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Fraissinet F, Pereira T, Violin A, Feugray G, Bach-Ngohou K, Brunel V. A novel fully-automated method to measure steroids in serum by liquid chromatography-tandem mass spectrometry. J Mass Spectrom Adv Clin Lab 2023; 27:24-32. [PMID: 36593910 PMCID: PMC9804132 DOI: 10.1016/j.jmsacl.2022.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 11/24/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Background Steroids play a key role in numerous physiological processes. Steroid determination is a useful tool to explore various endocrine diseases. Because of its specificity, mass spectrometry is considered to be a reference method for the determination of steroids in serum compared to radioimmunoassay. This technology could progress towards more automation for the optimal organization of clinical laboratories and ultimately for the benefit of patients. Methods A fully automated ultra-high-performance liquid chromatography-tandem mass spectrometry method was developed and fully validated to determine five steroids in serum. Sample preparation was based on protein precipitation with filtration followed by online solid phase extraction. Chromatographic separation was performed using a biphenyl stationary phase. Results The method was successfully validated according to European Medicine Agency guidelines. Coefficients of variation did not exceed, respectively, 8.4% and 8.1% for intra- and inter-assay precision. Method comparison with radioimmunoassay showed a proportional bias for all compounds, except for testosterone in men. Comparison with another LC-MS/MS method demonstrated acceptable concordance for all steroids, although a small bias was observed for androstenedione. Conclusion The novelty of this method is that it has been fully automated. Automation provides benefits in traceability and allows significant savings in cost and time.
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Key Words
- 11DF, 11-deoxycortisol
- 17OHP, 17-hydroxyprogesterone
- 2D-UHPLC-MS/MS, Two dimensional ultra-high performance liquid chromatography-tandem mass spectrometry
- Automation
- D4, delta4-androstenedione
- DHEA, dehydroepiandrosterone
- EMA, European Medicine Agency
- GC–MS/MS, Gas chromatography tandem mass spectrometry
- LC-MS/MS, Liquid chromatography tandem mass spectrometry
- LLE, Liquid-liquid extraction
- LLOQ, Lower limit of quantification
- Liquid chromatography tandem mass spectrometry
- MRM, Multiple reaction monitoring
- PTFE, Polytetrafluoroethylene
- QC, Quality control
- RIA, Radioimmunoassay
- Radioimmunoassay
- SLE, Supported liquid extraction
- SPE, Solid phase extraction
- SRM, Standard reference material
- Steroids
- T, Testosterone
- Testosterone
- UHPLC, Ultra-high performance liquid chromatography
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Affiliation(s)
- François Fraissinet
- Department of General Biochemistry, Rouen University Hospital, 76000 Rouen, France
| | - Tony Pereira
- Department of General Biochemistry, Rouen University Hospital, 76000 Rouen, France
| | - Alizée Violin
- Nantes Université, CHU Nantes, Department of Biology, Laboratory of Biochemistry, F-44000 Nantes, France
| | - Guillaume Feugray
- Department of General Biochemistry, Rouen University Hospital, 76000 Rouen, France
- Normandie University, UNIROUEN, INSERM U1096 Rouen, France
| | - Kalyane Bach-Ngohou
- Nantes Université, CHU Nantes, Department of Biology, Laboratory of Biochemistry, F-44000 Nantes, France
- Nantes Université, CHU Nantes, INSERM, The Enteric Nervous System in Gut and Brain Disorders, IMAD, F-44000 Nantes, France
| | - Valéry Brunel
- Department of General Biochemistry, Rouen University Hospital, 76000 Rouen, France
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Sun M, Mueller JW, Gilligan LC, Taylor AE, Shaheen F, Noczyńska A, T’Sjoen G, Denvir L, Shenoy S, Fulton P, Cheetham TD, Gleeson H, Rahman M, Krone NP, Taylor NF, Shackleton CHL, Arlt W, Idkowiak J. The broad phenotypic spectrum of 17α-hydroxylase/17,20-lyase (CYP17A1) deficiency: a case series. Eur J Endocrinol 2021; 185:729-741. [PMID: 34524979 PMCID: PMC8558848 DOI: 10.1530/eje-21-0152] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 09/15/2021] [Indexed: 12/29/2022]
Abstract
CONTEXT 17α-Hydroxylase/17,20-lyase deficiency (17OHD) caused by mutations in the CYP17A1 gene is a rare form of congenital adrenal hyperplasia typically characterised by cortisol deficiency, mineralocorticoid excess and sex steroid deficiency. OBJECTIVE To examine the phenotypic spectrum of 17OHD by clinical and biochemical assessment and corresponding in silico and in vitro functional analysis. DESIGN Case series. PATIENTS AND RESULTS We assessed eight patients with 17OHD, including four with extreme 17OHD phenotypes: two siblings presented with failure to thrive in early infancy and two with isolated sex steroid deficiency and normal cortisol reserve. Diagnosis was established by mass spectrometry-based urinary steroid profiling and confirmed by genetic CYP17A1 analysis, revealing homozygous and compound heterozygous sequence variants. We found novel (p.Gly111Val, p.Ala398Glu, p.Ile371Thr) and previously described sequence variants (p.Pro409Leu, p.Arg347His, p.Gly436Arg, p.Phe53/54del, p.Tyr60IlefsLys88X). In vitro functional studies employing an overexpression system in HEK293 cells showed that 17,20-lyase activity was invariably decreased while mutant 17α-hydroxylase activity retained up to 14% of WT activity in the two patients with intact cortisol reserve. A ratio of urinary corticosterone over cortisol metabolites reflective of 17α-hydroxylase activity correlated well with clinical phenotype severity. CONCLUSION Our findings illustrate the broad phenotypic spectrum of 17OHD. Isolated sex steroid deficiency with normal stimulated cortisol has not been reported before. Attenuation of 17α-hydroxylase activity is readily detected by urinary steroid profiling and predicts phenotype severity. SIGNIFICANCE STATEMENT Here we report, supported by careful phenotyping, genotyping and functional analysis, a prismatic case series of patients with congenital adrenal hyperplasia due to 17α-hydroxylase (CYP17A1) deficiency (17OHD). These range in severity from the abolition of function, presenting in early infancy, and unusually mild with isolated sex steroid deficiency but normal ACTH-stimulated cortisol in adult patients. These findings will guide improved diagnostic detection of CYP17A1 deficiency.
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Affiliation(s)
- Min Sun
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jonathan W Mueller
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Lorna C Gilligan
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Angela E Taylor
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Fozia Shaheen
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Anna Noczyńska
- Department of Endocrinology and Diabetology for Children and Adolescents, Wroclaw Medical University, Wroclaw, Poland
| | - Guy T’Sjoen
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Louise Denvir
- Department of Paediatric Endocrinology and Diabetes, Queen’s Medical Centre, Nottingham, UK
| | - Savitha Shenoy
- Children’s and Adolescent Services, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Piers Fulton
- West Midlands Regional Genetics Service, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - Timothy D Cheetham
- Newcastle University c/o Department of Paediatric Endocrinology, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Helena Gleeson
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mushtaqur Rahman
- Department of Endocrinology, Northwick Park Hospital, London Northwest University Healthcare NHS Trust, London, UK
| | - Nils P Krone
- Academic Unit of Child Health, Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
| | - Norman F Taylor
- Department of Clinical Biochemistry, King’s College Hospital, London, UK
| | - Cedric H L Shackleton
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Benioff Children’s Hospital, University of California San Francisco, Oakland, California, USA
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jan Idkowiak
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Department of Endocrinology and Diabetes, Birmingham Children’s Hospital, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
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