COMPARISON OF CORTISON LEVELS DURING AN ACTH STIMULATION TEST USING TANDEM MASS

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 本研究的目的是利用串联质谱仪这一新的分析方法来检测ACTH刺激试验后正常和疑似肾上腺功能不全患者的血清皮质醇水平。这些测定将与更标准的免疫测定结果进行比较，以确定MS/MS皮质醇测定是否会产生与标准免疫测定皮质醇类似但更准确的值。第二个目标是在促肾上腺皮质激素刺激试验中测定其他类固醇激素(雌二醇、总睾酮和未结合睾酮、脱氢表雄酮、脱氢表雄酮-S、雄烯二酮、17-羟孕酮、孕酮、皮质醇、11-脱氧皮质醇、总和未结合雌三醇、雌酮、2-羟雌酮、16-羟雌酮、醛固酮和别孕酮)。已知ACTH可以增加皮质醇和醛固酮的产生，但ACTH是否也刺激其他肾上腺类固醇的产生，以及这些措施是否可以为肾上腺功能的评估提供额外的有用数据，还没有研究。 具体目标： 本研究的主要目的是比较在ACTH刺激试验中使用串联质谱仪(MS/MS)(一种实验方法)和同时进行免疫分析(IA)(标准方法)测量的皮质醇。 第二个目标将是在促肾上腺皮质激素刺激试验中测定其他类固醇激素(雌二醇、总和未结合睾酮、脱氢表雄酮、脱氢表雄酮-S、雄烯二酮、17-羟孕酮、孕酮、皮质醇、11-脱氧皮质醇、总和未结合雌三醇、雌酮、2-羟雌酮、16-羟雌酮、醛固酮和别孕酮)。已知ACTH可以增加皮质醇和醛固酮的产生，但ACTH是否刺激其他肾上腺类固醇的产生还没有得到很好的研究。 用MS/MS测量皮质醇比用IA测量皮质醇的预期好处是： 1)IA对包括皮质醇在内的所有类固醇缺乏特异性。 2)MS/MS测量可能执行得更快(MS/MS大约5分钟，而IA大约30分钟)。 3)MS/MS可能比IA更准确。 4)MS/MS可能能够将皮质醇的测量与治疗类固醇分开，这将允许在某人服用泼尼松或其他治疗类固醇时进行ACTH刺激试验。 MS/MS分析的结果不会用于临床决策，但将与同时进行的IA的结果进行比较。 假设：我们的假设是，MS/MS测量皮质醇将产生与IA皮质醇测量相似但更准确的值。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The purpose of this study is to utilize tandem mass spectrometry, a novel analytical method, to measure serum cortisol levels following ACTH stimulation testing in patients who are normal and those suspected of having adrenal insufficiency. These determinations will be compared to the results obtained using more standard immunoassays in order to determine whether MS/MS measurement of cortisol will yield similar, but more accurate, values than standard immunoassay measurement of cortisol. A second goal will be to measure other steroid hormones (estradiol, total and unconjugated testosterone, DHEA, DHEA-S, androstenedione, 17-OH-progesterone, progesterone, cortisol, 11-deoxycortisol, total and uncongugated estriol, estrone, 2- OH -estrone, 16-OH- estrone, aldosterone and allopregnanolone) during an ACTH stimulation test. ACTH is known to increase the production of cortisol and aldosterone, but whether ACTH also stimulates other adrenal steroid production, and whether such measures might provide additional useful data in the evaluation of adrenal function, has not been studied. SPECIFIC AIMS: The primary purpose of this study is to compare measurements of cortisol using tandem mass spectrometry (MS/MS) (an experimental method) with simultaneously performed immunoassay (IA) (the standard method) during an ACTH stimulation test. A secondary goal will be to measure other steroid hormones (estradiol, total and unconjugated testosterone, DHEA, DHEA-S, androstenedione, 17-OH-progesterone, progesterone, cortisol, 11-deoxycortisol, total and uncongugated estriol, estrone, 2- OH -estrone, 16-OH- estrone, aldosterone and allopregnanolone) during an ACTH stimulation test. ACTH is known to increase the production of cortisol and aldoseterone, but it has not been well studied whether ACTH stimulates other adrenal steroid production. The expected benefits of measurement of cortisol with MS/MS over measurement of cortisol with IA are: 1) IA lacks specificity for all steroids including cortisol. 2) MS/MS measurements can potentially be performed more quickly (about 5 minutes by MS/MS versus about 30 minutes by IA). 3) MS/MS may be more accurate than IA. 4) MS/MS may be able to separate measurement of cortisol from therapeutic steroids, which would allow an ACTH stimulation test to be performed while someone is taking prednisone or other therapeutic steroids. The results of the MS/MS assays will not be used for clinical decision-making, but will be compared with the results of simultaneously performed IA. Hypothesis: Our hypothesis is that MS/MS measurement of cortisol will yield similar but more accurate values than IA measurement of cortisol.