title: Challenges and benefits of endogenous steroid analysis by LC-MS/MS.
abstract: Quantification of endogenous hormonal steroids and their precursors is essential for diagnosing a wide range of endocrine disorders. Historically, these analyses have been carried out using immunoassay, but such methods are problematic, especially for low-concentration analytes, due to assay interference by other endogenous steroids. MS offers improved specificity over immunoassay and can be highly sensitive. GC-MS, with use of stable isotopically labeled internal standards, is considered the 'gold standard' method for serum steroid analysis. GC-MS is the method of choice for profiling steroid metabolites in urine, but these techniques are not appropriate for routine use in clinical laboratories owing to a need for extensive sample preparation, as well as analytical expertise. LC-MS/MS compares well to GC-MS in terms of accuracy, precision and sensitivity, but allows simplified sample preparation. While most publications have featured only one or a limited number of steroids, we consider that steroid paneling (which we propose as the preferred term for multitargeted steroid analysis) has great potential to enable clinicians to make a definitive diagnosis. It is adaptable for use in a number of matrices, including serum, saliva and dried blood spots. However, LC-MS/MS-based steroid analysis is not straightforward, and understanding the chemical and analytical processes involved is essential for implementation of a robust clinical service. This article discusses specific challenges in the measurement of endogenous steroids using LC-MS/MS, and provides examples of the benefits it offers.
authors: Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK. lewis.couchman@nhs.net
authors: Lewis
authors: L
authors: Couchman
authors: Royce P
authors: RP
authors: Vincent
authors: Lea
authors: L
authors: Ghataore
authors: Caje F
authors: CF
authors: Moniz
authors: Norman F
authors: NF
authors: Taylor
mesh_terms: D000818:Animals; D002853:Chromatography, Liquid / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D013256:Steroids / Q000032:analysis* / Q000096:biosynthesis / Q000378:metabolism; D053719:Tandem Mass Spectrometry / Q000379:methods*
chemical_list: D013256:Steroids