Synthetic Glucocorticoid Screen, Serum
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.
Confirming the presence of listed synthetic glucocorticoids (see Interpretation)
Confirming the cause of secondary adrenal insufficiency
This assay does not detect fluticasone propionate.
This test screens for and quantitates, if present, the following synthetic glucocorticoids: betamethasone, budesonide, dexamethasone, fludrocortisone, flunisolide, fluorometholone, megestrol acetate, methylprednisolone, prednisolone, prednisone, triamcinolone, 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 the presence of fluticasone propionate in serum. Fluticasone propionate is quickly metabolized to fluticasone 17-beta carboxylic acid in urine. To screen for this metabolite, order 17BFP / Fluticasone 17-Beta-Carboxylic Acid, Urine.
This method cannot detect all of the available synthetic steroids either available as pharmaceutical compounds or chemicals present in food. The assay confirms only the listed synthetic glucocorticoids. (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.
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.
Betamethasone: 0.10 mcg/dL
Budesonide: 0.10 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).
Clinical References Provides recommendations for further 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 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