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HelpMayo Test ID SGSS Synthetic Glucocorticoid Screen, Serum
Ordering Guidance
Specimen Required
Supplies: Sarstedt Aliquot Tube, 5 mL (T914)
Collection Container/Tube:
Preferred: Red top
Acceptable: Serum gel
Submission Container/Tube: Plastic vial
Specimen Volume: 2 mL
Collection Instructions: Centrifuge and aliquot serum into a plastic vial.
Useful For
Confirming the presence of listed synthetic glucocorticoids (see Interpretation)
Confirming the cause of secondary adrenal insufficiency
This test is not useful for detection of fluticasone propionate.
Method Name
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS) Stable Isotope Dilution Analysis
Reporting Name
Synthetic Glucocorticoid Screen, SSpecimen Type
SerumSpecimen Minimum Volume
1.1 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Frozen (preferred) | 14 days | |
| Refrigerated | 7 days | ||
| Ambient | 24 hours |
Reject Due To
| Gross hemolysis | OK |
| Gross lipemia | OK |
| Gross icterus | OK |
Clinical Information
Synthetic glucocorticoids are widely used and have important clinical utility both as anti-inflammatory and immunosuppressive agents. The medical use of these agents, as well as their surreptitious use, can sometimes lead to a confusing clinical presentation. Patients exposed to these steroids may present with clinical features of Cushing syndrome but with suppressed cortisol levels and evidence of hypothalamus-pituitary-adrenal axis suppression.
Reference Values
Negative
Cutoff concentrations
Betamethasone: 0.10 mcg/dL
Budesonide: 0.20 mcg/dL
Dexamethasone: 0.10 mcg/dL
Fludrocortisone: 0.10 mcg/dL
Megestrol acetate: 0.10 mcg/dL
Methylprednisolone: 0.10 mcg/dL
Prednisolone: 0.10 mcg/dL
Prednisone: 0.10 mcg/dL
Triamcinolone acetonide: 0.10 mcg/dL
Values for normal patients not taking these synthetic glucocorticoids should be less than the cutoff concentration (detection limit).
Interpretation
This test screens for and quantitates, if present, the following synthetic glucocorticoids: betamethasone, budesonide, dexamethasone, fludrocortisone, megestrol acetate, methylprednisolone, prednisolone, prednisone, and triamcinolone acetonide.
The presence of synthetic glucocorticoids in serum indicates current or recent use of these compounds. Since several of these compounds exceed the potency of endogenous cortisol by 1 or more orders of magnitude, even trace levels may be associated with cushingoid features.
Cautions
This method cannot detect all available synthetic steroids available either as pharmaceutical compounds or chemicals present in food. The assay confirms only the listed synthetic glucocorticoids. For more information see Interpretation.
Lack of detection does not preclude use of synthetic glucocorticoids because adrenal suppression may persist for some time after the exogenous steroid is discontinued.
Clinical Reference
1. Cave A, Arlett P, Lee E: Inhaled and nasal corticosteroids: factors affecting the risks of systemic adverse effects. Pharmacol Ther. 1999 Sep;83(3):153-179
2. Bijlsma JWJ, Van Everdingen AA, Huisman M, De Nijs RNJTL, Jacobs JWG: Glucocorticoids in rheumatoid arthritis: effects on erosions and bone. Ann NY Acad Sci. 2002 Jun;966:82-90
3. Sandborn WJ: Steroid-dependent Crohn's disease. Can J Gastroenterol. 2000 Sep;14 Suppl C:17C-22C
4. Benvenuti S, Brandi ML: Corticosteroid-induced osteoporosis: pathogenesis and prevention. Clin Exp Rheumatol. 2000 Jul-Aug;18(4 Suppl 20):S64-S66
5. Loke TK, Sousa AR, Corrigan CJ, Lee TH: Glucocorticoid-resistant asthma. Curr Allergy Asthma Rep. 2002 Mar;2(2):144-150
6. Fardet L, Petersen I, Nazareth I: Monitoring of patients on long-term glucocorticoid therapy: a population-based cohort study. Medicine (Baltimore). 2015 Apr;94(15):e647. doi: 10.1097/MD.0000000000000647
7. Cronin JJ, McCoy S, Kennedy U, et al: A randomized trial of single-dose oral dexamethasone versus multidose prednisolone for acute exacerbations of asthma in children who attend the emergency department. Ann Emerg Med. 2016 May;67(5):593-601.e3. doi: 10.1016/j.annemergmed.2015.08.001
Method Description
The synthetic glucocorticoids are extracted from 0.5 mL of urine using an acetonitrile protein precipitation followed by methylene chloride liquid extraction of the solvent. Cortisol-9, 11, 12, 12-d, and triamcinolone-d1 acetonide-d6 are added to each sample before the liquid extraction and serve as the internal standards. Then, 17 mcL of the reconstituted sample extract is injected into a high-performance liquid chromatography system and analyzed by tandem mass spectrometry. The mass spectrometer has an electrospray interface and is operated in the multiple reaction monitoring positive mode. The calibration utilizes a 4-point standard curve over a concentration range of 0 to 25 mcg/dL.(McWhinney BC, Ward G, Hickman PE: Improved HPLC method for simultaneous analysis of cortisol, 11-deoxycortisol, prednisolone, methylprednisolone, and dexamethasone in serum and urine. Clin Chem. 1996 Jun;42:979-981; Savu S, Silvestro L, Haag A, Sorgel F: A confirmatory HPLC-MS/MS method for ten synthetic corticosteroids in bovine urines. J Mass Spectrom. 1996 Dec;31[12]:1351-1363; Djedovic NK, Rainbow SJ: Detection of synthetic glucocorticoids by liquid chromatography-tandem mass spectrometry in patients being investigated for Cushing's syndrome. Ann Clin Biochem. 2011 Nov;48(Pt 6):542-549. doi: 10.1258/acb.2011.010250)
Day(s) Performed
Wednesday
Report Available
5 to 10 daysSpecimen Retention Time
2 weeksPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
80299
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| SGSS | Synthetic Glucocorticoid Screen, S | 43141-1 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 23593 | Betamethasone | 41745-1 |
| 23594 | Budesonide | 41747-7 |
| 23595 | Dexamethasone | 14062-4 |
| 23596 | Fludrocortisone | 41754-3 |
| 23600 | Megestrol Acetate | 41762-6 |
| 23601 | Methylprednisolone | 14186-1 |
| 23602 | Prednisolone | 12727-4 |
| 23603 | Prednisone | 12434-7 |
| 23605 | Triamcinolone Acetonide | 41767-5 |