Test Catalog

Test Id : SGSS

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Synthetic Glucocorticoid Screen, Serum

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Overview

Test Catalog

Useful For
Suggests clinical disorders or settings where the test may be helpful

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
A short description of the method used to perform the test

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

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Synthetic Glucocorticoid Screen, S

Aliases
Lists additional common names for a test, as an aid in searching

Betamethasone

Budesonide

Celestone

Cutivate 0.005%

Decadron

Deltasone

Depo-Medrol

Dexamethasone

Diprolene

Diprolene AF

Diprosone

Entocort EC

Flonase

Flovent

Flovent Rotadisk

Fludrocortisone

Kenalog

Liquid Pred

Medrol

Megace

Megestrol Acetate

Methylprednisolone

Orasone

Prednisolone

Prednisone

Rhinocort

Solu-Medrol

Triamcinolone Acetonide

Pulmicort Turbuhaler

Specimen Type
Describes the specimen type validated for testing

Serum

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

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.

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.

1.1 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis OK
Gross lipemia OK
Gross icterus OK

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Serum Frozen (preferred) 14 days
Refrigerated 7 days
Ambient 24 hours

Useful For
Suggests clinical disorders or settings where the test may be helpful

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.

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

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
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

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
Provides information to assist in interpretation of the test results

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
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

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
Recommendations for in-depth reading of a clinical nature

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
Describes how the test is performed and provides a method-specific reference

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)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Wednesday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

5 to 10 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

2 weeks

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their account representative. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

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
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

80299

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
SGSS Synthetic Glucocorticoid Screen, S 43141-1
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
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

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports