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Fanelli F, Peitzsch M, Bruce S, Cantù M, Temchenko A, Mezzullo M, Lindner JM, Hawley JM, Ackermans MT, Van den Ouweland J, Koeppl D, Nardi E, MacKenzie F, Binz PA, Rauh M, Keevil BG, Vogeser M, Eisenhofer G, Heijboer AC, Pagotto U. Report from the HarmoSter study: different LC-MS/MS androstenedione, DHEAS and testosterone methods compare well; however, unifying calibration is a double-edged sword. Clin Chem Lab Med 2024; 62:1080-1091. [PMID: 38205643 DOI: 10.1515/cclm-2023-1138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES Current liquid chromatography-tandem mass spectrometry (LC-MS/MS) applications for circulating androgen measurements are technically diverse. Previously, variable results have been reported for testosterone. Data are scarce for androstenedione and absent for dehydroepiandrosterone sulfate (DHEAS). We assessed the agreement of androstenedione, DHEAS and testosterone LC-MS/MS measurements among nine European centers and explored benefits of calibration system unification. METHODS Androgens were measured twice by laboratory-specific procedures in 78 patient samples and in EQA materials. Results were obtained by in-house and external calibration. Intra- and inter-laboratory performances were valued. RESULTS Intra-laboratory CVs ranged between 4.2-13.2 % for androstenedione, 1.6-10.8 % for DHEAS, and 4.3-8.7 % and 2.6-7.1 % for female and male testosterone, respectively. Bias and trueness in EQA materials were within ±20 %. Median inter-laboratory CV with in-house vs. external calibration were 12.0 vs. 9.6 % for androstenedione (p<0.001), 7.2 vs. 4.9 % for DHEAS (p<0.001), 6.4 vs. 7.6 % for female testosterone (p<0.001) and 6.8 and 7.4 % for male testosterone (p=0.111). Median bias vs. all laboratory median with in-house and external calibration were -13.3 to 20.5 % and -4.9 to 18.7 % for androstenedione, -10.9 to 4.8 % and -3.4 to 3.5 % for DHEAS, -2.7 to 6.5 % and -11.3 to 6.6 % for testosterone in females, and -7.0 to 8.5 % and -7.5 to 11.8 % for testosterone in males, respectively. CONCLUSIONS Methods showed high intra-laboratory precision but variable bias and trueness. Inter-laboratory agreement was remarkably good. Calibration system unification improved agreement in androstenedione and DHEAS, but not in testosterone measurements. Multiple components, such as commutability of calibrators and EQA materials and internal standard choices, likely contribute to inter-laboratory variability.
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Affiliation(s)
- Flaminia Fanelli
- Department of Medical and Surgical Sciences, Endocrinology Research Group, Center for Applied Biomedical Research, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Mirko Peitzsch
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stephen Bruce
- Clinical Chemistry Laboratory, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Marco Cantù
- Laboratory of Clinical Biochemistry and Pharmacology, Institute of Laboratory Medicine EOLAB, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Anastasia Temchenko
- Department of Medical and Surgical Sciences, Endocrinology Research Group, Center for Applied Biomedical Research, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Marco Mezzullo
- Department of Medical and Surgical Sciences, Endocrinology Research Group, Center for Applied Biomedical Research, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Johanna M Lindner
- Institute of Laboratory Medicine, Hospital of the University of Munich (LMU), Munich, Germany
| | - James M Hawley
- Department of Clinical Biochemistry, University Hospital South Manchester, Manchester NHS Foundation Trust, Manchester, UK
| | - Mariette T Ackermans
- Faculty of Science, Van't Hoff Institute for Molecular Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Jody Van den Ouweland
- Department of Clinical Chemistry, Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - Daniel Koeppl
- Department of Pediatrics and Adolescent Medicine, University Hospital, Erlangen, Germany
| | - Elena Nardi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Finlay MacKenzie
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Pierre-Alain Binz
- Clinical Chemistry Laboratory, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Manfred Rauh
- Department of Pediatrics and Adolescent Medicine, University Hospital, Erlangen, Germany
| | - Brian G Keevil
- Department of Clinical Biochemistry, University Hospital South Manchester, Manchester NHS Foundation Trust, Manchester, UK
| | - Michael Vogeser
- Institute of Laboratory Medicine, Hospital of the University of Munich (LMU), Munich, Germany
| | - Graeme Eisenhofer
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Annemieke C Heijboer
- Endocrine Laboratory, Department of Clinical Chemistry, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Uberto Pagotto
- Department of Medical and Surgical Sciences, Endocrinology Research Group, Center for Applied Biomedical Research, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Unit of Endocrinology and Prevention and Care of Diabetes, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Braun V, Ceglarek U, Gaudl A, Gawinecka J, Müller D, Rauh M, Weber M, Seger C. Evaluation of five multisteroid LC‒MS/MS methods used for routine clinical analysis: comparable performance was obtained for nine analytes. Clin Chem Lab Med 2024; 62:900-910. [PMID: 38038605 DOI: 10.1515/cclm-2023-0847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVES A mass spectrometry (LC‒MS/MS)-based interlaboratory comparison study was performed for nine steroid analytes with five participating laboratories. The sample set contained 40 pooled samples of human serum generated from preanalyzed leftovers. To obtain a well-balanced distribution across reference intervals of each steroid, the leftovers first underwent a targeted mixing step. METHODS All participants measured a sample set once using their own multianalyte protocols and calibrators. Four participants used in-house developed measurement platforms, including IVD-CE certified calibrators, which were used by three participants; the 5th lab used the whole LC‒MS kit from an IVD manufacturer. All labs reported results for 17-hydroxyprogesterone, androstenedione, cortisol, and testosterone, and four labs reported results for 11-deoxycortisol, corticosterone, cortisone, dehydroepiandrosterone sulfate (DHEAS), and progesterone. RESULTS Good or acceptable overall comparability was found in Bland‒Altman and Passing‒Bablok analyses. Mean bias against the overall mean remained less than ±10 % except for DHEAS, androstenedione, and progesterone at one site and for cortisol and corticosterone at two sites (max. -18.9 % for androstenedione). The main analytical problems unraveled by this study included a bias not previously identified in proficiency testing, operator errors, non-supported matrix types and higher inaccuracy and imprecision at lower ends of measuring intervals. CONCLUSIONS This study shows that intermethod comparison is essential for monitoring the validity of an assay and should serve as an example of how external quality assessment could work in addition to organized proficiency testing schemes.
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Affiliation(s)
- Valentin Braun
- Institute of Pharmacy/Pharmacognosy, CCB - Centrum of Chemistry and Biomedicine, University of Innsbruck, Innsbruck, Austria
- Dr. Risch Ostschweiz AG, Buchs, Switzerland
| | - Uta Ceglarek
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Leipzig University, Leipzig, Germany
| | - Alexander Gaudl
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Leipzig University, Leipzig, Germany
| | - Joanna Gawinecka
- Institute of Clinical Chemistry, University Hospital Zurich, Zürich, Switzerland
| | - Daniel Müller
- Institute of Clinical Chemistry, University Hospital Zurich, Zürich, Switzerland
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital Basel, Basel, Switzerland
| | - Manfred Rauh
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
| | | | - Christoph Seger
- Institute of Pharmacy/Pharmacognosy, CCB - Centrum of Chemistry and Biomedicine, University of Innsbruck, Innsbruck, Austria
- Dr. Risch Ostschweiz AG, Buchs, Switzerland
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Lethin K, Aardal E, Lood Y, Ekman B, Wahlberg J. Effects of 12 Months' Treatment with Testosterone Undecanoate on Markers for Erythropoietic Activity and Safety Aspects in Transgender and Cisgender Hypogonadal Men. J Appl Lab Med 2024; 9:223-236. [PMID: 38085088 DOI: 10.1093/jalm/jfad096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/18/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND To investigate the erythropoietic activity and safety aspects of testosterone undecanoate (TU) injections in transgender men, assigned female at birth. METHODS Twenty-three men (13 hypogonadal cisgender men and 10 transgender men) who initiated TU at the study start (naïve) and 15 men (10 hypogonadal cisgender men and 5 transgender men) on steady-state treatment with TU (non-naïve) were included in this prospective 1-year observational study. A control group of 32 eugonadal cisgender men was investigated once at baseline. Complete blood count, testosterone in serum and saliva, and plasma lipids, and liver enzymes were assessed. RESULTS For naïve transgender men, a significant increase in hemoglobin concentration was noted (mean (SD)), 141 (8) g/L to 151 (13) g/L, while no increase was seen in naïve hypogonadal cisgender men. At the end of the study, naïve transgender men exhibited comparable levels of hemoglobin, hematocrit, and testosterone levels in serum and saliva to hypogonadal cisgender men, as well as to the eugonadal cisgender men. During the study, HDL-cholesterol decreased significantly in naïve transgender men, 1.4 (0.4) mmol/L to 1.2 (0.4) mmol/L, P = 0.03, whereas no significant change was noted in naïve hypogonadal cisgender men. Liver enzymes remained unchanged in all groups. CONCLUSIONS After 12 months of treatment with TU in naïve transgender men, hemoglobin and hematocrit increased to levels within the cisgender male reference range. A slight decrease in HDL-cholesterol was seen in naïve transgender men but liver enzymes remained unchanged.
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Affiliation(s)
- Kajsa Lethin
- Department of Endocrinology in Linköping, Linköping University, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Elisabeth Aardal
- Department of Clinical Chemistry, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Yvonne Lood
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- National Board of Forensic Medicine, Department of Forensic Genetics and Forensic Toxicology, Linköping University, Linköping, Sweden
| | - Bertil Ekman
- Department of Endocrinology in Linköping, Linköping University, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Medicine in Norrköping, Linköping University, Linköping, Sweden
| | - Jeanette Wahlberg
- Department of Endocrinology in Linköping, Linköping University, Linköping, Sweden
- Faculty of Medical Sciences, Örebro University, Örebro, Sweden
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Fanelli F, Cantù M, Temchenko A, Mezzullo M, Lindner JM, Peitzsch M, Hawley JM, Bruce S, Binz PA, Ackermans MT, Heijboer AC, Van den Ouweland J, Koeppl D, Nardi E, MacKenzie F, Rauh M, Eisenhofer G, Keevil BG, Vogeser M, Pagotto U. Report from the HarmoSter study: impact of calibration on comparability of LC-MS/MS measurement of circulating cortisol, 17OH-progesterone and aldosterone. Clin Chem Lab Med 2022; 60:726-739. [PMID: 35172417 DOI: 10.1515/cclm-2021-1028] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/31/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is recommended for measuring circulating steroids. However, assays display technical heterogeneity. So far, reproducibility of corticosteroid LC-MS/MS measurements has received scant attention. The aim of the study was to compare LC-MS/MS measurements of cortisol, 17OH-progesterone and aldosterone from nine European centers and assess performance according to external quality assessment (EQA) materials and calibration. METHODS Seventy-eight patient samples, EQA materials and two commercial calibration sets were measured twice by laboratory-specific procedures. Results were obtained by in-house (CAL1) and external calibrations (CAL2 and CAL3). We evaluated intra and inter-laboratory imprecision, correlation and agreement in patient samples, and trueness, bias and commutability in EQA materials. RESULTS Using CAL1, intra-laboratory CVs ranged between 2.8-7.4%, 4.4-18.0% and 5.2-22.2%, for cortisol, 17OH-progesterone and aldosterone, respectively. Trueness and bias in EQA materials were mostly acceptable, however, inappropriate commutability and target value assignment were highlighted in some cases. CAL2 showed suboptimal accuracy. Median inter-laboratory CVs for cortisol, 17OH-progesterone and aldosterone were 4.9, 11.8 and 13.8% with CAL1 and 3.6, 10.3 and 8.6% with CAL3 (all p<0.001), respectively. Using CAL1, median bias vs. all laboratory-medians ranged from -6.6 to 6.9%, -17.2 to 7.8% and -12.0 to 16.8% for cortisol, 17OH-progesterone and aldosterone, respectively. Regression lines significantly deviated from the best fit for most laboratories. Using CAL3 improved cortisol and 17OH-progesterone between-method bias and correlation. CONCLUSIONS Intra-laboratory imprecision and performance with EQA materials were variable. Inter-laboratory performance was mostly within specifications. Although residual variability persists, adopting common traceable calibrators and RMP-determined EQA materials is beneficial for standardization of LC-MS/MS steroid measurements.
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Affiliation(s)
- Flaminia Fanelli
- Department of Medical and Surgical Sciences, Unit of Endocrinology and Prevention and Care of Diabetes, Center for Applied Biomedical Research, University of Bologna, S. Orsola Policlinic, Bologna, Italy
| | - Marco Cantù
- Laboratory of Clinical Biochemistry and Pharmacology, Institute of Laboratory Medicine EOLAB, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Anastasia Temchenko
- Department of Medical and Surgical Sciences, Unit of Endocrinology and Prevention and Care of Diabetes, Center for Applied Biomedical Research, University of Bologna, S. Orsola Policlinic, Bologna, Italy
| | - Marco Mezzullo
- Department of Medical and Surgical Sciences, Unit of Endocrinology and Prevention and Care of Diabetes, Center for Applied Biomedical Research, University of Bologna, S. Orsola Policlinic, Bologna, Italy
| | - Johanna M Lindner
- Institute of Laboratory Medicine, Hospital of the University of Munich (LMU), Munich, Germany
| | - Mirko Peitzsch
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - James M Hawley
- Department of Clinical Biochemistry, University Hospital South Manchester, Manchester NHS Foundation Trust, Manchester, UK
| | - Stephen Bruce
- Clinical Chemistry Laboratory, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Pierre-Alain Binz
- Clinical Chemistry Laboratory, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Mariette T Ackermans
- Department of Clinical Chemistry, Endocrine Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Annemieke C Heijboer
- Department of Clinical Chemistry, Endocrine Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jody Van den Ouweland
- Department of Clinical Chemistry, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Daniel Koeppl
- Department of Pediatrics and Adolescent Medicine, University Hospital, Erlangen, Germany
| | - Elena Nardi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Finlay MacKenzie
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Manfred Rauh
- Department of Pediatrics and Adolescent Medicine, University Hospital, Erlangen, Germany
| | - Graeme Eisenhofer
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Brian G Keevil
- Department of Clinical Biochemistry, University Hospital South Manchester, Manchester NHS Foundation Trust, Manchester, UK
| | - Michael Vogeser
- Institute of Laboratory Medicine, Hospital of the University of Munich (LMU), Munich, Germany
| | - Uberto Pagotto
- Department of Medical and Surgical Sciences, Unit of Endocrinology and Prevention and Care of Diabetes, Center for Applied Biomedical Research, University of Bologna, S. Orsola Policlinic, Bologna, Italy
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Zheng S, Liu J, Kang B, Wang G. Design and synthesis of a novel ZB716-d6 as a stable isotopically labeled internal standard. SYNTHETIC COMMUN 2022; 52:1441-1447. [PMID: 36420104 PMCID: PMC9681137 DOI: 10.1080/00397911.2022.2095212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZB716 is a synthetic, steroidal, orally active anti-estrogen agent that is under clinical development for the treatment of estrogen receptor (ER)-positive metastatic breast cancer. The stable isotope-labeled ZB716 was required for use as an internal standard in LC-MS/MS assays. Therefore, a novel deuterated ZB716 (ZB716-d6) as an isotopically labeled internal standard was designed and synthesized through a newly developed route, which prepared ZB716-d6 in eight steps from the commercially available deuterium-labeled starting material [2H6]pentafluoropentanol. This procedure is very practicable and gives the final compound in good yield (19% total yield) and high purity (D, >99%, chemical purity 98%). At present, ZB716-d6 has been successfully used as an internal standard in clinical bioanalysis.
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Affiliation(s)
- Shilong Zheng
- RCMI Cancer Research Center and Department of Chemistry, Xavier University of Louisiana, New Orleans, LA, USA
| | - Jiawang Liu
- Department of Pharmaceutical Science and Medicinal Chemistry Core, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Borui Kang
- RCMI Cancer Research Center and Department of Chemistry, Xavier University of Louisiana, New Orleans, LA, USA
| | - Guangdi Wang
- RCMI Cancer Research Center and Department of Chemistry, Xavier University of Louisiana, New Orleans, LA, USA
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Fast accurate quantification of salivary cortisol and cortisone in a large-scale clinical stress study by micro-UHPLC-ESI-MS/MS using a surrogate calibrant approach. J Chromatogr B Analyt Technol Biomed Life Sci 2021; 1182:122939. [PMID: 34547590 DOI: 10.1016/j.jchromb.2021.122939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 11/23/2022]
Abstract
Cortisol and cortisone are common markers for stress and thus preferentially analyzed in matrices that allow non-invasive sampling such as saliva. Though the major drawback of immunoassays is lack of specificity due to cross reactivities, they are still most commonly used for quantification of steroid hormones. To overcome such problems, sensitive methods based on liquid chromatography-mass spectrometry are becoming more and more accepted as the golden standard for steroid bioanalysis as they achieve accurate quantification at trace levels for multiple analytes in the same run. Along this line, the aim of this study was the development of a new microflow UHPLC-ESI-MS/MS method for the measurement of salivary cortisol and cortisone, which due to its microflow regime provides enhanced sensitivity and is more ecofriendly. The developed method implemented sample preparation by Solid-Phase Extraction (SPE) in a 96-well plate format. Data acquisitions were carried out in MRM (multiple reaction monitoring) mode. The quantitative determination of endogenous compounds in saliva remains a challenge since analyte-free matrix is lacking. Hence, a surrogate calibrant approach with cortisol-d4 andcortisone-13C3 was applied for the target compounds in the presented method. A number of factors were optimized and the method validated. The lower limit of quantitation (LLOQ) was 72 and 62 pg mL-1for cortisol and cortisone, respectively. Linear calibration was achieved in the range from 0.062 to 75.5 ng mL-1for cortisol-d4 and 0.072 to 44 ng mL-1forcortisone-13C3. The performance of the method was also evaluated via proficiency test for salivary cortisol. Finally, it was applied successfully to evaluate cortisol and cortisone concentrations in multiple batches in routine clinical stress study samples (4056 total injections with 1983 study samples). Moreover, the instrument performance (in particular retention time variability) within each batch, between different batches and lot-to-lot of 5 investigated capillary columns over time is described. The work documents that micro-UHPLC-ESI-MS/MS is suitable and robust enough to carry out a full clinical study with greater than 1000s of samples over an extended period if adequate internal standards can be used.
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Lima TFN, Rakitina E, Blachman-Braun R, Ramasamy R. Evaluation of a serum 17-hydroxyprogesterone as a predictor of semen parameter improvement in men undergoing medical treatment for infertility. Can Urol Assoc J 2020; 15:E340-E345. [PMID: 33382370 DOI: 10.5489/cuaj.6846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The goal of medical therapy for infertile men with testosterone deficiency (TD) is to improve intratesticular testosterone (ITT). There is a gap in knowledge to identify those who will respond with semen parameter(s) improvement. We hypothesized that serum 17-hydroxyprogesterone (17-OHP) - a marker of ITT - can be used to predict improvement of semen parameter(s). METHODS Between July 2018 and January 2020, we conducted a prospective study of 31 men with primary infertility, TD, and secondary hypogonadism receiving clomiphene citrate (CC) and/or human chorionic gonadotropin (hCG) for three months. We assessed baseline and followup hormones, including testosterone, 17-OHP, semen parameter(s), and demographics. Semen quality upgrading was based on assisted reproduction eligibility: in-vitro fertilization (<5 million), intrauterine insemination (IUI) (5-9 million), and natural pregnancy (>9 million). Variables were compared using the Mann-Whitney U or Wilcoxon rank test. RESULTS Twenty-one men received CC and 10 received CC/hCG. Median followup was 3.7 (3.3-5.1) months. Sixteen men upgraded semen quality. Six of 10 men with baseline total motile sperm count (TMSC) of 0 had motile sperm after treatment, and 11/20 men with TMSC <5 upgraded semen quality into TMSC >5 range. Low 17-OHP was the only factor that predicted semen quality upgrading. Men with 17-OHP ≤55 ng/dL upgraded semen quality and improved hormones, whereas men with 17-OHP >55 ng/dL did not upgrade semen quality. CONCLUSIONS Medical therapy for infertile men with TD resulted in the improvement of sperm concentration, TMSC, testosterone, and 17-OHP. Semen quality upgrading appears to be more significant in patients with low 17-OHP, suggesting that ITT can be used as a biomarker to predict semen parameter(s) improvement.
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Affiliation(s)
| | - Evgeniya Rakitina
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Ruben Blachman-Braun
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Ranjith Ramasamy
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, United States
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Androgen receptor-reduced sensitivity is associated with increased mortality and poorer glycaemia in men with type 2 diabetes mellitus: a prospective cohort study. Cardiovasc Endocrinol Metab 2020; 10:37-44. [PMID: 33634254 DOI: 10.1097/xce.0000000000000230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 07/20/2020] [Indexed: 01/08/2023]
Abstract
Introduction Hypogonadism is associated with poorer glycaemic outcomes/increased all-cause and cardiovascular morbidity/mortality in type 2 diabetes mellitus (T2DM). Increasing CAG repeat number within exon-1 of the androgen receptor (AR) gene is associated with increased AR resistance/insulin resistance. Methods We determined in a long-term 14-year follow-up cohort of 423 T2DM Caucasian men, the association between baseline androgen status/CAG repeat number (by PCR then Sequenom sequencing) and metabolic/cardiovascular outcomes. Results Metabolic outcomes: Lower total testosterone was associated with higher BMI (kg/m2) at 14-year-follow-up: regression coefficient -0.30 (95% confidence interval -0.445 to -0.157), P = 0.0001. The range of CAG repeat number was 9-29 repeats. Higher CAG repeat number in exon-1 of the AR gene was associated with higher follow-up HbA1c2016 - each unit increase in CAG repeat-associated with an increment of 0.1% in HbA1C2016 (P = 0.04), independent of baseline testosterone. Cardiovascular outcomes and mortality: At an average of 14-year-follow-up, 55.8% of hypogonadal men had died vs 36.1% of eugonadal men (P = 0.001). There was a 'u' shaped relation between number of CAG repeats and mortality. Twenty-one CAG repeats were associated with an up to nearly 50% lower mortality rate than <21 CAG repeats and >21 CAG repeats - independent of baseline testosterone level. Conclusion A higher number of CAG repeats at the AR gene associates with higher future HbA1c. There was a 'u' shaped relation between CAG repeat number and mortality rate. Determination of CAG repeat number may become part of assessment of androgen status/its consequences for men with T2DM.
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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: 149] [Impact Index Per Article: 37.3] [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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Mezzullo M, Pelusi C, Fazzini A, Repaci A, Di Dalmazi G, Gambineri A, Pagotto U, Fanelli F. Female and male serum reference intervals for challenging sex and precursor steroids by liquid chromatography - tandem mass spectrometry. J Steroid Biochem Mol Biol 2020; 197:105538. [PMID: 31734493 DOI: 10.1016/j.jsbmb.2019.105538] [Citation(s) in RCA: 13] [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: 08/27/2019] [Revised: 10/29/2019] [Accepted: 11/11/2019] [Indexed: 02/03/2023]
Abstract
Measuring some sex and precursor steroids is still challenging even by liquid chromatography - tandem mass spectrometry (LC-MS/MS), and few normal values are available. We developed a LC-MS/MS method for estradiol, estrone, dihydrotestosterone and 17-hydroxypregnenolone measurement, compared it with direct immunoassays, and generated sex, age, menopausal and menstrual status specific reference intervals. Liquid-liquid extraction was optimized on 300 μL serum spiked with isotopic internal standards. A 2D-LC system allowed on-line purification and separation in 11 min run. Electrospray ionization was enhanced by ammonium fluoride. MS-detection was obtained by multiple reaction monitoring. Direct ECLIA for estradiol (n = 80) and RIA for estrone (n = 41) were compared with LC-MS/MS. Reference values were estimated in healthy, lean women in reproductive age (n = 118), menopausal women (n = 33) and men (n = 159). The assay showed satisfying imprecision, trueness, recovery and selectivity. Adequate functional sensitivity was achieved for measuring estrone (18.1 pmol/L) and 17-hydroxypregnenolone (117 pmol/L) in all subjects, and estradiol (35.9 pmol/L) and dihydrotestosterone (134 pmol/L) in women in reproductive age and men, but not in menopausal women. Compared with LC-MS/MS, immunoassays showed good agreement for estradiol but severe disagreement for estrone. Estrogens exhibited sex, menopausal and menstrual variations. Dihydrotestosterone and 17-hydroxypregnenolone depended on sex and menopause, the latter also declining with age in men. Strictly defined reference intervals in the adult female and male population were generated for challenging steroids such as estrogens, dihydrotestosterone and 17-hydroxypregnenolone by a novel LC-MS/MS method. Our achievement can be used to deepen the comprehension of several endocrine diseases.
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Affiliation(s)
- Marco Mezzullo
- Endocrinology Unit and Center for Applied Biomedical Research, Department of Medical and Surgical Sciences, University of Bologna, S.Orsola Policlinic, via Massarenti 9, 40138 Bologna, Italy.
| | - Carla Pelusi
- Endocrinology Unit and Center for Applied Biomedical Research, Department of Medical and Surgical Sciences, University of Bologna, S.Orsola Policlinic, via Massarenti 9, 40138 Bologna, Italy.
| | - Alessia Fazzini
- Endocrinology Unit and Center for Applied Biomedical Research, Department of Medical and Surgical Sciences, University of Bologna, S.Orsola Policlinic, via Massarenti 9, 40138 Bologna, Italy.
| | - Andrea Repaci
- Endocrinology Unit and Center for Applied Biomedical Research, Department of Medical and Surgical Sciences, University of Bologna, S.Orsola Policlinic, via Massarenti 9, 40138 Bologna, Italy.
| | - Guido Di Dalmazi
- Endocrinology Unit and Center for Applied Biomedical Research, Department of Medical and Surgical Sciences, University of Bologna, S.Orsola Policlinic, via Massarenti 9, 40138 Bologna, Italy.
| | - Alessandra Gambineri
- Endocrinology Unit and Center for Applied Biomedical Research, Department of Medical and Surgical Sciences, University of Bologna, S.Orsola Policlinic, via Massarenti 9, 40138 Bologna, Italy.
| | - Uberto Pagotto
- Endocrinology Unit and Center for Applied Biomedical Research, Department of Medical and Surgical Sciences, University of Bologna, S.Orsola Policlinic, via Massarenti 9, 40138 Bologna, Italy.
| | - Flaminia Fanelli
- Endocrinology Unit and Center for Applied Biomedical Research, Department of Medical and Surgical Sciences, University of Bologna, S.Orsola Policlinic, via Massarenti 9, 40138 Bologna, Italy.
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11
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Noe DA. Criteria for reporting noncompartmental estimates of half‐life and area under the curve extrapolated to infinity. Pharm Stat 2019; 19:101-112. [DOI: 10.1002/pst.1978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 08/19/2019] [Accepted: 09/15/2019] [Indexed: 11/11/2022]
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12
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Weiss RV, Hohl A, Athayde A, Pardini D, Gomes L, de Oliveira M, Meirelles R, Clapauch R, Spritzer PM. Testosterone therapy for women with low sexual desire: a position statement from the Brazilian Society of Endocrinology and Metabolism. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 63:190-198. [PMID: 31340240 PMCID: PMC10522198 DOI: 10.20945/2359-3997000000152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/22/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To summarize current evidence regarding testosterone treatment for women with low sexual desire. MATERIALS AND METHODS The Female Endocrinology and Andrology Department of the Brazilian Society of Endocrinology and Metabolism invited nine experts to review the physiology of testosterone secretion and the use, misuse, and side effects of exogenous testosterone therapy in women, based on the available literature and guidelines and statements from international societies. RESULTS Low sexual desire is a common complaint in clinical practice, especially in postmenopausal women, and may negatively interfere with quality of life. Testosterone seems to exert a positive effect on sexual desire in women with sexual dysfunction, despite a small magnitude of effect, a lack of long-term safety data, and insufficient evidence to make a broad recommendation for testosterone therapy. Furthermore, there are currently no testosterone formulations approved for women by the relevant regulatory agencies in the United States, Brazil, and most other countries, and testosterone formulations approved for men are not recommended for use by women. CONCLUSION Therefore, testosterone therapy might be considered if other strategies fail, but the risks and benefits must be discussed with the patient before prescription. Arch Endocrinol Metab. 2019;63(3):190-8.
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Affiliation(s)
- Rita V. Weiss
- Pontifícia Universidade Católica do Rio de JaneiroInstituto Estadual de Diabetes e Endocrinologia Luiz CapriglionePontifícia Universidade Católica do Rio de JaneiroEscola Médica de Pós-Graduação em EndocrinologiaRio de JaneiroRJBrasilInstituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Pontifícia Universidade Católica do Rio de Janeiro, Escola Médica de Pós-Graduação em Endocrinologia (IEDE-PUC/RJ), Rio de Janeiro, RJ, Brasil
| | - Alexandre Hohl
- Universidade Federal de Santa CatarinaDepartamento de Medicina InternaHospital UniversitárioUniversidade Federal de Santa CatarinaFlorianópolisSCBrasilServiço de Endocrinologia e Metabolismo, Departamento de Medicina Interna, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brasil
| | - Amanda Athayde
- Pontifícia Universidade Católica do Rio de JaneiroInstituto Estadual de Diabetes e Endocrinologia Luiz CapriglionePontifícia Universidade Católica do Rio de JaneiroEscola Médica de Pós-Graduação em EndocrinologiaRio de JaneiroRJBrasilInstituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Pontifícia Universidade Católica do Rio de Janeiro, Escola Médica de Pós-Graduação em Endocrinologia (IEDE-PUC/RJ), Rio de Janeiro, RJ, Brasil
- Universidade Federal do Rio de JaneiroUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Dolores Pardini
- Universidade Federal de São PauloUniversidade Federal de São PauloSão PauloSPBrasilDisciplina de Endocrinologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil
| | - Larissa Gomes
- Universidade de São PauloFaculdade de MedicinaHospital de ClínicasUniversidade de São PauloSão PauloSPBrasilDisciplina de Endocrinologia, Faculdade de Medicina, Hospital de Clínicas, Universidade de São Paulo (USP), São Paulo, SP, Brasil
| | - Monica de Oliveira
- Instituto de Medicina Integral Professor Fernando FigueiraInstituto de Medicina Integral Professor Fernando FigueiraRecifePEBrasilInstituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brasil
| | - Ricardo Meirelles
- Pontifícia Universidade Católica do Rio de JaneiroInstituto Estadual de Diabetes e Endocrinologia Luiz CapriglionePontifícia Universidade Católica do Rio de JaneiroEscola Médica de Pós-Graduação em EndocrinologiaRio de JaneiroRJBrasilInstituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Pontifícia Universidade Católica do Rio de Janeiro, Escola Médica de Pós-Graduação em Endocrinologia (IEDE-PUC/RJ), Rio de Janeiro, RJ, Brasil
| | - Ruth Clapauch
- Departamento de Fisiologia Endócrina e FisiologiaLaboratório de Pesquisas Clínicas e Experimentais em Biologia VascularRio de JaneiroRJBrasilDepartamento de Fisiologia Endócrina e Fisiologia e Laboratório de Pesquisas Clínicas e Experimentais em Biologia Vascular (BIOVASC), Rio de Janeiro, RJ, Brasil
| | - Poli Mara Spritzer
- Universidade Federal do Rio Grande do SulHospital de Clínicas de Porto AlegreDepartamento de FisiologiaUniversidade Federal do Rio Grande do SulPorto AlegreRSBrasilUnidade de Endocrinologia Ginecológica, Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre e Departamento de Fisiologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
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Malipatil NS, Yadegarfar G, Lunt M, Keevil B, Siddals K, Livingston M, Roberts S, Narayanan P, Rutter M, Gibson JM, Donn R, Hackett G, Jones TH, Heald A. Male hypogonadism: 14-year prospective outcome in 550 men with type 2 diabetes. Endocrinol Diabetes Metab 2019; 2:e00064. [PMID: 31294081 PMCID: PMC6613223 DOI: 10.1002/edm2.64] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/01/2019] [Accepted: 02/02/2019] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Hypogonadism is more prevalent in men with type 2 diabetes (T2DM) (25%-40%) than in men without T2DM. Hypogonadism has been associated with poorer glycaemic outcomes and increased cardiovascular morbidity/mortality. We report a 14-year follow-up study to evaluate the influence of baseline testosterone level on T2DM outcomes. RESEARCH DESIGN AND METHODS A total of 550 men with T2DM underwent baseline total testosterone and dihydrotestosterone measurement by tandem mass spectrometry. Mean age of the men was 59.7 ± 12 (mean ± SD) years. Sex hormone-binding globulin (SHBG) was measured and free testosterone estimated. Patients were followed up between 2002 and 2016. Mean follow-up period was 12.2 ± 4 years using the Salford (UK) Integrated Health Records system. RESULTS Mean baseline total testosterone was 13.7 ± 5.8 nmol/L, and mean free testosterone was 245.7 ± 88.0 pmol/L. Mean for low total testosterone (<10 nmol/L) was 7.6 ± 2.0 nmol/L (n = 154) and 142 men had a free testosterone <190 pmol/L. During the 14-year duration follow-up, 22% of men experienced a myocardial infarction, 18% experienced a stroke, 11% developed angina, 14% underwent coronary revascularization. About 38% of the men initially recruited died. A lower total testosterone was associated with a higher body mass index (kg/m2) at follow-up: regression coefficient -0.30 (95% CI -0.445 to -0.157), P = 0.0001. The mortality rate was higher in patients with lower total testosterone compared to normal baseline total testosterone (5.0% vs 2.8% per year, P < 0.0001). A similar phenomenon was seen for dihydrotestosterone (4.3% vs 2.9% per year, P = 0.002) for normal vs low dihydrotestosterone) and for lower SHBG. Over the whole follow-up period 36.1% (143/396), men with normal baseline testosterone died vs 55.8% (86/154) of hypogonadal men at baseline. In Cox regression, the age-adjusted hazard ratio (HR) for higher mortality associated with low total testosterone was 1.54 (95% CI: 1.2-2.0, P < 0.002), corresponding to a 3.2 year reduced life expectancy for hypogonadal T2DM men. CONCLUSION Low testosterone and dihydrotestosterone levels are associated with higher all-cause mortality in T2DM men. Hypogonadal men with T2DM should be considered as very high risk for cardiovascular events/death.
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Affiliation(s)
- Nagaraj S. Malipatil
- The School of Medicine and Manchester Academic Health Sciences CentreUniversity of ManchesterManchesterUK
- Department of Diabetes and EndocrinologySalford Royal HospitalSalfordUK
| | - Ghasem Yadegarfar
- The School of Medicine and Manchester Academic Health Sciences CentreUniversity of ManchesterManchesterUK
- Heart Failure Research Centre (HF/PROVE), School of Public HealthIsfahan University of Medical SciencesIsfahanIran
| | - Mark Lunt
- The School of Medicine and Manchester Academic Health Sciences CentreUniversity of ManchesterManchesterUK
| | - Brian Keevil
- University of South Manchester NHS Foundation TrustManchesterUK
| | - Kirk Siddals
- The School of Medicine and Manchester Academic Health Sciences CentreUniversity of ManchesterManchesterUK
| | | | - Siriol Roberts
- The School of Medicine and Manchester Academic Health Sciences CentreUniversity of ManchesterManchesterUK
| | - Prakash Narayanan
- The School of Medicine and Manchester Academic Health Sciences CentreUniversity of ManchesterManchesterUK
| | - Martin Rutter
- Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Manchester University NHS Foundation TrustManchesterUK
| | - J. Martin Gibson
- The School of Medicine and Manchester Academic Health Sciences CentreUniversity of ManchesterManchesterUK
- Department of Diabetes and EndocrinologySalford Royal HospitalSalfordUK
| | - Rachelle Donn
- The School of Medicine and Manchester Academic Health Sciences CentreUniversity of ManchesterManchesterUK
| | - Geoff Hackett
- Department of Sexual MedicineHeartlands HospitalBirminghamUK
| | - T. Hugh Jones
- Department of Oncology and MetabolismUniversity of SheffieldSheffieldUK
| | - Adrian Heald
- The School of Medicine and Manchester Academic Health Sciences CentreUniversity of ManchesterManchesterUK
- Department of Diabetes and EndocrinologySalford Royal HospitalSalfordUK
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14
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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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15
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Contreras M, Raisingani M, Chandler DW, Curtin WD, Barillas J, Brar PC, Prasad K, Shah B, David R. Salivary Testosterone during the Minipuberty of Infancy
. Horm Res Paediatr 2019; 87:111-115. [PMID: 28073108 DOI: 10.1159/000454862] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 11/01/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The hypothalamic-pituitary-gonadal axis is transiently activated during the postnatal months in boys, a phenomenon termed "minipuberty" of infancy, when serum testosterone (T) increases to pubertal levels. Despite high circulating T there are no signs of virilization. We hypothesize that free T as measured in saliva is low, which would explain the absence of virilization. METHODS We measured serum total T and free T in saliva using liquid chromatography-tandem mass spectrometry (LC-MS/MS) in 30 infant boys, aged 1-6 months, and in 12 adolescents, aged 11-17 years. RESULTS Total serum T in all infants was, as expected, high (172 ± 78 ng/dL) while salivary T was low (7.7 ± 4 pg/mL or 0.45 ± 0.20%). In contrast, salivary T in the adolescents was much higher (41 ± 18 pg/mL or 1.3 ± 0.36%) in relation to their total serum T (323 ± 117 ng/dL). We provide for the first time reference data for salivary T in infants. CONCLUSION Measurement of salivary T by LC-MS/MS is a promising noninvasive technique to reflect free T in infants. The low free T explains the absence of virilization. The minipuberty of infancy is more likely of intragonadal than peripheral significance.
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16
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Asselmann E, Kische H, Haring R, Hertel J, Schmidt CO, Nauck M, Beesdo-Baum K, Grabe HJ, Pané-Farré CA. Prospective associations of androgens and sex hormone-binding globulin with 12-month, lifetime and incident anxiety and depressive disorders in men and women from the general population. J Affect Disord 2019; 245:905-911. [PMID: 30699875 DOI: 10.1016/j.jad.2018.11.052] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 10/05/2018] [Accepted: 11/03/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Findings on associations of androgens and sex hormone-binding globulin (SHBG) with anxiety and depressive disorders in the general population remain inconclusive. METHODS We used data of n = 993 men and n = 980 women from the Study of Health in Pomerania (SHIP, a prospective-longitudinal general population study from northeastern Germany). Immunoassay-measured serum concentrations of total testosterone, androstenedione and SHBG were assessed when participants were aged 20-80. 12-month, lifetime and incident DSM-IV anxiety and depressive disorders were assessed with the DIA-X/M-CIDI at 10-year follow-up, when participants were aged 29-89. Logistic regressions were adjusted for age, smoking, alcohol consumption, physical activity, waist circumference, hypertension and oral contraceptive use (women only) at baseline and follow-up interval. RESULTS In men and women, androgens and SHBG were not associated significantly with incident anxiety and depressive disorders. In men, higher total testosterone predicted any 12-month (OR = 1.46) and lifetime (OR = 1.34) anxiety disorder, lifetime social phobia (OR = 2.15), and 12-month (OR = 1.48) and lifetime (OR = 1.39) specific phobia, but neither 12-month nor lifetime depression. Moreover, androstenedione in men interacted with age in predicting lifetime anxiety disorders (OR = 0.98): Higher androstenedione more strongly predicted lifetime anxiety in younger vs. older men. These findings, however, did not survive correction for multiple testing. In women, androgens and SHBG were not associated significantly with 12-month and lifetime anxiety and depressive disorders. LIMITATIONS The follow-up period was relatively long and other factors might have affected the examined associations. CONCLUSIONS Higher serum total testosterone in men and androstenedione in younger men may relate to an increased risk of anxiety disorders.
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Affiliation(s)
- Eva Asselmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany; Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
| | - Hanna Kische
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Robin Haring
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Johannes Hertel
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | | | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research, Partner Site Greifswald, University Medicine Greifswald, Greifswald, Germany
| | - Katja Beesdo-Baum
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Hans-Jörgen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Christiane A Pané-Farré
- Department of Physiological and Clinical Psychology, University of Greifswald, Greifswald, Germany
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Desai R, Harwood DT, Handelsman DJ. Simultaneous measurement of 18 steroids in human and mouse serum by liquid chromatography-mass spectrometry without derivatization to profile the classical and alternate pathways of androgen synthesis and metabolism. CLINICAL MASS SPECTROMETRY (DEL MAR, CALIF.) 2019; 11:42-51. [PMID: 34841072 PMCID: PMC8620903 DOI: 10.1016/j.clinms.2018.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/26/2018] [Accepted: 12/30/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The recently identified alternate, or backdoor, pathway of DHT synthesis provides important novel information on androgen biosynthesis beyond the classical pathway. We report a rapid and versatile liquid chromatography-tandem mass spectrometry (LC-MS/MS) method to simultaneously and accurately quantify key steroids in human or mouse serum involved in either the classical or backdoor androgen synthesis pathways. METHODS Serum (200 µL) fortified with isotopically labelled internal standards underwent liquid-liquid extraction (LLE) with MTBE and extracts were analysed on a LC-MS/MS. The targeted steroids for quantification were testosterone (T), dihydrotestosterone (DHT), 5α-androstane-3α,17β-diol (3α diol), 5α-androstane-3β,17β-diol (3β diol), dehydroepiandrosterone (DHEA), androstenedione (A4), androsterone (AD), estradiol (E2), estrone (E1), progesterone (P4), pregnenolone (P5), androstenediol (Adiol), 17-hydroxyprogesterone (17-OHP4) and 17-hydroxypregnenolone (17-OHP5), corticosterone (B), cortisol (F), allopregnanolone (Allo-P5) and dihydroprogesterone (DHP). RESULTS The limits of quantification (LOQ) were 5 pg/mL for E2 and E1, 25 pg/mL for T, 50 pg/mL for A4 and 0.10 ng/mL for DHT, 17OHP5, P4, P5, AD, Adiol, DHEA, AlloP5 and 0.20 ng/mL for 17OHP4, 3α diol, 3β diol, DHP, 0.25 ng/mL for B and 1 ng/mL for F. Accuracy, precision, reproducibility and recovery were within acceptable limits for bioanalytical method validation. The method is illustrated in human and mouse, male and female serum. CONCLUSIONS The presented method is sufficiently sensitive, specific and reproducible to meet the quality criteria for routine laboratory application for accurate quantitation of 18 steroid concentrations in male and female serum from humans or mice for the purpose of profiling androgen synthesis and metabolism pathways.
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Key Words
- 17OHP4, 17-hydroxyprogesterone
- 17OHP5, 17hydroxypregnenolone
- 3α diol, 5α-androstane-3α17β-diol
- 3β diol, 5α-androstane-3β17β-diol
- A4, androstenedione
- AD, androsterone
- APPI, atmospheric pressure photoionization
- Adiol, androstenediol
- AlloP5, allopregnanolone
- Androgen
- B, corticosterone
- CSP, Charcoal Stripped Plasma
- DHEA, dehydroepiandrosterone
- DHP, dihydroprogesterone
- DHT, dihydrotestosterone
- Dihydrotestosterone
- E1, estrone
- E2, estradiol
- F, cortisol
- IS, internal standard
- LOD, lower limit of detection
- LOQ, lower limit of quantification
- Liquid chromatography–mass spectrometry
- ME, matrix effect
- MTBE, methyl tert-butyl ether
- NMI, National Measurement Institute
- P4, progesterone
- P5, pregnenolone
- S/N, signal-to-noise ratio
- Steroidogenesis
- T, testosterone
- Testosterone
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Affiliation(s)
- Reena Desai
- ANZAC Research Institute, University of Sydney, Sydney, NSW 2139, Australia
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18
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French D, Drees J, Stone JA, Holmes DT, van der Gugten JG. Comparison of four clinically validated testosterone LC-MS/MS assays: Harmonization is an attainable goal. CLINICAL MASS SPECTROMETRY 2018; 11:12-20. [PMID: 34841068 DOI: 10.1016/j.clinms.2018.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 11/30/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Abstract
Introduction Immunoassays and liquid chromatography-tandem mass spectrometry assays are commonly employed in clinical laboratories for measurement of total testosterone in serum. Results obtained from either of these methodologies compare poorly due to differences in calibration and/or inadvertent detection of interfering substances by the immunoassays. Standardization efforts are underway, but recent studies indicate that accuracy remains an issue. Methods This study compares the results from four independently developed and validated LC-MS/MS assays for total testosterone. The calibration for each assay was verified using National Institute of Standards and Technology Standard Reference Material 971. Results Initially, one of the four assays had a mean percent difference of +11.44%, compared to the All Method Mean, but following re-verification of all five non-zero calibrator concentrations with the NIST SRM 971, the mean percent difference decreased to -4.88%. Subsequently, the agreement between all four assays showed a mean bias of <5% across the range of all testosterone concentrations (0.13-38.10 nmol/L; 3.7-1098 ng/dL), including at low concentrations of <1 nmol/L (<29 ng/dL). Conclusions Excellent agreement between four independently developed LC-MS/MS assays demonstrates that harmonization using standard reference material is attainable. However, as we found in this study, to ensure accurate calibration it is critical to validate the concentrations of new lots of calibrators.
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Key Words
- AMM, All Method Mean
- CDC, Centers for Disease Control and Prevention
- CofA, certificate of analysis
- ESI, electrospray ionization
- GC-MS, gas chromatography-mass spectrometry
- GC-MS/MS, gas chromatography-tandem mass spectrometry
- HoSt, Hormone Standardization Program
- KP, Kaiser Permanente Northern California Regional Laboratory
- LC-MS/MS, harmonization
- LC-MS/MS, liquid chromatography-tandem mass spectrometry
- Mass spectrometry
- NIST SRM 971, National Institute of Standards and Technology Standard Reference Material 971
- NIST, National Institute of Standards and Technology
- RIA, radioimmunoassay
- RMP, reference measurement procedure
- SD, standard deviation
- SPH, Department of Pathology and Laboratory Medicine, St Paul’s Hospital
- SRM, selected reaction monitoring
- Standardization
- Testosterone
- UCSD, University of California San Diego Health Center for Advanced Laboratory Medicine
- UCSF, Department of Laboratory Medicine, University of California San Francisco
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Affiliation(s)
- Deborah French
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94107, United States
| | - Julia Drees
- Kaiser Permanente Northern California Regional Laboratory, Richmond, CA, United States
| | - Judith A Stone
- University of California San Diego Health Center for Advanced Laboratory Medicine, San Diego, CA, United States
| | - Daniel T Holmes
- Department of Pathology and Laboratory Medicine, St Paul's Hospital, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - J Grace van der Gugten
- Department of Pathology and Laboratory Medicine, St Paul's Hospital, Vancouver, British Columbia, Canada
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How low can you go? Analytical performance of five automated testosterone immunoassays. Clin Biochem 2018; 58:64-71. [DOI: 10.1016/j.clinbiochem.2018.05.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/21/2018] [Accepted: 05/08/2018] [Indexed: 11/18/2022]
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Brossaud J, Leban M, Corcuff JB, Boux de Casson F, Leloupp AG, Masson D, Moal V, Bach-Ngohou K. LC-MSMS assays of urinary cortisol, a comparison between four in-house assays. ACTA ACUST UNITED AC 2018; 56:1109-1116. [DOI: 10.1515/cclm-2017-0806] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/30/2017] [Indexed: 12/18/2022]
Abstract
Abstract
Background:
Twenty-four hour urinary free cortisol (UFC) determination can be used for screening and follow-up of Cushing syndrome (CS). As immunoassay methods lack specificity for UFC measurement, the use of high-performance liquid chromatography coupled to mass spectrometer (LC-MSMS) is recommended. The aim of our study was to compare UFC results using four LC-MSMS methods performed in four independent laboratories in order to evaluate interlaboratory agreement.
Methods:
Frozen aliquots of 24-h urine samples (78 healthy volunteers and 20 patients with CS) were sent to four different laboratories for analysis. Following liquid-liquid or solid-liquid extraction, UFC were determined using four different LC-MSMS assay.
Results:
UFC intra- and interassays variation coefficients were lower than 10% for each centre. External quality control results were not significantly different. UFC normal ranges (established from healthy volunteers) were 17–126, 15–134, 12–118 and 27–157 nmol/day, respectively. Classification of UFC from healthy volunteers and patients with CS using a 95th percentile threshold was similar. However, for extreme UFC values (<50 or >270 nmol/day), negative or positive bias was noted.
Conclusions:
Even for highly specific methods such as LC-MSMS, variations of results can be found depending on analytical process. Validation of LC-MSMS methods including determination of the reference range is essential.
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Comas I, Ferrer R, Planas J, Celma A, Regis L, Morote J. A systematic review of methods for quantifying serum testosterone in patients with prostate cancer who underwent castration. Actas Urol Esp 2018; 42:86-93. [PMID: 28259362 DOI: 10.1016/j.acuro.2017.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 01/04/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND The clinical practice guidelines recommend measuring serum testosterone in patients with prostate cancer (PC) who undergo castration. The serum testosterone concentration should be <50ng/dL, a level established by using a radioimmunoassay method. The use of chemiluminescent immunoassays (IA) has become widespread, although their metrological characteristics do not seem appropriate for quantifying low testosterone concentrations. The objective of this review is to analyse the methods for quantifying testosterone and to establish whether there is scientific evidence that justifies measuring it in patients with PC who undergo castration, through liquid chromatography attached to a mass spectrometry in tandem (LC-MSMS). MATERIAL AND METHODS We performed a search in PubMed with the following MeSH terms: measurement, testosterone, androgen suppression and prostate cancer. We selected 12 studies that compared the metrological characteristics of various methods for quantifying serum testosterone compared with MS detection methods. RESULTS IAs are standard tools for measuring testosterone levels; however, there is evidence that IAs lack accuracy and precision for quantifying low concentrations. Most chemiluminescent IAs overestimate their concentration, especially below 100ng/dL. The procedures that use LC-MSMS have an adequate lower quantification limit and proper accuracy and precision. We found no specific evidence in patients with PC who underwent castration. CONCLUSIONS LC-MSMS is the appropriate method for quantifying low serum testosterone concentrations. We need to define the level of castration with this method and the optimal level related to better progression of the disease.
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Affiliation(s)
- I Comas
- Servicio de Bioquímica Clínica, Laboratoris Clínics, Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, España.
| | - R Ferrer
- Servicio de Bioquímica Clínica, Laboratoris Clínics, Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, España
| | - J Planas
- Servicio de Urología, Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, España
| | - A Celma
- Servicio de Urología, Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, España
| | - L Regis
- Servicio de Urología, Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, España
| | - J Morote
- Servicio de Urología, Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, España
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Chen L, Smith J, Mikl J, Fryer R, Pack F, Williams BJ, Phillips JA, Papov VV. A Multiplatform Approach for the Discovery of Novel Drug-Induced Kidney Injury Biomarkers. Chem Res Toxicol 2017; 30:1823-1834. [PMID: 28885000 DOI: 10.1021/acs.chemrestox.7b00159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Drug-induced kidney injury (DIKI) is a common toxicity observed in pharmaceutical development. We demonstrated the use of label-free liquid chromatography-mass spectrometry (LC-MS) and multiplex liquid chromatography-single reaction monitoring (LC-SRM) as practical extensions of standard immunoassay based safety biomarker assessments for identification of new toxicity marker candidates and for improved mechanistic understanding. Two different anticancer drugs, doxorubicin (DOX) and cisplatin (cis-diamminedichloridoplatinum, CDDP), were chosen as the toxicants due to their different modes of nephrotoxicity. Analyses of urine samples from toxicant treated and untreated rats were compared to identify biochemical analytes that changed in response to toxicant exposure. A discovery (label-free LC-MS) and targeted proteomics (multiplex LC-SRM) approach was used in combination with well established immunoassay experiments for the identification of a panel of urinary protein markers related to drug induced nephrotoxicity in rats. The initial generation of an expanded set of markers was accomplished using the label-free LC-MS discovery screen and ELISA based analysis of six nephrotoxicity biomarker proteins. Diagnostic performance of the expanded analyte set was statistically compared to conventional nephrotoxicity biomarkers. False discovery rate (FDR) analysis revealed 18 and 28 proteins from the CDDP and DOX groups, respectively, exhibiting significant differences between the vehicle and treated groups. Multiplex SRM assays were constructed to more precisely quantify candidate markers selected from the discovery screen and immunoassay experiments. To evaluate the sensitivity and specificity for each of the candidate biomarkers, histopathology severity scores were used as a benchmark for renal injury followed by receiver-operating characteristic (ROC) curve analysis on selected biomarkers. Further examination of the best performing analytes revealed relevant biological significance after consideration of anatomical localization and functional roles. In summary, the inclusion of mass spectrometry together with conventional ELISA based assays resulted in the identification of an expanded set of biomarkers with a realistic potential for providing additional beneficial information in mechanistic investigations of drug induced kidney injury and with similar responsiveness to conventionally applied indicators of renal injury.
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Affiliation(s)
- Liuxi Chen
- Boehringer Ingelheim Pharmaceuticals , Ridgefield, Connecticut 06877, United States
| | - James Smith
- Boehringer Ingelheim Pharmaceuticals , Ridgefield, Connecticut 06877, United States
| | - Jaromir Mikl
- Boehringer Ingelheim Pharmaceuticals , Ridgefield, Connecticut 06877, United States
| | - Ryan Fryer
- Boehringer Ingelheim Pharmaceuticals , Ridgefield, Connecticut 06877, United States
| | - Frank Pack
- Boehringer Ingelheim Pharmaceuticals , Ridgefield, Connecticut 06877, United States
| | - Brad J Williams
- Waters Corporation, Milford, Massachusetts 01757, United States
| | - Jonathan A Phillips
- Boehringer Ingelheim Pharmaceuticals , Ridgefield, Connecticut 06877, United States
| | - Vladimir V Papov
- Boehringer Ingelheim Pharmaceuticals , Ridgefield, Connecticut 06877, United States
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23
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Pätzug K, Friedrich N, Kische H, Hannemann A, Völzke H, Nauck M, Keevil BG, Haring R. Sex hormones and quantitative ultrasound parameters at the heel in men and women from the general population. Bone Rep 2017; 7:51-56. [PMID: 28875157 PMCID: PMC5574814 DOI: 10.1016/j.bonr.2017.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 08/15/2017] [Accepted: 08/17/2017] [Indexed: 11/28/2022] Open
Abstract
Purpose/introduction The present study investigates potential associations between liquid chromatography-mass spectrometry (LC-MS) measured sex hormones, dehydroepiandrosterone sulphate, sex hormone-binding globulin (SHBG) and bone ultrasound parameters at the heel in men and women from the general population. Methods Data from 502 women and 425 men from the population-based Study of Health in Pomerania (SHIP-TREND) were used. Cross-sectional associations of sex hormones including testosterone (TT), calculated free testosterone (FT), dehydroepiandrosterone sulphate (DHEAS), androstenedione (ASD), estrone (E1) and SHBG with quantitative ultrasound (QUS) parameters at the heel, including broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (SI) were examined by analysis of variance (ANOVA) and multivariable quantile regression models. Results Multivariable regression analysis showed a sex-specific inverse association of DHEAS with SI in men (Beta per SI unit = − 3.08, standard error (SE) = 0.88), but not in women (Beta = − 0.01, SE = 2.09). Furthermore, FT was positively associated with BUA in men (Beta per BUA unit = 29.0, SE = 10.1). None of the other sex hormones (ASD, E1) or SHBG was associated with QUS parameters after multivariable adjustment. Conclusions This cross-sectional population-based study revealed independent associations of DHEAS and FT with QUS parameters in men, suggesting a potential influence on male bone metabolism. The predictive role of DHEAS and FT as a marker for osteoporosis in men warrants further investigation in clinical trials and large-scale observational studies. Population-based data of healthy men and women from the general population Sex hormone panel measured by liquid chromatography-mass spectrometry (LC-MS) Associations of dehydroepiandrosterone sulphate and free testosterone with bone ultrasound parameters in men Estrone, androstenedione and SHBG were not associated with bone ultrasound parameters in both sexes.
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Key Words
- ANOVA, analysis of variance
- ASD, androstenedione
- BMD, bone mineral density
- BUA, broadband ultrasound attenuation
- Bone
- CI, confidence interval
- DHEAS
- DHEAS, dehydroepiandrosterone sulphate
- E1, estrone
- FT, free testosterone
- LC-MS, liquid chromatography-mass spectrometry
- QUS, quantitative ultrasound
- SE, standard error
- SHBG, sex hormone-binding globulin
- SHIP, Study of Health in Pomerania
- SI, stiffness index
- SOS, speed of sound
- Sex hormones
- Stiffness index
- TT, testosterone
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Affiliation(s)
- Konrad Pätzug
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Germany
| | - Nele Friedrich
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Germany
| | - Hanna Kische
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Germany
| | - Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Greifswald, Germany.,DZD (German Centre for Diabetes Research), Greifswald, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Greifswald, Germany
| | - Brian G Keevil
- Department of Clinical Chemistry, University Hospital South Manchester, UK
| | - Robin Haring
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Germany.,European University of Applied Sciences, Faculty of Applied Public Health, Rostock, Germany.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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24
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van Gemert WA, Monninkhof EM, May AM, Elias SG, van der Palen J, Veldhuis W, Stapper M, Stellato RK, Schuit JA, Peeters PH. Association between changes in fat distribution and biomarkers for breast cancer. Endocr Relat Cancer 2017; 24:297-305. [PMID: 28512158 DOI: 10.1530/erc-16-0490] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 04/07/2017] [Indexed: 12/12/2022]
Abstract
We assessed the associations between changes in total and abdominal fat and changes in biomarkers for breast cancer risk using data of the SHAPE-2 trial. In the SHAPE-2 trial, 243 postmenopausal overweight women were included. The intervention in this trial consisted of 5-6 kg weight loss either by diet only or exercise plus diet. After 16 weeks, we measured serum sex hormones, inflammatory markers, total body fat (measured by DEXA scan) and intra and subcutaneous abdominal fat (measured by MRI). Associations between changes in different body fat depots and biomarkers were analysed by linear regression using the study cohort irrespective of randomisation to make maximal use of the distribution of changes in fat measures. We found that a loss in total body fat was associated with favourable changes in free oestradiol, free testosterone, leptin and sex hormone binding globulin (SHBG). The loss of intra-abdominal fat was associated with a decrease in free testosterone, hsCRP and leptin, and an increase in SHBG. In the multivariable analysis, the best fitted models for the biomarkers free oestradiol, SHBG leptin and adiponectin included only total body fat. For free testosterone, this was subcutaneous abdominal fat, and for hsCRP and IL-6, only intra-abdominal fat change was important. For IL-6 and adiponectin, however, associations were weak and not significant. We conclude that, in our population of healthy overweight postmenopausal women, loss of fat at different body locations was associated with changes in different types of biomarkers, known to be related to risk of breast cancer.
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Affiliation(s)
- Willemijn A van Gemert
- Department of EpidemiologyJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Evelyn M Monninkhof
- Department of EpidemiologyJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anne M May
- Department of EpidemiologyJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sjoerd G Elias
- Department of EpidemiologyJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Job van der Palen
- Medisch Spectrum Twente HospitalDepartment of Epidemiology, Enschede, the Netherlands
- Department of Research methodologyMeasurement and Data analysis, University of Twente, Enschede, the Netherlands
| | - Wouter Veldhuis
- Department of RadiologyUniversity Medical Center Utrecht, Utrecht, the Netherlands
| | - Maaike Stapper
- Department of EpidemiologyJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rebecca K Stellato
- Department of Biostatistics and Research SupportJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jantine A Schuit
- Division of Public Health and Health CareNational Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Department of Health Sciences and EMGO Institute for Health and Care ResearchVU University, Amsterdam, the Netherlands
| | - Petra H Peeters
- Department of EpidemiologyJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- MRC-PHE Centre for Environment and HealthDepartment of Epidemiology and Biostatistics, School of Public Health, Imperial College, South Kensington Campus, London, UK
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25
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Sex-specific metabolic profiles of androgens and its main binding protein SHBG in a middle aged population without diabetes. Sci Rep 2017; 7:2235. [PMID: 28533544 PMCID: PMC5440388 DOI: 10.1038/s41598-017-02367-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 04/10/2017] [Indexed: 01/21/2023] Open
Abstract
The role of androgens in metabolism with respect to sex-specific disease associations is poorly understood. Therefore, we aimed to provide molecular signatures in plasma and urine of androgen action in a sex-specific manner using state-of-the-art metabolomics techniques. Our study population consisted of 430 men and 343 women, aged 20-80 years, who were recruited for the cross-sectional population-based Study of Health in Pomerania (SHIP-TREND), Germany. We used linear regression models to identify associations between testosterone, androstenedione and dehydroepiandrosterone-sulfate (DHEAS) as well as sex hormone-binding globulin and plasma or urine metabolites measured by mass spectrometry. The analyses revealed major sex-specific differences in androgen-associated metabolites, particularly for levels of urate, lipids and metabolic surrogates of lifestyle factors, like cotinine or piperine. In women, in particular in the postmenopausal state, androgens showed a greater impact on the metabolome than in men (especially DHEAS and lipids were highly related in women). We observed a novel association of androstenedione on the metabolism of biogenic amines and only a small sex-overlap of associations within steroid metabolism. The present study yields new insights in the interaction between androgens and metabolism, especially about their implication in female metabolism.
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Kische H, Gross S, Wallaschofski H, Grabe HJ, Völzke H, Nauck M, Haring R. Associations of androgens with depressive symptoms and cognitive status in the general population. PLoS One 2017; 12:e0177272. [PMID: 28498873 PMCID: PMC5428943 DOI: 10.1371/journal.pone.0177272] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 04/25/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Associations between androgens and depressive symptoms were mostly reported from cross-sectional and patient-based studies. STUDY DESIGN/MAIN OUTCOME MEASURES Longitudinal data from 4,110 participants of the Study of Health in Pomerania were used to assess sex-specific associations of baseline total and free testosterone, androstenedione and sex hormone-binding globulin with incident depressive symptoms and cognitive status at 5- and 10-year follow-up. RESULTS Despite sex-specific differences in depressive symptoms prevalence at baseline (women: 17.4%, men: 8.1%), cross-sectional analyses showed no associations between sex hormones and depressive symptoms. In age-adjusted longitudinal analyses, total testosterone was associated with incident depressive symptoms (relative risk at 5-year follow-up: 0.73, 95% confidence interval: 0.58-0.92). Similarly, age-adjusted analyses showed a positive association between sex hormone-binding globulin and cognitive status in men (β-coefficient per standard deviation: 0.44, 95% confidence interval: 0.13-0.74). In women, age-adjusted associations of androstenedione with baseline depressive symptoms (relative risk: 0.88, 95% confidence interval: 0.77-0.99) were found. None of the observed associations remained after multivariable adjustment. CONCLUSIONS The present population-based, longitudinal study revealed inverse associations between sex hormones and depressive symptoms. However, the null finding after multivariable adjustment suggests, that the observed associations were not independent of relevant confounders including body mass index, smoking and physical inactivity. Furthermore, the low number of incident endpoints in our non-clinical population-based sample limited the statistical power and reduced the chance to detect a statistically significant effect.
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Affiliation(s)
- Hanna Kische
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
- * E-mail:
| | - Stefan Gross
- German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
- Department of Cardiology, University Medicine Greifswald, Greifswald, Germany
| | - Henri Wallaschofski
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Hans Jörgen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
| | - Robin Haring
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
- European University of Applied Sciences, Faculty of Applied Public Health, Rostock, Germany
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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27
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Causal relationship between obesity and serum testosterone status in men: A bi-directional mendelian randomization analysis. PLoS One 2017; 12:e0176277. [PMID: 28448539 PMCID: PMC5407807 DOI: 10.1371/journal.pone.0176277] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 04/07/2017] [Indexed: 11/20/2022] Open
Abstract
CONTEXT Obesity in men is associated with low serum testosterone and both are associated with several diseases and increased mortality. OBJECTIVES Examine the direction and causality of the relationship between body mass index (BMI) and serum testosterone. DESIGN Bi-directional Mendelian randomization (MR) analysis on prospective cohorts. SETTING Five cohorts from Denmark, Germany and Sweden (Inter99, SHIP, SHIP Trend, GOOD and MrOS Sweden). PARTICIPANTS 7446 Caucasian men, genotyped for 97 BMI-associated SNPs and three testosterone-associated SNPs. MAIN OUTCOME MEASURES BMI and serum testosterone adjusted for age, smoking, time of blood sampling and site. RESULTS 1 SD genetically instrumented increase in BMI was associated with a 0.25 SD decrease in serum testosterone (IV ratio: -0.25, 95% CI: -0.42--0.09, p = 2.8*10-3). For a body weight reduction altering the BMI from 30 to 25 kg/m2, the effect would equal a 13% increase in serum testosterone. No association was seen for genetically instrumented testosterone with BMI, a finding that was confirmed using large-scale data from the GIANT consortium (n = 104349). CONCLUSIONS Our results suggest that there is a causal effect of BMI on serum testosterone in men. Population level interventions to reduce BMI are expected to increase serum testosterone in men.
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Cao ZT, Botelho JC, Rej R, Vesper H. Accuracy-based proficiency testing for testosterone measurements with immunoassays and liquid chromatography-mass spectrometry. Clin Chim Acta 2017; 469:31-36. [PMID: 28288785 DOI: 10.1016/j.cca.2017.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Accurate testosterone measurements are needed to correctly diagnose and treat patients. Proficiency Testing (PT) programs using modified specimens for testing can be limited because of matrix effects and usage of non-reference measurement procedure (RMP)-defined targets for evaluation. Accuracy-based PT can overcome such limitations; however, there is a lack of information on accuracy-based PT and feasibility of its implementation in evaluation for testosterone measurements. METHODS Unaltered, single-donor human serum from 2 male and 2 female adult donors were analyzed for testosterone by 142 NYSDH-certified clinical laboratories using 16 immunoassays and LC-MS/MS methods. Testosterone target values were determined using an RMP. RESULTS The testosterone target concentrations for the 4 specimens were 15.5, 30.0, 402 and 498ng/dl. The biases ranged from -17.8% to 73.1%, 3.1% to 21.3%, -24.8% to 8.6%, and -22.1% to 6.8% for the 4 specimens, respectively. Using a total error target of ±25.1%, which was calculated using the minimum allowable bias and imprecision, 73% of participating laboratories had ≥3 of the 4 results within these limits. CONCLUSIONS The variability in total testosterone measurements can affect clinical decisions. Accuracy-based PT can significantly contribute to improving testosterone testing by providing reliable data on accuracy in patient care to laboratories, assay manufacturers, and standardization programs.
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Affiliation(s)
- Zhimin Tim Cao
- Wadsworth Center, New York State Department of Health, Albany, NY, United States; College of Arts and Sciences, University at Albany, State University of New York, Albany, NY, United States
| | | | - Robert Rej
- Wadsworth Center, New York State Department of Health, Albany, NY, United States; School of Public Health, University at Albany, State University of New York, Albany, NY, United States
| | - Hubert Vesper
- Centers for Disease Control and Prevention, Atlanta, GA, United States.
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29
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Romanski P, Stanic AK. Practical Approach to the PCOS Patient. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0190-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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30
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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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31
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Kische H, Gross S, Wallaschofski H, Völzke H, Dörr M, Nauck M, Haring R. Clinical correlates of sex hormones in women: The study of health in Pomerania. Metabolism 2016; 65:1286-96. [PMID: 27506736 DOI: 10.1016/j.metabol.2016.05.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/25/2016] [Accepted: 05/17/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite associations of sex hormones in women with increased cardiometabolic risk and mortality, the clinical correlates of altered sex hormone concentrations in women are less clearly understood. We investigated a broad range of clinical correlates of sex hormones in women from a large population-based sample. METHODS Data from 2560 women from two cohorts of the Study of Health in Pomerania were used. Stepwise multivariable regression models were implemented to investigate a broad range of behavioral, socio-demographic, and cardiometabolic clinical correlates related to total testosterone (TT), free testosterone (fT), androstenedione (ASD), dehydroepiandrosterone-sulfate (DHEAS), estrone (E1), estradiol (E2), and sex hormone-binding globulin (SHBG). RESULTS Waist circumference and BMI (β-coefficient: -0.03; 95% CI: -0.04; 0.03) were inversely related to SHBG, and BMI was positively related to TT (β-coefficient: 0.005; 95% CI: 0.001; 0.009), fT, E1, and E2. Smoking was positively related to TT (β-coefficient: 0.04; 95% CI: 0.01; 0.06), ASD, and fT. Systolic blood pressure (TT: β-coefficient: 0.002; 95% CI: 0.001; 0.003), hypertension (TT: β-coefficient: 0.05; 95% CI: 0.003; 0.11), low-density lipoprotein (LDL) cholesterol (TT: β-coefficient: 0.02; 95% CI: 0.01; 0.05), and total cholesterol (TT: β-coefficient: -0.03; 95% CI: 0.01; 0.05) were positively related to TT and ASD. Finally, type 2 diabetes mellitus (T2DM), and metabolic syndrome (MetS) were positively related to fT, but inversely related to SHBG. CONCLUSIONS Our population-based study, with sex hormone concentrations measured by liquid chromatography tandem mass spectrometry, revealed associations between clinical correlates including waist circumference, smoking, cohabitation, systolic blood pressure, cholesterol, and MetS with sex hormones. Thus, sex hormones and SHBG may play a role in the cardiovascular risk profile of women.
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Affiliation(s)
- Hanna Kische
- Institute of Clinical Chemistry and Laboratory Medicine.
| | - Stefan Gross
- German Centre for Cardiovascular Research (DZHK), site Greifswald; Department of Cardiology, University Medicine Greifswald, Germany
| | | | - Henry Völzke
- German Centre for Cardiovascular Research (DZHK), site Greifswald; Institute for Community Medicine
| | - Marcus Dörr
- German Centre for Cardiovascular Research (DZHK), site Greifswald; Department of Cardiology, University Medicine Greifswald, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine; German Centre for Cardiovascular Research (DZHK), site Greifswald
| | - Robin Haring
- Institute of Clinical Chemistry and Laboratory Medicine; European University of Applied Sciences, Faculty of Applied Public Health, Rostock, Germany
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Kische H, Gross S, Wallaschofski H, Völzke H, Dörr M, Nauck M, Felix SB, Haring R. Serum androgen concentrations and subclinical measures of cardiovascular disease in men and women. Atherosclerosis 2016; 247:193-200. [PMID: 26926599 DOI: 10.1016/j.atherosclerosis.2016.02.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/09/2016] [Accepted: 02/17/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Most of the observed associations of androgens and sex hormone-binding globulin (SHBG) with subclinical cardiovascular disease (CVD) stem from selected study samples with immunoassay-based hormone measurements. Thus, we used a large population-based sample with total testosterone (TT) and androstenedione (ASD) concentrations measured by liquid chromatography-tandem mass spectrometry. DESIGN Data of 2140 individuals (mean age: 60,8 years) from the cohort Study of Health in Pomerania were assessed at baseline and 5-year follow-up. METHODS Multivariable regression models were implemented to assess cross-sectional and longitudinal associations of TT, free testosterone (fT), ASD, SHBG and dehydroepiandrosterone-sulphate (DHEAS) with measures of subclinical CVD including intima media thickness (IMT), carotid plaques, left ventricular mass (LVM), fractional shortening (FS), relative wall thickness (RWT), and left ventricular geometry. RESULTS Cross-sectional analyses yielded an association of TT with IMT in women (β-coefficient per log unit increase: 0.02; 95% CI: 0.007; 0.45) and ASD with FS in both sexes (men: β-coefficient: -2.94; 95% CI: -4.75; -1.12; women: β-coefficient: 1.64; 95% CI: 0.55; 2.73). In longitudinal analyses, DHEAS was positively associated with FS change (β-coefficient: 2.34; 95% CI: -0.59; 4.08). In women, SHBG was positively associated with incident plaques (Q1 vs. Q3 (Ref.): β-coefficient: 1.35; 95% CI: 1.04; 1.74). In both sexes, longitudinal analyses showed no consistent association of TT with subclinical CVD. CONCLUSIONS Despite several sex-specific associations of androgens and SHBG with subclinical CVD, the present representative study for the age group ≥45 years among men and women from the general population detected no consistent associations in longitudinal analyses.
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Affiliation(s)
- Hanna Kische
- Institute of Clinical Chemistry and Laboratory Medicine, Germany.
| | - Stefan Gross
- German Centre for Cardiovascular Research (DZHK), Greifswald, Germany; Department of Cardiology, University Medicine Greifswald, Germany
| | - Henri Wallaschofski
- Institute of Clinical Chemistry and Laboratory Medicine, Germany; German Centre for Cardiovascular Research (DZHK), Greifswald, Germany
| | - Henry Völzke
- German Centre for Cardiovascular Research (DZHK), Greifswald, Germany; Institute for Community Medicine, Germany
| | - Marcus Dörr
- German Centre for Cardiovascular Research (DZHK), Greifswald, Germany; Department of Cardiology, University Medicine Greifswald, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, Germany; German Centre for Cardiovascular Research (DZHK), Greifswald, Germany
| | - Stephan B Felix
- German Centre for Cardiovascular Research (DZHK), Greifswald, Germany; Department of Cardiology, University Medicine Greifswald, Germany
| | - Robin Haring
- Institute of Clinical Chemistry and Laboratory Medicine, Germany; European University of Applied Sciences, Faculty of Applied Public Health, Rostock, Germany
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Comparison of eight routine unpublished LC–MS/MS methods for the simultaneous measurement of testosterone and androstenedione in serum. Clin Chim Acta 2016; 454:112-8. [DOI: 10.1016/j.cca.2016.01.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 01/02/2016] [Accepted: 01/04/2016] [Indexed: 01/01/2023]
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Samietz S, Holtfreter B, Friedrich N, Mundt T, Hoffmann W, Völzke H, Nauck M, Kocher T, Biffar R. Prospective association of sex steroid concentrations with periodontal progression and incident tooth loss. J Clin Periodontol 2016; 43:10-8. [DOI: 10.1111/jcpe.12493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2015] [Indexed: 01/07/2023]
Affiliation(s)
- Stefanie Samietz
- Policlinic of Prosthetic Dentistry, Gerodontology and Biomaterials; Center of Oral Health; University Medicine Greifswald; Greifswald Germany
| | - Birte Holtfreter
- Unit of Periodontology; Department of Restorative Dentistry, Endodontology Periodontology and Pediatric Dentistry; Center of Oral Health; University Medicine Greifswald; Greifswald Germany
| | - Nele Friedrich
- Institute of Clinical Chemistry and Laboratory Medicine; University Medicine Greifswald; Greifswald Germany
| | - Torsten Mundt
- Policlinic of Prosthetic Dentistry, Gerodontology and Biomaterials; Center of Oral Health; University Medicine Greifswald; Greifswald Germany
| | - Wolfgang Hoffmann
- Institute of Community Medicine; Section Epidemiology of Health Care and Community Health; University Medicine Greifswald; Greifswald Germany
| | - Henry Völzke
- Institute for Community Medicine SHIP/Clinical-Epidemiological Research; University Medicine Greifswald; Greifswald Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine; University Medicine Greifswald; Greifswald Germany
| | - Thomas Kocher
- Unit of Periodontology; Department of Restorative Dentistry, Endodontology Periodontology and Pediatric Dentistry; Center of Oral Health; University Medicine Greifswald; Greifswald Germany
| | - Reiner Biffar
- Policlinic of Prosthetic Dentistry, Gerodontology and Biomaterials; Center of Oral Health; University Medicine Greifswald; Greifswald Germany
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Rappold BA. Mass Spectrometry Selectivity, Specifically. Clin Chem 2016; 62:154-6. [DOI: 10.1373/clinchem.2015.240614] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 07/30/2015] [Indexed: 11/06/2022]
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Fenske B, Kische H, Gross S, Wallaschofski H, Völzke H, Dörr M, Nauck M, Keevil BG, Brabant G, Haring R. Endogenous Androgens and Sex Hormone-Binding Globulin in Women and Risk of Metabolic Syndrome and Type 2 Diabetes. J Clin Endocrinol Metab 2015; 100:4595-603. [PMID: 26445113 DOI: 10.1210/jc.2015-2546] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
CONTEXT AND OBJECTIVES The association of endogenous androgens and sex hormone-binding globulin (SHBG) with metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM) mostly 23562 refers to small and selected study samples with immunoassay-based measurements. Thus, we investigated the association of hormone levels with MetS and T2DM in women from a large population-based sample. DESIGN, SETTING, AND PARTICIPANTS A total of 2077 women from the Study of Health in Pomerania were assessed at baseline (N = 3160, 1997-2001) and 5-year follow-up (N = 1711, 2002-2006). MAIN OUTCOMES AND MEASURES We investigated associations of total testosterone (T) and androstenedione measured by liquid chromatography-tandem mass spectrometry, SHBG by immunoassay, and free T and free androgen index with MetS and T2DM. RESULTS Baseline prevalence of MetS and T2DM was 23.1% (N = 365) and 9.5% (N = 196), with an incidence of 17.7 and 7.0 per 1.000 person-years, respectively. Cross-sectional analyses yielded inverse associations of SHBG with MetS (relative risk [RR], 0.67; 95% confidence interval [CI], 0.60-0.74) and T2DM (RR, 0.61; 95% CI, 0.50-0.74) after multivariable adjustment. In longitudinal analyses, only age-adjusted models showed an inverse association of baseline SHBG with incident MetS (RR, 0.61; 95% CI, 0.51-0.73) and T2DM (RR, 0.58; 95% CI, 0.43-0.78). Multivariable-adjusted models stratified by menopausal status revealed an inverse association between SHBG and incident MetS risk in postmenopausal women (RR, 0.65; 95% CI, 0.51-0.81). CONCLUSIONS This longitudinal population-based study revealed independent inverse associations of SHBG with MetS and T2DM, suggesting low SHBG as a potential risk marker for cardiometabolic morbidity, especially among postmenopausal women.
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Affiliation(s)
- Benjamin Fenske
- Institute of Clinical Chemistry and Laboratory Medicine (B.F., H.K. H.W., M.N., R.H.), DZHK (German Centre for Cardiovascular Research) (S.G., H.W., H.V., M.D., M.N., R.H.), Greifswald, Germany 17475, Institute for Community Medicine (H.V.), Department of Cardiology (S.G., M.D.), University Medicine Greifswald, Germany 17475; Department of Clinical Chemistry (B.G.K.), University Hospital, South Manchester, United Kingdom M23 9LT; Department of Internal Medicine I (G.B.), University Lübeck, Germany 23562; and European University of Applied Sciences (R.H.), Faculty of Applied Public Health, Rostock, Germany 18057
| | - Hanna Kische
- Institute of Clinical Chemistry and Laboratory Medicine (B.F., H.K. H.W., M.N., R.H.), DZHK (German Centre for Cardiovascular Research) (S.G., H.W., H.V., M.D., M.N., R.H.), Greifswald, Germany 17475, Institute for Community Medicine (H.V.), Department of Cardiology (S.G., M.D.), University Medicine Greifswald, Germany 17475; Department of Clinical Chemistry (B.G.K.), University Hospital, South Manchester, United Kingdom M23 9LT; Department of Internal Medicine I (G.B.), University Lübeck, Germany 23562; and European University of Applied Sciences (R.H.), Faculty of Applied Public Health, Rostock, Germany 18057
| | - Stefan Gross
- Institute of Clinical Chemistry and Laboratory Medicine (B.F., H.K. H.W., M.N., R.H.), DZHK (German Centre for Cardiovascular Research) (S.G., H.W., H.V., M.D., M.N., R.H.), Greifswald, Germany 17475, Institute for Community Medicine (H.V.), Department of Cardiology (S.G., M.D.), University Medicine Greifswald, Germany 17475; Department of Clinical Chemistry (B.G.K.), University Hospital, South Manchester, United Kingdom M23 9LT; Department of Internal Medicine I (G.B.), University Lübeck, Germany 23562; and European University of Applied Sciences (R.H.), Faculty of Applied Public Health, Rostock, Germany 18057
| | - Henri Wallaschofski
- Institute of Clinical Chemistry and Laboratory Medicine (B.F., H.K. H.W., M.N., R.H.), DZHK (German Centre for Cardiovascular Research) (S.G., H.W., H.V., M.D., M.N., R.H.), Greifswald, Germany 17475, Institute for Community Medicine (H.V.), Department of Cardiology (S.G., M.D.), University Medicine Greifswald, Germany 17475; Department of Clinical Chemistry (B.G.K.), University Hospital, South Manchester, United Kingdom M23 9LT; Department of Internal Medicine I (G.B.), University Lübeck, Germany 23562; and European University of Applied Sciences (R.H.), Faculty of Applied Public Health, Rostock, Germany 18057
| | - Henry Völzke
- Institute of Clinical Chemistry and Laboratory Medicine (B.F., H.K. H.W., M.N., R.H.), DZHK (German Centre for Cardiovascular Research) (S.G., H.W., H.V., M.D., M.N., R.H.), Greifswald, Germany 17475, Institute for Community Medicine (H.V.), Department of Cardiology (S.G., M.D.), University Medicine Greifswald, Germany 17475; Department of Clinical Chemistry (B.G.K.), University Hospital, South Manchester, United Kingdom M23 9LT; Department of Internal Medicine I (G.B.), University Lübeck, Germany 23562; and European University of Applied Sciences (R.H.), Faculty of Applied Public Health, Rostock, Germany 18057
| | - Marcus Dörr
- Institute of Clinical Chemistry and Laboratory Medicine (B.F., H.K. H.W., M.N., R.H.), DZHK (German Centre for Cardiovascular Research) (S.G., H.W., H.V., M.D., M.N., R.H.), Greifswald, Germany 17475, Institute for Community Medicine (H.V.), Department of Cardiology (S.G., M.D.), University Medicine Greifswald, Germany 17475; Department of Clinical Chemistry (B.G.K.), University Hospital, South Manchester, United Kingdom M23 9LT; Department of Internal Medicine I (G.B.), University Lübeck, Germany 23562; and European University of Applied Sciences (R.H.), Faculty of Applied Public Health, Rostock, Germany 18057
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine (B.F., H.K. H.W., M.N., R.H.), DZHK (German Centre for Cardiovascular Research) (S.G., H.W., H.V., M.D., M.N., R.H.), Greifswald, Germany 17475, Institute for Community Medicine (H.V.), Department of Cardiology (S.G., M.D.), University Medicine Greifswald, Germany 17475; Department of Clinical Chemistry (B.G.K.), University Hospital, South Manchester, United Kingdom M23 9LT; Department of Internal Medicine I (G.B.), University Lübeck, Germany 23562; and European University of Applied Sciences (R.H.), Faculty of Applied Public Health, Rostock, Germany 18057
| | - Brian G Keevil
- Institute of Clinical Chemistry and Laboratory Medicine (B.F., H.K. H.W., M.N., R.H.), DZHK (German Centre for Cardiovascular Research) (S.G., H.W., H.V., M.D., M.N., R.H.), Greifswald, Germany 17475, Institute for Community Medicine (H.V.), Department of Cardiology (S.G., M.D.), University Medicine Greifswald, Germany 17475; Department of Clinical Chemistry (B.G.K.), University Hospital, South Manchester, United Kingdom M23 9LT; Department of Internal Medicine I (G.B.), University Lübeck, Germany 23562; and European University of Applied Sciences (R.H.), Faculty of Applied Public Health, Rostock, Germany 18057
| | - Georg Brabant
- Institute of Clinical Chemistry and Laboratory Medicine (B.F., H.K. H.W., M.N., R.H.), DZHK (German Centre for Cardiovascular Research) (S.G., H.W., H.V., M.D., M.N., R.H.), Greifswald, Germany 17475, Institute for Community Medicine (H.V.), Department of Cardiology (S.G., M.D.), University Medicine Greifswald, Germany 17475; Department of Clinical Chemistry (B.G.K.), University Hospital, South Manchester, United Kingdom M23 9LT; Department of Internal Medicine I (G.B.), University Lübeck, Germany 23562; and European University of Applied Sciences (R.H.), Faculty of Applied Public Health, Rostock, Germany 18057
| | - Robin Haring
- Institute of Clinical Chemistry and Laboratory Medicine (B.F., H.K. H.W., M.N., R.H.), DZHK (German Centre for Cardiovascular Research) (S.G., H.W., H.V., M.D., M.N., R.H.), Greifswald, Germany 17475, Institute for Community Medicine (H.V.), Department of Cardiology (S.G., M.D.), University Medicine Greifswald, Germany 17475; Department of Clinical Chemistry (B.G.K.), University Hospital, South Manchester, United Kingdom M23 9LT; Department of Internal Medicine I (G.B.), University Lübeck, Germany 23562; and European University of Applied Sciences (R.H.), Faculty of Applied Public Health, Rostock, Germany 18057
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Dias JP, Melvin D, Simonsick EM, Carlson O, Shardell MD, Ferrucci L, Chia CW, Basaria S, Egan JM. Effects of aromatase inhibition vs. testosterone in older men with low testosterone: randomized-controlled trial. Andrology 2015; 4:33-40. [PMID: 26588809 DOI: 10.1111/andr.12126] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 09/28/2015] [Accepted: 10/03/2015] [Indexed: 02/06/2023]
Abstract
Aging in men is associated with loss of bone mass, impaired physical function and altered body composition. The objective of this proof-of-concept randomized, double-blind, placebo-controlled, parallel-group, single-center trial was to determine the relative effects of testosterone (T) and estradiol (E(2)) on bone mineral density, body composition, and physical performance in older men. The primary outcome was lumbar spine bone mineral density (BMD), and secondary outcomes were body composition, muscle strength, gait speed, and sex hormone concentrations. Forty three men (age range, 65-82 years; mean age 71 years) with low total T levels <350 ng/dL were randomized to one of three groups: 5 g transdermal testosterone gel (TT) (N = 16), anastrozole (AI) 1 mg (N = 14) or placebo daily (N = 13) for 12 months. Outcomes were assessed at baseline, 3, 6, and 12 months. Both TT and AI increased serum TT levels (>500 ng/dL, p < 0.05) compared to baseline; T values remained stable throughout the duration of the trial. At 12 months, TT improved the primary outcome of lumbar spine BMD (p < 0.01).Both interventions improved knee strength at 12 months compared to baseline (p < 0.05) while lean body mass significantly increased only in the AI group at 6 and 12 months (1.49 ± 0.38 kg, p < 0.01; 1.24 ± 0.39 kg, p < 0.05, respectively) compared to baseline. Interestingly, TT improved fast gait speed at 3 and 12 months (p < 0.01, p < 0.05, respectively). In summary, this proof-of-concept study confirms that aromatization of T is required for maintaining BMD in older men with low-T levels. The trial also uncovered the novel finding that aromatization of T is required for improvement in fast gait speed, an observation that needs to be verified in future studies.
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Affiliation(s)
- J P Dias
- Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, USA
| | - D Melvin
- Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, USA
| | - E M Simonsick
- Translational Gerontology Branch, National Institute on Aging, Baltimore, MD, USA
| | - O Carlson
- Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, USA
| | - M D Shardell
- Translational Gerontology Branch, National Institute on Aging, Baltimore, MD, USA
| | - L Ferrucci
- Translational Gerontology Branch, National Institute on Aging, Baltimore, MD, USA
| | - C W Chia
- Translational Gerontology Branch, National Institute on Aging, Baltimore, MD, USA
| | - S Basaria
- Section on Men's Health, Aging and Metabolism, Brigham and Women's Hospital Harvard Medical School, Boston, MA, USA
| | - J M Egan
- Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, USA
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Owen LJ, Wu FC, Büttler RM, Keevil BG. A direct assay for the routine measurement of testosterone, androstenedione, dihydrotestosterone and dehydroepiandrosterone by liquid chromatography tandem mass spectrometry. Ann Clin Biochem 2015; 53:580-7. [PMID: 26589631 DOI: 10.1177/0004563215621096] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND The measurement of androgens in many laboratories is often limited to testosterone. To more accurately determine the androgen status in both sexes, the measurement of other androgens such as dihydrotestosterone, the more potent metabolite of testosterone, and androstenendione and dehydroepiandrosterone, the most abundant circulating androgens in women would be informative. We report a combined liquid chromatography tandem mass spectrometry method for the measurement of these androgens. METHODS Internal standards in methanol (10 µL) were added to 100 µL serum followed by the addition of zinc sulphate (100 µL). After mixing, 100 µL of acetonitrile was added and was further mixed. The samples were centrifuged and the steroids extracted using an automated online solid phase extraction on a C18 cartridge by a Waters Acquity with online sample manager coupled to a TQS mass spectrometer. RESULTS Separation of the androgens was achieved by liquid chromatography. The run time was 6.5 min per sample. The lower limit of quantitation was 0.1 nmol/L for testosterone, androstenedione and dihydrotestosterone and 1 nmol/L for dehydroepiandrosterone. The coefficient of variation of the assay in serum for testosterone was <6%, androstenedione <8% and dihydrotestosterone and dehydroepiandrosterone <10%. DISCUSSION We have developed a rapid assay for the liquid chromatography tandem mass spectrometry measurement of testosterone, androstenedione, dihydrotestosterone and dehydroepiandrosterone in a routine clinical laboratory. The assay requires a small volume of serum, and all analytes are measured simultaneously. The assay is rapid and simple to execute offering the potential for routine clinical application.
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Affiliation(s)
- Laura J Owen
- Manchester Academic Health Science Centre, Biochemistry Department, University Hospital of South Manchester, Manchester, UK
| | - Frederick C Wu
- Andrology Research Unit, The University of Manchester, Manchester, UK
| | - Rahel M Büttler
- Endocrine Laboratory, Department of Clinical Chemistry, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Brian G Keevil
- Manchester Academic Health Science Centre, Biochemistry Department, University Hospital of South Manchester, Manchester, UK
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Bann D, Hardy R, Cooper R, Lashen H, Keevil B, Wu FCW, Holly JMP, Ong KK, Ben-Shlomo Y, Kuh D. Socioeconomic conditions across life related to multiple measures of the endocrine system in older adults: Longitudinal findings from a British birth cohort study. Soc Sci Med 2015; 147:190-9. [PMID: 26588434 PMCID: PMC4686046 DOI: 10.1016/j.socscimed.2015.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 10/08/2015] [Accepted: 11/01/2015] [Indexed: 12/29/2022]
Abstract
Background Little is known about how socioeconomic position (SEP) across life impacts on different axes of the endocrine system which are thought to underlie the ageing process and its adverse consequences. We examined how indicators of SEP across life related to multiple markers of the endocrine system in late midlife, and hypothesized that lower SEP across life would be associated with an adverse hormone profile across multiple axes. Methods Data were from a British cohort study of 875 men and 905 women followed since their birth in March 1946 with circulating free testosterone and insulin-like growth factor-I (IGF-I) measured at both 53 and 60–64 years, and evening cortisol at 60–64 years. Indicators of SEP were ascertained prospectively across life—paternal occupational class at 4, highest educational attainment at 26, household occupational class at 53, and household income at 60–64 years. Associations between SEP and hormones were investigated using multiple regression and logistic regression models. Results Lower SEP was associated with lower free testosterone among men, higher free testosterone among women, and lower IGF-I and higher evening cortisol in both sexes. For example, the mean standardised difference in IGF-I comparing the lowest with the highest educational attainment at 26 years (slope index of inequality) was −0.4 in men (95% CI -0.7 to −0.2) and −0.4 in women (−0.6 to −0.2). Associations with each hormone differed by SEP indicator used and sex, and were particularly pronounced when using a composite adverse hormone score. For example, the odds of having 1 additional adverse hormone concentration in the lowest compared with highest education level were 3.7 (95% CI: 2.1, 6.3) among men, and 1.6 (1.0, 2.7) among women (P (sex interaction) = 0.02). We found no evidence that SEP was related to apparent age-related declines in free testosterone or IGF-I. Conclusions Lower SEP was associated with an adverse hormone profile across multiple endocrine axes. SEP differences in endocrine function may partly underlie inequalities in health and function in later life, and may reflect variations in biological rates of ageing. Further studies are required to assess the likely functional relevance of these associations. Socioeconomic position (SEP) across life was related to multiple hormone measures. Lower SEP was related to lower testosterone in men, higher testosterone in women. Lower SEP was related to lower IGF-I and higher evening cortisol in both sexes. SEP differences in multiple hormone axes may underlie later life health inequality.
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Affiliation(s)
- David Bann
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK; Centre for Longitudinal Studies, UCL Institute of Education, London, UK.
| | - Rebecca Hardy
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Rachel Cooper
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Hany Lashen
- Department of Human Metabolism, The University of Sheffield, Sheffield, UK
| | - Brian Keevil
- Andrology Research Unit, School of Biomedicine, University of Manchester, UK
| | - Frederick C W Wu
- Andrology Research Unit, School of Biomedicine, University of Manchester, UK
| | - Jeff M P Holly
- School of Clinical Science, Bristol University, Bristol, UK
| | - Ken K Ong
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, Bristol University, Bristol, UK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
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Büttler RM, Martens F, Fanelli F, Pham HT, Kushnir MM, Janssen MJW, Owen L, Taylor AE, Soeborg T, Blankenstein MA, Heijboer AC. Comparison of 7 Published LC-MS/MS Methods for the Simultaneous Measurement of Testosterone, Androstenedione, and Dehydroepiandrosterone in Serum. Clin Chem 2015; 61:1475-83. [PMID: 26503965 DOI: 10.1373/clinchem.2015.242859] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 09/08/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Recently, LC-MS/MS was stated to be the method of choice to measure sex steroids. Because information on the mutual agreement of LC-MS/MS methods is scarce, we compared 7 published LC-MS/MS methods for the simultaneous measurement of testosterone, androstenedione, and dehydroepiandrosterone (DHEA). METHODS We used 7 published LC-MS/MS methods to analyze in duplicate 55 random samples from both men and women. We performed Passing-Bablok regression analysis and calculated Pearson correlation coefficients to assess the agreement of the methods investigated with the median concentration measured by all methods, and we calculated the intraassay CV of each method derived from duplicate results and the CVs between the methods. RESULTS Median concentrations of testosterone were 0.22-1.36 nmol/L for women and 8.27-27.98 nmol/L for men. Androstenedione and DHEA concentrations were 0.05-5.53 and 0.58-18.04 nmol/L, respectively. Intraassay CVs were 2.9%-10%, 1.2%-8.8%, 2.7%-13%, and 4.3%-16% for testosterone in women, testosterone in men, androstenedione, and DHEA. Slopes of the regression lines calculated by Passing-Bablok regression analysis were 0.92-1.08, 0.92-1.08, 0.90-1.13, and 0.91-1.41 for all testosterone values, testosterone in women, androstenedione, and DHEA. Intermethod CVs were 14%, 8%, 30%, and 22% for testosterone in women, testosterone in men, androstenedione, and DHEA. CONCLUSIONS In general, the LC-MS/MS methods investigated show reasonable agreement. However, some of the assays show differences in standardization, and others show high variation.
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Affiliation(s)
- Rahel M Büttler
- Endocrine Laboratory, Department of Clinical Chemistry, VU University Medical Center, Amsterdam, Netherlands
| | - Frans Martens
- Endocrine Laboratory, Department of Clinical Chemistry, VU University Medical Center, Amsterdam, Netherlands
| | - Flaminia Fanelli
- Endocrinology Unit and Center for Applied Biomedical Research, Department of Medical and Surgical Sciences, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Hai T Pham
- Biocrates Life Sciences AG, Innsbruck, Austria
| | - Mark M Kushnir
- Department of Pathology, University of Utah, Salt Lake City, UT; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT
| | - Marcel J W Janssen
- Laboratory of Clinical Chemistry and Hematology, VieCuri Medical Center Venlo, Netherlands
| | - Laura Owen
- Department of Clinical Biochemistry, University Hospital of South Manchester, Manchester, UK
| | - Angela E Taylor
- Centre for Endocrinology, Diabetes and Metabolism, School of Clinical and Experimental Medicine, University of Birmingham, UK
| | - Tue Soeborg
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Marinus A Blankenstein
- Endocrine Laboratory, Department of Clinical Chemistry, VU University Medical Center, Amsterdam, Netherlands
| | - Annemieke C Heijboer
- Endocrine Laboratory, Department of Clinical Chemistry, VU University Medical Center, Amsterdam, Netherlands;
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van Gemert WAM, Schuit AJ, van der Palen J, May AM, Iestra JA, Wittink H, Peeters PH, Monninkhof EM. Effect of weight loss, with or without exercise, on body composition and sex hormones in postmenopausal women: the SHAPE-2 trial. Breast Cancer Res 2015; 17:120. [PMID: 26330303 PMCID: PMC4557857 DOI: 10.1186/s13058-015-0633-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 08/18/2015] [Indexed: 12/13/2022] Open
Abstract
Introduction Physical inactivity and overweight are risk factors for postmenopausal breast cancer. The effect of physical activity may be partially mediated by concordant weight loss. We studied the effect on serum sex hormones, which are known to be associated with postmenopausal breast cancer risk, that is attributable to exercise by comparing randomly obtained equivalent weight loss by following a hypocaloric diet only or mainly by exercise. Methods Overweight, insufficiently active women were randomised to a diet (N = 97), mainly exercise (N = 98) or control group (N = 48). The goal of both interventions was to achieve 5–6 kg of weight loss by following a calorie-restricted diet or an intensive exercise programme combined with only a small caloric restriction. Primary outcomes after 16 weeks were serum sex hormones and sex hormone-binding globulin (SHBG). Body fat and lean mass were measured by dual-energy X-ray absorptiometry. Results Both the diet (−4.9 kg) and mainly exercise (−5.5 kg) groups achieved the target weight loss. Loss of body fat was significantly greater with exercise versus diet (difference −1.4 kg, P < 0.001). In the mainly exercise arm, the reduction in free testosterone was statistically significantly greater than that of the diet arm (treatment effect ratio [TER] 0.92, P = 0.043), and the results were suggestive of a difference for androstenedione (TER 0.90, P = 0.064) and SHBG (TER 1.05, P = 0.070). Compared with the control arm, beneficial effects were seen with both interventions, diet and mainly exercise, respectively, on oestradiol (TER 0.86, P = 0.025; TER 0.83, P = 0.007), free oestradiol (TER 0.80, P = 0.002; TER 0.77, P < 0.001), SHBG (TER 1.14; TER 1.21, both P < 0.001) and free testosterone (TER 0.91, P = 0.069; TER = 0.84, P = 0.001). After adjustment for changes in body fat, intervention effects attenuated or disappeared. Conclusions Weight loss with both interventions resulted in favourable effects on serum sex hormones, which have been shown to be associated with a decrease in postmenopausal breast cancer risk. Weight loss induced mainly by exercise additionally resulted in maintenance of lean mass, greater fitness, greater fat loss and a larger effect on (some) sex hormones. The greater fat loss likely explains the observed larger effects on sex hormones. Trial registration ClinicalTrials.gov identifier: NCT01511276. Registered on 12 January 2012. Electronic supplementary material The online version of this article (doi:10.1186/s13058-015-0633-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Willemijn A M van Gemert
- Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Albertine J Schuit
- National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands. .,Department of Health Sciences and EMGO Institute for Health and Care Research, VU University, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Job van der Palen
- Department of Epidemiology, Medisch Spectrum Twente, P.O. Box 50000, 7500 KA, Enschede, The Netherlands. .,Department of Research Methodology, Measurement, and Data Analysis, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
| | - Anne M May
- Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Jolein A Iestra
- Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Harriet Wittink
- Lifestyle and Health Research Group, Faculty of Health Care, Utrecht University of Applied Sciences, P.O. Box 85182, 3508 AD, Utrecht, The Netherlands.
| | - Petra H Peeters
- Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Evelyn M Monninkhof
- Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
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Bui HN, Sluss PM, Hayes FJ, Blincko S, Knol DL, Blankenstein MA, Heijboer AC. Testosterone, free testosterone, and free androgen index in women: Reference intervals, biological variation, and diagnostic value in polycystic ovary syndrome. Clin Chim Acta 2015; 450:227-32. [PMID: 26327459 DOI: 10.1016/j.cca.2015.08.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 08/21/2015] [Accepted: 08/21/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of our study was to determine reference intervals and biologic variation for testosterone (T), free testosterone (fT), and free androgen index (FAI) in women with accurate methods and to test the discriminative value of these parameters in a polycystic ovary syndrome (PCOS)-population. METHODS Serum was obtained daily during a normal menstrual cycle from 25 healthy women (677 data-points). A single serum sample was obtained from 44 PCOS-patients. T was measured by LC–MS/MS and by Architect® 2nd generation T Immunoassay. Sex hormone-binding globulin was measured to calculate fT and FAI. Results: Reference intervals which were established in healthy women with an ovulatory menstrual cycle were T = 0.3-1.6 nmol/L and 0.5-2.0 nmol/L, fT = 5.2-26 pmol/L and 7.2-33 pmol/L, and FAI = 0.4-2.9 and 0.6-4.4, by LC-MS/MS and immunoassay, respectively. T, fT and FAI were higher in PCOS patients than in controls (p b 0.0001). The areas under the curve of receiver operator characteristic (ROC) plots were not different for T, fT, or FAI when T was measured by LC–MS/MS versus immunoassay based on prediction of PCOS. FAI and fT were the strongest predictors of PCOS. CONCLUSIONS When based upon the appropriate reference intervals and ROC analysis, LC-MS/MS and second generation immunoassay have equivalent clinical utility for the diagnosis of PCOS.
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Affiliation(s)
- H N Bui
- Dept. of Clinical Chemistry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - P M Sluss
- Clinical Pathology Core Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | - F J Hayes
- Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - S Blincko
- Abbott Diagnostics, Wiesbaden, Germany
| | - D L Knol
- Dept. of Epidemiology and Biostatistics, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - M A Blankenstein
- Dept. of Clinical Chemistry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - A C Heijboer
- Dept. of Clinical Chemistry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
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Association of sex hormones with incident 10-year cardiovascular disease and mortality in women. Maturitas 2015; 82:424-30. [PMID: 26385535 DOI: 10.1016/j.maturitas.2015.08.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 08/20/2015] [Accepted: 08/21/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aims of this study were to ascertain whether women with high levels of serum total testosterone (TT) or low levels of sex hormone-binding globulin (SHBG) are more likely to develop cardiovascular disease (CVD), and to investigate potential associations between sex hormones and mortality (all-cause, as well as cause-specific) in the general population. STUDY DESIGN AND MAIN OUTCOME MEASURES Data on 2129 women with a mean age of 49.0 years were obtained from the population-based Study of Health in Pomerania over a median follow-up of 10.9 years. Associations of baseline levels of TT, SHBG, and rostenedione (ASD), and free testosterone (fT), and of the free androgen index (FAI), with follow-up CVD morbidity, as well as all-cause and CVD mortality, were analyzed using multivariable regression modeling. RESULTS At baseline the prevalence rate of CVD was 17.8% (378 women) and the incidence of CVD over the follow-up was 50.9 per 1000 person-years. We detected an inverse association between SHBG and baseline CVD in age-adjusted models (relative risk per standard deviation increase: 0.83; 95% confidence interval: 0.74-0.93). We did not detect any significant associations between sex hormone concentrations and incident CVD in age- and multivariable-adjusted Poisson regression models. Furthermore, none of the sex hormones (TT, SHBG, ASD, fT, FAI) were associated with all-cause mortality. CONCLUSIONS This population-based cohort study did not yield any consistent associations between sex hormones in women and incident CVD or mortality risk.
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Bann D, Wu FCW, Keevil B, Lashen H, Adams J, Hardy R, Muniz G, Kuh D, Ben‐Shlomo Y, Ong KK. Changes in testosterone related to body composition in late midlife: Findings from the 1946 British birth cohort study. Obesity (Silver Spring) 2015; 23:1486-92. [PMID: 26053924 PMCID: PMC4744737 DOI: 10.1002/oby.21092] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 02/25/2015] [Indexed: 12/02/2022]
Abstract
OBJECTIVE Randomized trials in men with testosterone deficiency have provided evidence of short-term effects of testosterone therapy on muscle and fat mass but it is unclear whether this persists over a longer period or how testosterone affects women. We examined whether the midlife decline in testosterone relates to fat and lean mass in both sexes. METHODS Data were collected from 440 men and 560 women participating in the 1946 British birth cohort study with testosterone measured at 53 and/or 60-64 years. Fat and appendicular lean mass were measured at 60-64 years using dual-energy X-ray absorptiometry. RESULTS Mean free testosterone concentrations were lower at 60-64 than 53 years, by 26% in both sexes. At both ages testosterone was negatively associated with fat mass in men and positively associated in women. A larger decline in free testosterone was associated with higher fat mass in men but with lower fat mass among women. In contrast, declines in testosterone were not associated with lean mass in either sex. CONCLUSIONS Our findings suggest sex-divergent relationships between testosterone and fat mass and their distribution but do not support the hypothesis that midlife declines in testosterone lead to lower lean mass.
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Affiliation(s)
- David Bann
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK
| | - Frederick C. W. Wu
- Andrology Research Unit, School of BiomedicineUniversity of ManchesterManchesterUK
| | - Brian Keevil
- Andrology Research Unit, School of BiomedicineUniversity of ManchesterManchesterUK
| | - Hany Lashen
- Department of Human MetabolismThe University of SheffieldSheffieldUK
| | - Judith Adams
- Department of RadiologyCentral Manchester University Hospital NHS Foundation Trust, Manchester Academic Health Science CenterManchesterUK
| | - Rebecca Hardy
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK
| | | | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK
| | - Yoav Ben‐Shlomo
- School of Social and Community MedicineBristol UniversityBristolUK
| | - Ken K. Ong
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK.
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A novel application of salivary testosterone in systolic heart failure. Cardiovasc Endocrinol 2015. [DOI: 10.1097/xce.0000000000000047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Fiers T, Delanghe J, T'Sjoen G, Van Caenegem E, Wierckx K, Kaufman JM. A critical evaluation of salivary testosterone as a method for the assessment of serum testosterone. Steroids 2014; 86:5-9. [PMID: 24793565 DOI: 10.1016/j.steroids.2014.04.013] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 04/11/2014] [Accepted: 04/15/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Although salivary testosterone (T) is often used in clinical studies accuracy is mostly questionable. State of the art data for men is sparse and for women absent. Our objective was to perform a critical evaluation of salivary T (Sal-T) as a method for indirect assessment of serum T using state of the art methods. Saliva was collected via 'Salivette' and 'passive drooling' methods. Sal-T and free T in serum after equilibrium dialysis were measured by LC-MS/MS RESULTS: Evaluation of Sal-T results versus free T by equilibrium dialysis (ED-T) for men gave: 'Salivette' Sal-T=0.05+0.88x ED-T, r=0.43; 'passive drooling' Sal-T=0.17+0.91x ED-T r=0.71. In women, correlation was comparable but values are higher than free T: 'passive drooling' Sal-T=0.12+2.32x ED-T, r=0.70. The higher than expected T values in saliva, appear to be explained by T binding to salivary proteins. Iso-electric focusing of saliva proteins, followed by fractionation and LC-MS/MS assay of T showed marked testosterone peaks at pH 5.3 and 8.4, providing evidence for T binding in saliva to proteins such as albumin and proline rich protein (PRP). CONCLUSIONS Passive drooling is the collection method of choice for testosterone in saliva. Sal-T is not directly comparable to serum free T due to T binding to saliva proteins, which substantially affects the low Sal-T in women but not the higher Sal-T in healthy adult men.
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Affiliation(s)
- Tom Fiers
- Ghent University Hospital, Clinical Chemistry, Belgium.
| | | | - Guy T'Sjoen
- Ghent University Hospital, Endocrinology, Belgium
| | | | | | - Jean-Marc Kaufman
- Ghent University Hospital, Clinical Chemistry, Belgium; Ghent University Hospital, Endocrinology, Belgium
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Lerchbaum E, Pilz S, Trummer C, Rabe T, Schenk M, Heijboer AC, Obermayer-Pietsch B. Serum vitamin D levels and hypogonadism in men. Andrology 2014; 2:748-54. [PMID: 25044703 DOI: 10.1111/j.2047-2927.2014.00247.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/16/2014] [Accepted: 06/18/2014] [Indexed: 12/14/2022]
Abstract
There is inconsistent evidence on a possible association of vitamin D and androgen levels in men. We therefore aim to investigate the association of 25-hydroxyvitamin D (25(OH)D) with androgen levels in a cohort of middle-aged men. This cross-sectional study included 225 men with a median (interquartile range) age of 35 (30-41) years. We measured 25(OH)D, total testosterone (TT) and SHBG concentrations. Hypogonadism was defined as TT <10.4 nmol/L. We found no significant correlation of 25(OH)D and androgen levels. Furthermore, androgen levels were not significantly different across 25(OH)D quintiles. The overall prevalence of hypogonadism was 21.5% and lowest in men within 25(OH)D quintile 4 (82-102 nmol/L). We found a significantly increased risk of hypogonadism in men within the highest 25(OH)D quintile (>102 nmol/L) compared to men in quintile 4 (reference) in crude (OR 5.10, 1.51-17.24, p = 0.009) as well as in multivariate adjusted analysis (OR 9.21, 2.27-37.35, p = 0.002). We found a trend towards increased risk of hypogonadism in men within the lowest 25(OH)D quintile (≤43.9 nmol/L). In conclusion, our data suggest that men with very high 25(OH)D levels (>102 nmol/L) might be at an increased risk of hypogonadism. Furthermore, we observed a trend towards increased risk of hypogonadism in men with very low vitamin D levels indicating a U-shaped association of vitamin D levels and hypogonadism. With respect to risk of male hypogonadism, our results suggest optimal serum 25(OH)D concentrations of 82-102 nmol/L.
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Affiliation(s)
- E Lerchbaum
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria; University Women's Hospital, Heidelberg, Germany
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Martits AM, Costa EMF, Nardi AC, Nardozza Jr A, Faria G, Facio Jr FN, Bernardo WM. Late-onset hypogonadism or ADAM: diagnosis. Rev Assoc Med Bras (1992) 2014; 60:286-94. [DOI: 10.1590/1806-9282.60.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Indexed: 11/22/2022] Open
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49
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Total testosterone quantitative measurement in serum by LC-MS/MS. Clin Chim Acta 2014; 436:263-7. [PMID: 24960363 DOI: 10.1016/j.cca.2014.06.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 05/20/2014] [Accepted: 06/09/2014] [Indexed: 01/22/2023]
Abstract
Reliable measurement of total testosterone is essential for the diagnosis, treatment and prevention of a number of hormone-related diseases affecting adults and children. A mass spectrometric method for testosterone determination in human serum was carefully developed and thoroughly validated. Total testosterone from 100 μL serum is released from proteins with acidic buffer and isolated by two serial liquid-liquid extraction steps. The first extraction step isolates the lipid fractions from an acidic buffer solution using ethyl acetate and hexane. The organic phase is dried down and reconstituted in a basic buffer solution. The second extraction step removes the phospholipids and other components by hexane extraction. Liquid chromatography-isotopic dilution tandem mass spectrometry is used to quantify the total testosterone. The sample preparation is automatically conducted in a liquid-handling system with 96-deepwell plates. The method limit of detection is 9.71 pmol/L (0.280 ng/dL) and the method average percent bias is not significantly different from reference methods. The performance of this method has proven to be consistent with the method precision over a 2-year period ranging from 3.7 to 4.8% for quality control pools at the concentrations 0.527, 7.90 and 30.7 nmol/L (15.2, 228, and 886 ng/dL), respectively. This method provides consistently high accuracy and excellent precision for testosterone determination in human serum across all clinical relevant concentrations.
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50
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Keevil BG, MacDonald P, Macdowall W, Lee DM, Wu FCW. Salivary testosterone measurement by liquid chromatography tandem mass spectrometry in adult males and females. Ann Clin Biochem 2014; 51:368-78. [PMID: 24194586 PMCID: PMC5029560 DOI: 10.1177/0004563213506412] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Salivary testosterone (Sal-T) may be a useful surrogate of serum free testosterone. The study aims were to use a novel liquid chromatography tandem mass spectrometry (LC-MS/MS) assay to determine whether Sal-T concentrations accurately reflect Sal-T concentrations in both sexes and to investigate practical aspects of sample collection. METHODS Saliva and serum samples were collected in 104 male and 91 female subjects. A more sensitive LC-MS/MS assay was developed to enable Sal-T quantitation in the low concentrations found in females. Saliva (200 µL) was extracted with 1 mL of methyl-tert-butyl ether following the addition of D5-testosterone. Quantitation was performed using a Waters TQ-S mass spectrometer. RESULTS The assay achieved a lower limit of quantification of 5 pmol/L, sufficiently sensitive to measure testosterone in female saliva. Sal-T showed a diurnal variation but samples taken at weekly and monthly intervals showed no significant differences. Sal-T was stable at ambient temperature for up to 5 days, after freeze-thawing and 3 years frozen storage. Reference intervals for Sal-T were 93-378 pmol/L in males and 5-46 pmol/L in females. Sal-T correlated significantly with serum calculated free-T in males (r = 0.71, P < 0.001) and in females (r = 0.39, P < 0.001). CONCLUSIONS These results confirm that testosterone can be reliably and accurately measured by LC-MS/MS in both adult male and female saliva samples. These results lay the foundation for further exploration of the clinical application of Sal- T as a reliable alternative to serum testosterone in the diagnosis and management of androgen disorders and assessment of androgen status in clinical research.
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Affiliation(s)
- B G Keevil
- Department of Clinical Biochemistry, University Hospital of South Manchester, Manchester, UK
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