Test ID: SGSS
Synthetic Glucocorticoid Screen, Serum
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
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 assay does not detect 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
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
Azmacort
Betamethasone
Budesonide
Celestone
Cutivate 0.005%
Decadron
Deltasone
Depo-Medrol
Dexamethasone
Diprolene
Diprolene AF
Diprosone
Entocort EC
Flonase
Flovent
Flovent Rotadisk
Fludrocortisone
Flunisolide
Fluorometholone
FML Forte Liquifilm
FML Liquifilm
FML S.O.P.
Kenalog
Liquid Pred
Medrol
Megace
Megestrol Acetate
Methylprednisolone
Mycolog-II
Nasalide
Orasone
Prednisolone
Prednisone
PULMICORT TURBUHALER
Rhinocort
Solu-Medrol
Triamcinolone Acetonide
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Collection Container/Tube:
Preferred: Red top
Acceptable: Serum gel
Submission Container/Tube: Plastic vial
Specimen Volume: 2 mL
Forms: If not ordering electronically, submit a General Request Form (Supply T239) with the specimen.
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | Mild OK; Gross OK |
| Lipemia | Mild OK; Gross OK |
| Icterus | Mild OK; Gross OK |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Serum | Frozen (preferred) | 14 days |
| Refrigerated | 7 days | |
| Ambient | 24 hours |
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: 0.10 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).
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, 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/89739 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.
Clinical Reference 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
Method Description Describes how the test is performed and provides a method-specific reference
The synthetic glucocorticoids are extracted from 0.5 mL of serum using an acetonitrile protein precipitation followed by methylene chloride liquid extraction of the solvent. Cortisol-9, 11, 12, 12-d4, and triamcinolone-d1 acetonide-d6 are added to each sample before the liquid extraction and serve as the internal standards. Next, 17 mcL of the reconstituted specimen extract is injected onto a high-performance liquid chromatography (HPLC) system and analyzed by tandem mass spectrometry (LC-MS/MS). 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;42:979-981; Savu SR, Silvestro L, Haag A, Sorgel F: A confirmatory HPLC-MS/MS method for ten synthetic corticosteroids in bovine urines. J Mass Spectrom 1996;31:1351-1363)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Tuesday, Friday, 9 a.m.
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
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's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
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 Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
82544
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| 23593 | Betamethasone | 41745-1 |
| 23594 | Budesonide | 41747-7 |
| 23595 | Dexamethasone | 14062-4 |
| 23596 | Fludrocortisone | 41754-3 |
| 23597 | Flunisolide | 41755-0 |
| 23598 | Fluorometholone | 41756-8 |
| 23599 | Fluticasone Propionate | 41757-6 |
| 23600 | Megestrol Acetate | 41762-6 |
| 23601 | Methylprednisolone | 14186-1 |
| 23602 | Prednisolone | 12727-4 |
| 23603 | Prednisone | 12434-7 |
| 23604 | Triamcinolone | 41766-7 |
| 23605 | Triamcinolone Acetonide | 41767-5 |
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