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的一个 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可以在其他CRISP条目中表示。所列机构为 研究中心，而研究中心不一定是研究者所在的机构。 本研究的目的是利用串联质谱法，一种新的分析方法，以测量血清皮质醇水平的ACTH刺激试验后，在患者谁是正常的和那些怀疑有肾上腺皮质功能不全。将这些测定结果与使用更多标准免疫测定法获得的结果进行比较，以确定皮质醇的MS/MS测量是否会产生与皮质醇的标准免疫测定法测量结果相似但更准确的值。第二个目标是在ACTH刺激试验期间测量其它类固醇激素（雌二醇、总睾酮和未结合睾酮、DHEA、DHEA-S、雄烯二酮、17-OH-孕酮、孕酮、皮质醇、11-脱氧皮质醇、总雌三醇和未结合雌三醇、雌酮、2- OH -雌酮、16-OH-雌酮、醛固酮和别孕烯醇酮）。 促肾上腺皮质激素已知可增加皮质醇和醛固酮的产生，但促肾上腺皮质激素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能在肾上腺功能的评估中提供额外的有用数据，尚未研究。 具体目标： 本研究的主要目的是比较皮质醇的测量使用串联质谱（MS/MS）（实验方法），同时进行免疫测定（IA）（标准方法）在促肾上腺皮质激素刺激试验。 次要目标是在ACTH刺激试验期间测量其他类固醇激素（雌二醇、总睾酮和未结合睾酮、DHEA、DHEA-S、雄烯二酮、17-OH-孕酮、孕酮、皮质醇、11-脱氧皮质醇、总雌三醇和未结合雌三醇、雌酮、2- OH -雌酮、16-OH-雌酮、醛固酮和别孕烯醇酮）。 促肾上腺皮质激素是已知的增加皮质醇和醛酮的生产，但它还没有得到很好的研究是否促肾上腺皮质激素刺激其他肾上腺类固醇的生产。 使用MS/MS测量皮质醇相对于使用IA测量皮质醇的预期益处是： 第一章 IA对包括皮质醇在内的所有类固醇缺乏特异性。 （二） MS/MS测量可能更快地进行（MS/MS约5分钟，IA约30分钟）。 第三章 MS/MS可能比IA更准确。 四、 MS/MS可能能够将皮质醇的测量与治疗性类固醇分开，这将允许在某人服用泼尼松或其他治疗性类固醇时进行ACTH刺激测试。 MS/MS测定的结果将不用于临床决策，但将与同时进行的IA的结果进行比较。 假设：我们的假设是，皮质醇的MS/MS测量将产生类似的，但更准确的值比皮质醇的IA测量。

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.