Comparison of multiple steroid concentrations in serum and dried blood spots throughout the day of patients with congenital adrenal hyperplasia.
OBJECTIVE
periodic measurement of plasma concentrations of cortisol precursors on a clinic visit may be of limited value in patients with congenital adrenal hyperplasia because it does not reflect a patient's circadian patterns of adrenal steroid secretion. Steroid profiling in dried blood spots (DBS) may allow for more frequent and sensitive monitoring.


METHODS
we compared the agreement between 17α-hydroxyprogesterone (17-OHP) and androstenedione (D4A) levels determined from DBS samples and concurrently collected serum samples. Blood was drawn from 9 congenital adrenal hyperplasia patients every 4 h over a 24-hour period. Serum and DBS steroid levels were measured by liquid chromatography tandem mass spectrometry.


RESULTS
DBS determinations of 17-OHP overestimated corresponding serum levels (mean difference 1.67 ng/ml), and underestimated D4A serum levels (mean difference 0.84 ng/ml). However, the DBS assay yielded excellent agreement (97%) with serum 17-OHP, but did considerably poorer for D4A (31%).


CONCLUSIONS
our results indicate an excellent agreement between DBS and serum 17-OHP measurements to identify the peaks and troughs associated with an individual's circadian pattern. Larger-scale studies are required to evaluate the utility of DBS for home monitoring and to determine if more frequent monitoring leads to improved clinical outcomes.
Sarafoglou
Kyriakie
K
Department of Pediatrics, School of Public Health, University of Minnesota, Minneapolis, Minn. 55455, USA. saraf010@umn.edu
Himes
John H
JH
Lacey
Jean M
JM
Netzel
Brian C
BC
Singh
Ravinder J
RJ
Matern
Dietrich
D
D019326:17-alpha-Hydroxyprogesterone / Q000097:blood*; D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000097:blood / Q000188:drug therapy; D000328:Adult; D000735:Androstenedione / Q000097:blood*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001800:Blood Specimen Collection; D002648:Child; D002675:Child, Preschool; D002940:Circadian Rhythm; D016903:Drug Monitoring / Q000379:methods*; D005438:Fludrocortisone / Q000627:therapeutic use; D020249:Hormone Replacement Therapy; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D008297:Male; D015203:Reproducibility of Results
D000893:Anti-Inflammatory Agents; D000735:Androstenedione; D019326:17-alpha-Hydroxyprogesterone; D005438:Fludrocortisone; D006854:Hydrocortisone
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