Test ID: SGSU Synthetic Glucocorticoid Screen, Random, Urine
Reporting Name
Synthetic Glucocorticoid Screen, UUseful For
Confirming the presence of the listed synthetic glucocorticoids (see Interpretation)
Confirming the cause of secondary adrenal insufficiency
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.
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 urine 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.
Report Available
5 to 10 daysDay(s) Performed
Wednesday
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 Name
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS) Stable Isotope Dilution Analysis
Specimen Type
UrineOrdering Guidance
Fluticasone propionate is reported with this test and is also available separately. It is quickly metabolized to fluticasone 17-beta carboxylic acid in urine. To screen for this metabolite, order 17BFP / Fluticasone 17-Beta-Carboxylic Acid, Random, Urine.
Specimen Required
Supplies: Urine tubes, 10 mL (T068)
Container/Tube: Plastic, 10-mL urine tube
Specimen Volume: 5 mL
Collection Instructions:
1. Collect a random urine specimen.
2. No preservative.
Specimen Minimum Volume
0.6 mL
Specimen Stability Information
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
Urine | Frozen | 14 days |
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
Fluticasone propionate: 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).
Test Classification
This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test 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 |
---|---|---|
SGSU | Synthetic Glucocorticoid Screen, U | 46959-3 |
Result ID | Test Result Name | Result LOINC Value |
---|---|---|
23562 | Betamethasone | 46946-0 |
23563 | Budesonide | 46947-8 |
23564 | Dexamethasone | 46948-6 |
23565 | Fludrocortisone | 46949-4 |
23568 | Fluticasone Propionate | 46952-8 |
23569 | Megestrol Acetate | 46953-6 |
23570 | Methylprednisolone | 46954-4 |
23571 | Prednisolone | 46955-1 |
23572 | Prednisone | 46956-9 |
23574 | Triamcinolone Acetonide | 46958-5 |
mml-adrenal-gonad-pituitary