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Lucassen P, van Ockenburg S, Gans R, Rosmalen J, Olde Hartman T. [Fatigue]. Ned Tijdschr Geneeskd 2022; 166:D6282. [PMID: 35736359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Many patients with fatigue do not visit a physician. In patients who do consult the general practitioner, the cause of their fatigue is explained in about a quarter: 8 percent has a somatic cause while psychosocial causes explain 16 percent. In about three quarters the cause of fatigue remains unexplained. Because of the low prevalence of somatic causes the general practitioner will be reluctant to perform additional examinations but a thorough physical examination is essential. In patients with a longer duration of fatigue (> 6 months) it is indicated to expand inquiries. This starts with extending history taking in the direction of consanguinity and hereditary diseases. More comprehensive blood tests and investigation of sleep are important further steps. Referral to a specialist is essential as specialists are more familiar with scripts of rare diseases. The prognosis of longer lasting fatigue is bad, especially in the case of fatigue meeting criteria for ME/CFS. Treatment of longer lasting fatigue could compromise of psycho-education, exercise and specific therapies for sleeping disorders.
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Affiliation(s)
- Peter Lucassen
- Radboudumc, Research Institute of Health Sciences, afd. Eerstelijnsgeneeskunde, Nijmegen
| | | | - Rijk Gans
- UMCG, Groningen. Afd. Interne Geneeskunde
| | - Judith Rosmalen
- UMCG, Groningen. Afd. Interdisciplinair Centrum Psychopathologie en Emotieregulatie
| | - Tim Olde Hartman
- Radboudumc, Research Institute of Health Sciences, afd. Eerstelijnsgeneeskunde, Nijmegen
- Contact: Tim olde Hartman
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van Faassen M, van der Veen A, van Ockenburg S, de Jong H, de Vries EGE, Kema IP. Mass spectrometric quantification of urinary 6-sulfatoxymelatonin: age-dependent excretion and biological variation. Clin Chem Lab Med 2021; 59:187-195. [DOI: 10.1515/cclm-2020-0455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/23/2020] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
Regulators of circadian rhythm, including melatonin, influence fundamental biological processes. Measuring the melatonin metabolite 6-sulfatoxymelatonin in urine can estimate melatonin production. 6-sulfatoxymelatonin is mainly analyzed by immunoassays, but these methods are hampered by cross-reactivity and poor reproducibility when used to analyze small molecules. Therefore, we validated a high-throughput liquid chromatography with tandem mass spectrometry (LC–MS/MS) method to quantify 6-sulfatoxymelatonin in urine. We evaluated age-dependent 24-h excretion of 6-sulfatoxymelatonin into urine and the biological variation of urinary excretion in healthy individuals.
Methods
The online solid phase extraction method combined with LC–MS/MS was validated according to international guidelines, and used to measure the excretion of 6-sulfatoxymelatonin into urine of 240 healthy individuals. Biological variation of 6-sulfatoxymelatonin excretion was examined in 10 healthy individuals.
Results
Urinary 6-sulfatoxymelatonin results were well within the validation criteria (interassay coefficient of variation: <5.4%, quantification limit: 0.2 nmol/L). There was an age-related decrease in 6-sulfatoxymelatonin excretion into 24-h urine [F(5, 234)=13.9; p<0.001]. Within-subject variation of 6-sulfatoxymelatonin was 39.2% in day urine, 15.1% in night urine, and 12.2% in 24-h urine. Between-subject variation was 39.1% in day urine, 37.9% in night urine, and 36.8% in 24-h urine.
Conclusions
This MS-based method enables straightforward, reproducible, and sensitive quantification of 6-sulfatoxymelatonin in urine. Urinary 6-sulfatoxymelatonin levels decreased with age. Biological variation of 6-sulfatoxymelatonin excretion into urine was high between subjects and lower within subjects, indicating that repeated measurements of 6-sulfatoxymelatonin in 24-h urine are needed in future studies.
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Affiliation(s)
- Martijn van Faassen
- Department of Laboratory Medicine , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Anna van der Veen
- Department of Laboratory Medicine , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Sonja van Ockenburg
- Department of Endocrinology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Helma de Jong
- Department of Laboratory Medicine , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Elisabeth G. E. de Vries
- Department of Medical Oncology , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Ido P. Kema
- Department of Laboratory Medicine , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
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