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Test ID: SGSU Synthetic Glucocorticoid Screen, Urine

Reporting Name

Synthetic Glucocorticoid Screen, U

Useful 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.

 

The fluticasone propionate analyte is reported with this test and is also available separately, see 17BFP / Fluticasone 17-Beta-Carboxylic Acid, Urine for more information.

Interpretation

This test screens for and quantitates, if present, the following synthetic glucocorticoids: beclomethasone dipropionate, betamethasone, budesonide, dexamethasone, fludrocortisone, flunisolide, fluorometholone, megestrol acetate, methylprednisolone, prednisolone, prednisone, triamcinolone, 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.

Analytic Time

3 days

Day(s) and Time(s) Performed

Tuesday, Thursday; 9 a.m.

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 JW, van Everdingen AA, Huisman M, et al: 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

Method Name

Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) Stable Isotope Dilution Analysis

Specimen Type

Urine


Specimen Required


Container/Tube: Plastic, 10-mL urine tube (T068)

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

Beclomethasone dipropionate: 0.10 mcg/dL

Betamethasone: 0.10 mcg/dL

Budesonide: 0.20 mcg/dL

Dexamethasone: 0.10 mcg/dL

Fludrocortisone: 0.10 mcg/dL

Flunisolide: 0.10 mcg/dL

Fluorometholone: 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 0.30 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 U.S. 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
23561 Beclomethasone Dipropionate 46945-2
23562 Betamethasone 46946-0
23563 Budesonide 46947-8
23564 Dexamethasone 46948-6
23565 Fludrocortisone 46949-4
23566 Flunisolide 46950-2
23567 Fluorometholone 46951-0
23568 Fluticasone Propionate 46952-8
23569 Megestrol Acetate 46953-6
23570 Methylprednisolone 46954-4
23571 Prednisolone 46955-1
23572 Prednisone 46956-9
23573 Triamcinolone 46957-7
23574 Triamcinolone Acetonide 46958-5
Mayo Clinic Laboratories | Endocrinology Catalog Additional Information:

mml-adrenal-gonad-pituitary