ADT, with reassessment of therapeutic strategy if testosterone is not suppressed or if PSA rises regardless of adequate testosterone suppression. The panel also emphasizes the need for greater awareness and education regarding testosterone assay specifications, and strongly promotes the use of mass spectrometry-based assays to ensure accurate measurement of testosterone at castrate levels.
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Affiliation(s)
- Laurence Klotz
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON; Canada
| | | | - Chantal Guillemette
- Université Laval and CHU de Québec-Université Laval, Quebec City, QC; Canada
| | | | | | - Dominique Guérette
- Université Laval and CHU de Québec-Université Laval, Quebec City, QC; Canada
| | | | | | - Patrick O. Richard
- Centre Hospitalier Universitaire de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, QC; Canada
| | - Fred Saad
- Centre Hospitalier de l’Université de Montréal, Montreal, QC; Canada
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Fanson KV, Németh Z, Ramenofsky M, Wingfield JC, Buchanan KL. Inter‐laboratory variation in corticosterone measurement: Implications for comparative ecological and evolutionary studies. Methods Ecol Evol 2017. [DOI: 10.1111/2041-210x.12821] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kerry V. Fanson
- Centre for Integrative Ecology School of Life and Environmental Sciences Deakin University Geelong Australia
| | - Zoltán Németh
- Department of Neurobiology, Physiology and Behavior University of California Davis Davis CA USA
- Department of Evolutionary Zoology MTA‐DE “Lendület” Behavioural Ecology Research Group University of Debrecen Debrecen Hungary
| | - Marilyn Ramenofsky
- Centre for Integrative Ecology School of Life and Environmental Sciences Deakin University Geelong Australia
- Department of Neurobiology, Physiology and Behavior University of California Davis Davis CA USA
| | - John C. Wingfield
- Centre for Integrative Ecology School of Life and Environmental Sciences Deakin University Geelong Australia
- Department of Neurobiology, Physiology and Behavior University of California Davis Davis CA USA
| | - Katherine L. Buchanan
- Centre for Integrative Ecology School of Life and Environmental Sciences Deakin University Geelong Australia
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Abstract
The diagnosis of male hypogonadism depends on an assessment of the clinical signs and symptoms of hypogonadism and serum testosterone level. Current clinical laboratory testosterone assay platforms include immunoassays and mass spectrometry. Despite significant advances to improve the accuracy and precision of the currently available assays, limited comparability exists between assays at the lower and upper extremes of the testosterone range. Because of this lack of comparability, there is no current gold standard assay for the assessment of total testosterone levels.
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Affiliation(s)
- Amin S Herati
- Scott Department of Urology, Center for Reproductive Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Cenk Cengiz
- Scott Department of Urology, Center for Reproductive Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Dolores J Lamb
- Scott Department of Urology, Center for Reproductive Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA.
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21
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Veldhuis JD, Dyer RB, Trushin SA, Bondar OP, Singh RJ, Klee GG. Interleukins 6 and 8 and abdominal fat depots are distinct correlates of lipid moieties in healthy pre- and postmenopausal women. Endocrine 2016; 54:671-680. [PMID: 27444747 PMCID: PMC5107333 DOI: 10.1007/s12020-016-1041-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 06/27/2016] [Indexed: 01/24/2023]
Abstract
UNLABELLED Available data associate lipids concentrations in men with body mass index, anabolic steroids, age, and certain cytokines. Data were less clear in women, especially across the full adult lifespan, and when segmented by premenopausal and postmenopausal status. SUBJECTS 120 healthy women (60 premenopausal and 60 postmenopausal) in Olmsted County, MN, USA, a stable well studied clinical population. Dependent variables: measurements of 10 h fasting high-density lipoprotein cholesterol, total cholesterol, low-density lipoprotein cholesterol, and triglycerides. INDEPENDENT VARIABLES testosterone, estrone, estradiol, 5-alpha-dihydrotestosterone, and sex-hormone binding globulin (by mass spectrometry); insulin, glucose, and albumin; abdominal visceral, subcutaneous, and total abdominal fat [abdominal visceral fat, subcutaneous fat, total abdominal fat by computerized tomography scan]; and a panel of cytokines (by enzyme-linked immunosorbent assay). Multivariate forward-selection linear-regression analysis was applied constrained to P < 0.01. Lifetime data: High-density lipoprotein cholesterol was correlated jointly with age (P < 0.0001, positively), abdominal visceral fat (P < 0.0001, negatively), and interleukin-6 (0.0063, negatively), together explaining 28.1 % of its variance (P = 2.3 × 10-8). Total cholesterol was associated positively with multivariate age only (P = 6.9 × 10-4, 9.3 % of variance). Triglycerides correlated weakly with sex-hormone binding globulin (P = 0.0115), and strongly with abdominal visceral fat (P < 0.0001), and interleukin-6 (P = 0.0016) all positively (P = 1.6 × 10-12, 38.9 % of variance). Non high-density lipoprotein cholesterol and low-density lipoprotein cholesterol correlated positively with both total abdominal fat and interleukin-8 (P = 2.0 × 10-5, 16.9 % of variance; and P = 0.0031, 9.4 % of variance, respectively). Premenopausal vs. postmenopausal comparisons identified specific relationships that were stronger in premenopausal than postmenopausal individuals, and vice versa. Age was a stronger correlate of low-density lipoprotein cholesterol; interleukin-6 of triglycerides and high-density lipoprotein; and both sex-hormone binding globulin and total abdominal fat of non high-density lipoprotein cholesterol in premenopausal than postmenopausal women. Conversely, sex-hormone binding globulin, abdominal visceral fat, interleukin-8, adiponectin were stronger correlates of triglycerides; abdominal visceral fat, and testosterone of high-density lipoprotein cholesterol; and age of both non high-density lipoprotein and low-density lipoprotein in postmenopausal than premenopausal women. Our data delineate correlations of total abdominal fat and interleukin-8 (both positively) with non high-density lipoprotein cholesterol and low-density lipoprotein cholesterol in healthy women across the full age range of 21-79 years along with even more specific associations in premenopausal and postmenopausal individuals. Whether some of these outcomes reflect causal relationships would require longitudinal and interventional or genetic studies.
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Affiliation(s)
- Johannes D Veldhuis
- Endocrine Research Unit, Mayo School of Graduate Medical Education, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Roy B Dyer
- Immunochemical Laboratory, 200 First Street SW, Rochester, MN, 55905, USA
| | - Sergey A Trushin
- Immunochemical Laboratory, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Neurology, 200 First Street SW, Rochester, MN, 55905, USA
| | - Olga P Bondar
- Immunochemical Laboratory, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ravinder J Singh
- Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - George G Klee
- Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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22
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Seftel A. How Best to Measure and Test for Androgen Deficiency. J Urol 2016; 195:1329-1330. [DOI: 10.1016/j.juro.2016.02.077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2016] [Indexed: 11/15/2022]
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23
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Assuring the Proper Analytical Performance of Measurement Procedures for Immunosuppressive Drug Concentrations in Clinical Practice. Ther Drug Monit 2016; 38:170-89. [DOI: 10.1097/ftd.0000000000000269] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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24
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Kalogera E, Pistos C, Provatopoulou X, Christophi CA, Zografos GC, Stefanidou M, Spiliopoulou C, Athanaselis S, Gounaris A. Bioanalytical LC-MS Method for the Quantification of Plasma Androgens and Androgen Glucuronides in Breast Cancer. J Chromatogr Sci 2016; 54:583-92. [PMID: 26762957 DOI: 10.1093/chromsci/bmv190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Indexed: 12/22/2022]
Abstract
The physiological and pathological development of the breast is strongly affected by the hormonal milieu consisting of steroid hormones. Mass spectrometry (MS) technologies of high sensitivity and specificity enable the quantification of androgens and consequently the characterization of the hormonal status. The aim of this study is the assessment of plasma androgens and androgen glucuronides, in the par excellence hormone-sensitive tissue of the breast, through the application of liquid chromatography-mass spectrometry (LC-MS). A simple and efficient fit-for-purpose method for the simultaneous identification and quantification of dehydroepiandrosterone sulfate (DHEAS), androstenedione (A4), androsterone glucuronide (ADTG) and androstane-3α, 17β-diol-17-glucuronide (3α-diol-17G) in human plasma was developed and validated. The presented method permits omission of derivatization, requires a single solid-phase extraction procedure and the chromatographic separation can be achieved on a single C18 analytical column, for all four analytes. The validated method was successfully applied for the analysis of 191 human plasma samples from postmenopausal women with benign breast disease (BBD), lobular neoplasia (LN), ductal carcinoma in situ and invasive ductal carcinoma (IDC). DHEAS plasma levels exhibited significant differences between LN, IDC and BBD patients (P < 0.05). Additionally, ADTG levels were significantly higher in patients with LN compared with those with BBD (P < 0.05).
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Affiliation(s)
- Eleni Kalogera
- Research Center, Hellenic Anticancer Institute, 11 Valtetsiou st, Athens, 10680, Greece
| | - Constantinos Pistos
- Department of Forensic Medicine and Toxicology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Xeni Provatopoulou
- Research Center, Hellenic Anticancer Institute, 11 Valtetsiou st, Athens, 10680, Greece
| | - Costas A Christophi
- Cyprus International Institute for Environmental and Public Health in association with Harvard School of Public Health, Cyprus University of Technology, Limassol, Cyprus Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - George C Zografos
- Breast Unit, 1st Department of Propaedeutic Surgery, Hippokratio Hospital, University of Athens, Athens, Greece
| | - Maria Stefanidou
- Department of Forensic Medicine and Toxicology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Chara Spiliopoulou
- Department of Forensic Medicine and Toxicology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Athanaselis
- Department of Forensic Medicine and Toxicology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonia Gounaris
- Research Center, Hellenic Anticancer Institute, 11 Valtetsiou st, Athens, 10680, Greece
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25
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Le M, Flores D, May D, Gourley E, Nangia AK. Current Practices of Measuring and Reference Range Reporting of Free and Total Testosterone in the United States. J Urol 2015; 195:1556-1561. [PMID: 26707506 DOI: 10.1016/j.juro.2015.12.070] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE The evaluation and management of male hypogonadism should be based on symptoms and on serum testosterone levels. Diagnostically this relies on accurate testing and reference values. Our objective was to define the distribution of reference values and assays for free and total testosterone by clinical laboratories in the United States. MATERIALS AND METHODS Upper and lower reference values, assay methodology and source of published reference ranges were obtained from laboratories across the country. A standardized survey was reviewed with laboratory staff via telephone. Descriptive statistics were used to tabulate results. RESULTS We surveyed a total of 120 laboratories in 47 states. Total testosterone was measured in house at 73% of laboratories. At the remaining laboratories studies were sent to larger centralized reference facilities. The mean ± SD lower reference value of total testosterone was 231 ± 46 ng/dl (range 160 to 300) and the mean upper limit was 850 ± 141 ng/dl (range 726 to 1,130). Only 9% of laboratories where in-house total testosterone testing was performed created a reference range unique to their region. Others validated the instrument recommended reference values in a small number of internal test samples. For free testosterone 82% of laboratories sent testing to larger centralized reference laboratories where equilibrium dialysis and/or liquid chromatography with mass spectrometry was done. The remaining laboratories used published algorithms to calculate serum free testosterone. CONCLUSIONS Reference ranges for testosterone assays vary significantly among laboratories. The ranges are predominantly defined by limited population studies of men with unknown medical and reproductive histories. These poorly defined and variable reference values, especially the lower limit, affect how clinicians determine treatment.
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Affiliation(s)
- Margaret Le
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas
| | - David Flores
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas
| | - Danica May
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas
| | - Eric Gourley
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas
| | - Ajay K Nangia
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas.
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Jeanneret F, Tonoli D, Rossier MF, Saugy M, Boccard J, Rudaz S. Evaluation of steroidomics by liquid chromatography hyphenated to mass spectrometry as a powerful analytical strategy for measuring human steroid perturbations. J Chromatogr A 2015. [PMID: 26195035 DOI: 10.1016/j.chroma.2015.07.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This review presents the evolution of steroid analytical techniques, including gas chromatography coupled to mass spectrometry (GC-MS), immunoassay (IA) and targeted liquid chromatography coupled to mass spectrometry (LC-MS), and it evaluates the potential of extended steroid profiles by a metabolomics-based approach, namely steroidomics. Steroids regulate essential biological functions including growth and reproduction, and perturbations of the steroid homeostasis can generate serious physiological issues; therefore, specific and sensitive methods have been developed to measure steroid concentrations. GC-MS measuring several steroids simultaneously was considered the first historical standard method for analysis. Steroids were then quantified by immunoassay, allowing a higher throughput; however, major drawbacks included the measurement of a single compound instead of a panel and cross-reactivity reactions. Targeted LC-MS methods with selected reaction monitoring (SRM) were then introduced for quantifying a small steroid subset without the problems of cross-reactivity. The next step was the integration of metabolomic approaches in the context of steroid analyses. As metabolomics tends to identify and quantify all the metabolites (i.e., the metabolome) in a specific system, appropriate strategies were proposed for discovering new biomarkers. Steroidomics, defined as the untargeted analysis of the steroid content in a sample, was implemented in several fields, including doping analysis, clinical studies, in vivo or in vitro toxicology assays, and more. This review discusses the current analytical methods for assessing steroid changes and compares them to steroidomics. Steroids, their pathways, their implications in diseases and the biological matrices in which they are analysed will first be described. Then, the different analytical strategies will be presented with a focus on their ability to obtain relevant information on the steroid pattern. The future technical requirements for improving steroid analysis will also be presented.
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Affiliation(s)
- Fabienne Jeanneret
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, 1211 Geneva 4, Switzerland; Human Protein Sciences Department, University of Geneva, 1211 Geneva 4, Switzerland; Swiss Centre for Applied Human Toxicology, Geneva, Switzerland
| | - David Tonoli
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, 1211 Geneva 4, Switzerland; Human Protein Sciences Department, University of Geneva, 1211 Geneva 4, Switzerland; Swiss Centre for Applied Human Toxicology, Geneva, Switzerland
| | - Michel F Rossier
- Swiss Centre for Applied Human Toxicology, Geneva, Switzerland; Institut Central (ICHV), Hôpital du Valais, Sion, Switzerland
| | - Martial Saugy
- Swiss Laboratory for Doping Analyses, University Center of Legal Medicine, Epalinges, Switzerland
| | - Julien Boccard
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, 1211 Geneva 4, Switzerland
| | - Serge Rudaz
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, 1211 Geneva 4, Switzerland; Swiss Centre for Applied Human Toxicology, Geneva, Switzerland.
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Paduch DA, Brannigan RE, Fuchs EF, Kim ED, Marmar JL, Sandlow JI. The Laboratory Diagnosis of Testosterone Deficiency. Urology 2014; 83:980-8. [DOI: 10.1016/j.urology.2013.12.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 11/07/2013] [Accepted: 12/13/2013] [Indexed: 10/25/2022]
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28
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Feswick A, Ankley GT, Denslow N, Ellestad LE, Fuzzen M, Jensen KM, Kroll K, Lister A, MacLatchy DL, McMaster ME, Orlando EF, Servos MR, Tetreault GR, Van Den Heuvel MR, Munkittrick KR. An inter-laboratory study on the variability in measured concentrations of 17β-estradiol, testosterone, and 11-ketotestosterone in white sucker: implications and recommendations. ENVIRONMENTAL TOXICOLOGY AND CHEMISTRY 2014; 33:847-857. [PMID: 24375479 DOI: 10.1002/etc.2503] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 09/16/2013] [Accepted: 12/03/2013] [Indexed: 06/03/2023]
Abstract
Endocrine-disrupting chemicals are exogenous substances that can impact the reproduction of fish, potentially by altering circulating concentrations of 17β-estradiol (E2), testosterone (T), and 11-ketotestosterone (11-KT). Common methods to measure steroids in plasma samples include radioimmunoassays (RIAs) and enzyme-linked immunosorbant assays (ELISAs). The present study examines variability in E2, T, and 11-KT across 8 laboratories measuring reference and pulp mill effluent-exposed white sucker (Catostomus commersoni) plasma. We examine the contribution of assay type (RIA vs ELISA), standardized hormone extraction, location of values on the standard curve (upper and lower limits), and other variables on the ability to distinguish hormone levels between reference and exposed fish and the impact of these variables on quantitation of hormones in different laboratories. Of the 8 participating laboratories, 7 of 8 and 7 of 7 identified differences between sites for female E2 and female T, respectively, and 7 of 7 and 4 of 5 identified no differences between male T and male 11-KT. Notably, however, the ng/mL concentration of steroids measured across laboratories varied by factors of 10-, 6-, 14-, and 10-fold, respectively. Within laboratory intra-assay variability was generally acceptable and below 15%. Factors contributing to interlaboratory variability included calculation errors, assay type, and methodology. Based on the interlaboratory variability detected, we provide guidelines and recommendations to improve the accuracy and precision of steroid measurements in fish ecotoxicology studies.
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Affiliation(s)
- April Feswick
- Department of Biology, University of New Brunswick, Saint John, New Brunswick, Canada
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Zimmerman Y, Eijkemans MJC, Coelingh Bennink HJT, Blankenstein MA, Fauser BCJM. The effect of combined oral contraception on testosterone levels in healthy women: a systematic review and meta-analysis. Hum Reprod Update 2013; 20:76-105. [PMID: 24082040 PMCID: PMC3845679 DOI: 10.1093/humupd/dmt038] [Citation(s) in RCA: 179] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
UNLABELLED BACKGROUND; Combined oral contraceptives (COCs) reduce levels of androgen, especially testosterone (T), by inhibiting ovarian and adrenal androgen synthesis and by increasing levels of sex hormone-binding globulin (SHBG). Although this suppressive effect has been investigated by numerous studies over many years, to our knowledge no systematic review concerning this issue had been performed. This systematic review and meta-analysis was performed to evaluate the effect of COCs on concentrations of total T, free T and SHBG in healthy women and to evaluate differences between the various types of COCs (e.g. estrogen dose, type of progestin) and the assays used to assess total T and free T. METHODS A review of the literature was performed using database searches (MEDLINE, EMBASE and the Cochrane Central Register of Clinical Trials) and all publications (from inception date until July 2012) investigating the effect of COCs on androgen levels in healthy women were considered eligible for selection. Three reviewers were involved in study selection, data extraction and critical appraisal. For the meta-analysis, data on total T, free T and SHBG were extracted and combined using random effects analysis. Additional subgroup analyses were performed to evaluate differences between the various types of COCs (e.g. estrogen dose, type of progestin) and the assays used to assess total T or free T. RESULTS A total of 151 records were identified by systematic review and 42 studies with a total of 1495 healthy young women (age range: 18-40 years) were included in the meta-analysis. All included studies were experimental studies and 21 were non-comparative. Pooling of the results derived from all the included papers showed that total T levels significantly decreased during COC use [mean difference (MD) (95% confidence interval, CI) -0.49 nmol/l (-0.55, -0.42); P < 0.001]. Significantly lower levels of free T were also found [relative change (95% CI) 0.39 (0.35, 0.43); P < 0.001], with a mean decrease of 61%. On the contrary, SHBG concentrations significantly increased during all types of COC use [MD (95% CI) 99.08 nmol/l (86.43, 111.73); P < 0.001]. Subgroup analyses revealed that COCs containing 20-25 µg EE had similar effects on total and free T compared with COCs with 30-35 µg EE. In addition, suppressive effects on T levels were not different when comparing different types of progestins. However, subgroup analyses for the estrogen dose and the progestin type in relation to changes in SHBG levels did show significant differences: COCs containing second generation progestins and/or the lower estrogen doses (20-25 µg EE) were found to have less impact on SHBG concentrations. CONCLUSIONS The current literature review and meta-analysis demonstrates that COCs decrease circulating levels of total T and free T and increase SBHG concentrations. Due to the SHBG increase, free T levels decrease twice as much as total T. The estrogen dose and progestin type of the COC do not influence the decline of total and free T, but both affect SHBG. The clinical implications of suppressed androgen levels during COC use remain to be elucidated.
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Affiliation(s)
- Y Zimmerman
- Pantarhei Bioscience, PO Box 464, 3700 AL Zeist, The Netherlands
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30
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Abstract
Mass spectrometry methods have the potential to measure different hormones during the same analysis and have improved specificity and a wide analytical range compared with many immunoassay methods. Increasingly in clinical laboratories liquid chromatography-tandem mass spectrometry (LC-MS/MS) assays are replacing immunoassays for the routine measurement of testosterone, 17-hydroxyprogesterone, and other steroid hormones. Reference LC-MS/MS methods for steroid, thyroid, and peptide hormones are being used for assessment of the performance and calibration of commercial immunoassays. In this chapter, the general principles of tandem mass spectrometry and examples of hormone assays are described.
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Affiliation(s)
- Helen P Field
- Department of Specialist Laboratory Medicine, St. James's University Hospital, Leeds, UK
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31
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French D. Development and validation of a serum total testosterone liquid chromatography–tandem mass spectrometry (LC–MS/MS) assay calibrated to NIST SRM 971. Clin Chim Acta 2013; 415:109-17. [DOI: 10.1016/j.cca.2012.10.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Revised: 10/04/2012] [Accepted: 10/05/2012] [Indexed: 11/30/2022]
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Janse F, Tanahatoe S, Eijkemans M, Fauser B. Testosterone concentrations, using different assays, in different types of ovarian insufficiency: a systematic review and meta-analysis. Hum Reprod Update 2012; 18:405-19. [DOI: 10.1093/humupd/dms013] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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33
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Abstract
Quantification of endogenous hormonal steroids and their precursors is essential for diagnosing a wide range of endocrine disorders. Historically, these analyses have been carried out using immunoassay, but such methods are problematic, especially for low-concentration analytes, due to assay interference by other endogenous steroids. MS offers improved specificity over immunoassay and can be highly sensitive. GC–MS, with use of stable isotopically labeled internal standards, is considered the ‘gold standard’ method for serum steroid analysis. GC–MS is the method of choice for profiling steroid metabolites in urine, but these techniques are not appropriate for routine use in clinical laboratories owing to a need for extensive sample preparation, as well as analytical expertise. LC–MS/MS compares well to GC–MS in terms of accuracy, precision and sensitivity, but allows simplified sample preparation. While most publications have featured only one or a limited number of steroids, we consider that steroid paneling (which we propose as the preferred term for multitargeted steroid analysis) has great potential to enable clinicians to make a definitive diagnosis. It is adaptable for use in a number of matrices, including serum, saliva and dried blood spots. However, LC–MS/MS-based steroid analysis is not straightforward, and understanding the chemical and analytical processes involved is essential for implementation of a robust clinical service. This article discusses specific challenges in the measurement of endogenous steroids using LC–MS/MS, and provides examples of the benefits it offers.
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Dallal C, Taioli E. Urinary 2/16 estrogen metabolite ratio levels in healthy women: a review of the literature. Mutat Res 2010; 705:154-162. [PMID: 20601100 PMCID: PMC3760212 DOI: 10.1016/j.mrrev.2010.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 06/10/2010] [Accepted: 06/23/2010] [Indexed: 12/18/2022]
Abstract
This is a summary of the published literature on the urinary 2/16 estrogen metabolite ratio in human populations, and a report the observed range of normal values in healthy women. Original research studies that included the measurement of urinary estrogen metabolites in human subjects were identified through an extensive Medline search; 43 distinct studies were identified, including a total of 6802 healthy women. The range of mean values of the 2/16 ratio measured with the ELISA method varied from 0.98 to 1.74; in studies of pre-menopausal women the range of mean values was 1.5-2.74, in studies of post-menopausal women mean values ranged from 1.15 to 2.25. The heterogeneity across studies was highly significant (p-value Q-test: <0.0001). In multivariable analyses, only race confirmed its role as an independent predictor of 2/16 ratio (F-value: 7.95; p-value: 0.009), after adjustment for age and menopausal status. There appears to be a large body of data on the 2/16 urinary ratio in healthy women. However, summary estimates are difficult to perform due to the high variability of the published study-specific values. The data suggests that race may be a contributor to 2/16 urinary ratio levels.
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Affiliation(s)
- Cher Dallal
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Emanuela Taioli
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States; Department of Epidemiology and Biostatistics, SUNY Downstate Medical Center, Brooklyn, NY, United States.
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Ceglarek U, Werner M, Kortz L, Körner A, Kiess W, Thiery J, Kratzsch J. Preclinical challenges in steroid analysis of human samples. J Steroid Biochem Mol Biol 2010; 121:505-12. [PMID: 20302937 DOI: 10.1016/j.jsbmb.2010.03.039] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 03/02/2010] [Accepted: 03/08/2010] [Indexed: 11/25/2022]
Abstract
Preclinical challenges in the analysis of steroid hormones are primarily determined by biological factors involved in the physiology and pathophysiology of hormone secretion. Major biologically influencing factors like age, sex, pubertal stage, pregnancy, phase of the menstruation, and diurnal rhythm have to be considered in the definition of reference ranges for steroids and their clinical interpretation. Hitherto, in clinical routine laboratories steroids were mainly determined by direct immunoassays applied on automated platforms, which are simple, rapid and cheap if a high number of samples are measured. However, technical factors like cross-reactivity of related steroid metabolites or limited analytical ranges have to be taken in account and may impair accuracy and precision of these direct methods. The actual development of mass spectrometry based analytical platforms for the determination of single steroid or steroid patterns seems to be an alternative analytical approach combining multi-parametric analysis, high sensitivity and specificity as well simple sample pre-treatment, robustness and low running costs for steroid analysis. This short review will give an overview about biological influencing factors and technical disturbing factors of routinely used immunoassay for the analysis of steroids. The application of LC-MS/MS as an alternative routine high-throughput platform for steroid analysis and its perspective role in the standardization and harmonisation of steroid measurements in clinical routine application will be discussed.
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Affiliation(s)
- Uta Ceglarek
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Paul List-Str.13-15, Germany
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Krasnoff JB, Basaria S, Pencina MJ, Jasuja GK, Vasan RS, Ulloor J, Zhang A, Coviello A, Kelly-Hayes M, D'Agostino RB, Wolf PA, Bhasin S, Murabito JM. Free testosterone levels are associated with mobility limitation and physical performance in community-dwelling men: the Framingham Offspring Study. J Clin Endocrinol Metab 2010; 95:2790-9. [PMID: 20382680 PMCID: PMC2902069 DOI: 10.1210/jc.2009-2680] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Mobility limitation is associated with increased morbidity and mortality. The relationship between circulating testosterone and mobility limitation and physical performance is incompletely understood. OBJECTIVE Our objective was to examine cross-sectional and prospective relations between baseline sex hormones and mobility limitations and physical performance in community-dwelling older men. DESIGN, SETTING, AND PARTICIPANTS We conducted cross-sectional and longitudinal analyses of 1445 men (mean age 61.0 +/- 9.5 yr) who attended Framingham Offspring Study examinations 7 and 8 (mean 6.6 yr apart). Total testosterone (TT) was measured by liquid chromatography tandem mass spectrometry at examination 7. Cross-sectional and longitudinal analyses of mobility limitation and physical performance were performed with continuous (per SD) and dichotomized [low TT and free testosterone (FT) and high SHBG vs. normal] hormone levels. MAIN OUTCOME MEASURES Self-reported mobility limitation, subjective health, usual walking speed, and grip strength were assessed at examinations 7 and 8. Short physical performance battery was performed at examination 7. RESULTS Higher continuous FT was positively associated with short physical performance battery score (beta = 0.13; P = 0.008), usual walking speed (beta = 0.02; P = 0.048), and lower risk of poor subjective health [odds ratio (OR) = 0.72; P = 0.01]. In prospective analysis, 1 SD increase in baseline FT was associated with lower risk of developing mobility limitation (OR = 0.78; 95% confidence interval = 0.62-0.97) and progression of mobility limitation (OR = 0.75; 95% confidence interval = 0.60-0.93). Men with low baseline FT had 57% higher odds of reporting incident mobility limitation (P = 0.03) and 68% higher odds of worsening of mobility limitation (P = 0.007). CONCLUSIONS Lower levels of baseline FT are associated with a greater risk of incident or worsening mobility limitation in community-dwelling older men. Whether this risk can be reduced with testosterone therapy needs to be determined by randomized trials.
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Affiliation(s)
- Joanne B Krasnoff
- Boston University School of Medicine, Section of Endocrinology, Diabetes, and Nutrition, 670 Albany Street, Second Floor, Boston, Massachusetts 02118-2393, USA
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Key TJ, Appleby PN, Allen NE, Reeves GK. Pooling biomarker data from different studies of disease risk, with a focus on endogenous hormones. Cancer Epidemiol Biomarkers Prev 2010; 19:960-5. [PMID: 20233851 PMCID: PMC2875156 DOI: 10.1158/1055-9965.epi-10-0061] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Large numbers of observations are needed to provide adequate power in epidemiologic studies of biomarkers and cancer risk. However, there are currently few large mature studies with adequate numbers of cases with biospecimens available. Therefore, pooling biomarker measures from different studies is a valuable approach, enabling investigators to make robust estimates of risk and to examine associations in subgroups of the population. The ideal situation is to have standardized methods in all studies so that the biomarker data can be pooled in their original units. However, even when the studies do not have standardized methods, as with existing studies on hormones and cancer, a simple approach using study-specific quantiles or percentage increases can provide substantial information on the relationship of the biomarker with cancer risk.
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Affiliation(s)
- Timothy J Key
- Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, Oxford University, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, United Kingdom.
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39
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Abstract
BACKGROUND Accrediting organizations require laboratories to establish analytic performance criteria that ensure their tests provide results of the high quality required for patient care. However, the procedures for instituting performance criteria that are directly linked to the needs of medical practice are not well established, and therefore alternative strategies often are used to create and implement surrogate performance standards. CONTENT We reviewed 6 approaches for establishing outcome-related analytic performance goals: (a) limits defined by regulations and external assessment programs, (b) limits based on biologic variation, (c) limits based on surveys of clinicians about their needs, (d) limits based on effects on guideline driven medical decisions, (e) limits based on analysis of patterns for ordering follow-up clinical tests, and (f) limits based on formal medical decision models. Performance criteria were tabulated for 12 common chemistry analytes and 4 routine hematology tests. CONCLUSIONS There is no consensus currently about the preferred methods for establishing medically necessary analytic performance limits. The various methods reviewed give considerably different performance limits. The analytic performance limits claimed by a laboratory should correspond to those limits that can be reliably maintained based on validated QC monitoring systems. These limits generally are larger than the observed CVs and bias parameters collected for assay validation. There is a major need for increased communication among laboratorians and clinicians on this topic, especially when the analytic performance limits that can be consistently maintained by a laboratory are inconsistent with the expectations of health care providers.
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Affiliation(s)
- George G Klee
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.
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Abstract
Most steroid disorders of the adrenal cortex come to clinical attention in childhood and in order to investigate these problems, there are many challenges to the laboratory which need to be appreciated to a certain extent by clinicians. The analysis of sex steroids in biological fluids from neonates, over adrenarche and puberty present challenges of specificities and concentrations often in small sample sizes. Different reference ranges are also needed for interpretations. For around 40 years, quantitative assays for the steroids and their regulatory peptide hormones have been possible using immunoassay techniques. Problems are recognised and this review aims to summarise the benefits and failings of immunoassays and introduce where tandem mass spectrometry is anticipated to meet the clinical needs for steroid analysis in paediatric endocrine investigations. It is important to keep a dialogue between clinicians and the laboratory, especially when any laboratory result does not make sense in the clinical investigation.
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Affiliation(s)
- John W Honour
- Clinical Biochemistry, University College London Hospitals, London, England.
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