Test Id : SGSU
Synthetic Glucocorticoid Screen, Random, Urine
Useful For
Suggests clinical disorders or settings where the test may be helpful
Confirming the presence of listed synthetic glucocorticoids in urine specimens (see Interpretation)
Confirming the cause of glucocorticoid-induced 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)
NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test
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
Fludrocortisone
Kenalog
Liquid Pred
Medrol
Megace
Megestrol Acetate
Methylprednisolone
Orasone
Prednisolone
Prednisone
Rhinocort
Solu-Medrol
Triamcinolone Acetonide
Vancenase
Vanceril
Pulmicort Turbuhaler
Specimen Type
Describes the specimen type validated for testing
Urine
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Supplies: Urine tubes, 10 mL (T068)
Container/Tube: Plastic, 10-mL urine tube
Specimen Volume: 5 mL
Collection Instructions:
1. Collect a random urine specimen.
2. No preservative.
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.
0.6 mL
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
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 |
|---|---|---|---|
| Urine | Frozen | 14 days |
Useful For
Suggests clinical disorders or settings where the test may be helpful
Confirming the presence of listed synthetic glucocorticoids in urine specimens (see Interpretation)
Confirming the cause of glucocorticoid-induced 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
The primary use of this test is to assess exposure to synthetic glucocorticoids in patients with suspected central adrenal insufficiency.
Synthetic glucocorticoids are widely used as anti-inflammatory and immunosuppressive agents. Synthetic glucocorticoids can be used through various routes: oral, intravenous, intramuscular, inhaled, intranasal, and topical. In most cases, exposure to synthetic glucocorticoids is clearly documented in the medical record. However, occasionally, exposure to synthetic glucocorticoids is not clearly evident. This may occur when patients use non-prescription preparations (usually oral or topical) that have glucocorticoids.
Exposure to synthetic glucocorticoids leads to development of features of Cushing syndrome (weight gain, abdominal obesity, moon facies, skin thinning, easy bruising, and metabolic comorbidities) or to glucocorticoid-induced adrenal insufficiency due to hypothalamic-pituitary-adrenal axis suppression by the circulating supraphysiologic synthetic glucocorticoids. Hormonal work up in these cases demonstrates very low corticotropin and cortisol concentrations.
This test allows for measurement of nine synthetic glucocorticoids in patients in whom exogenous glucocorticoid exposure is suspected.
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 cause hypothalamic-pituitary-adrenal axis suppression with development of glucocorticoid-induced adrenal insufficiency.
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 of listed synthetic glucocorticoids does not exclude previous exposure to one or more of tested glucocorticoids, as glucocorticoid-induced adrenal insufficiency (and resolution of features of overt Cushing syndrome) may persist for weeks-months after exogenous glucocorticoids were discontinued. In a patient with documented glucocorticoid exposure, circulating concentrations of synthetic glucocorticoids depend on the route of administration (detected for longer time if joint injection), dose and type of glucocorticoid that influence metabolism and clearance of the glucocorticoid (longer for triamcinolone).
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;83(3):153-179
2. 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;48(Pt 6):542-9. doi:10.1258/acb.2011.010250
3. Bijlsma JW, Van Everdingen AA, Huisman M, De Nijs RN, Jacobs JW. Glucocorticoids in rheumatoid arthritis: effects on erosions and bone. Ann N Y Acad Sci. 2002;966:82-90. doi:10.1111/j.1749-6632.2002.tb04205.x
4. Sandborn WJ. Steroid-dependent Crohn's disease. Can J Gastroenterol. 2000 Sep;14 Suppl C:17C-22C
5. Benvenuti S, Brandi ML: Corticosteroid-induced osteoporosis: pathogenesis and prevention. Clin Exp Rheumatol. 2000;18(4 Suppl 20):S64-S66
6. Loke TK, Sousa AR, Corrigan CJ, Lee TH. Glucocorticoid-resistant asthma. Curr Allergy Asthma Rep. 2002;2(2):144-150
7. Fardet L, Petersen I, Nazareth I. Monitoring of patients on long-term glucocorticoid therapy: a population-based cohort study. Medicine (Baltimore). 2015;94(15):e647. doi:10.1097/MD.0000000000000647
8. 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;67(5):593-601.e3. doi:10.1016/j.annemergmed.2015.08.001
9. Ponzetto F, Parasiliti-Caprino M, Settanni F, et al. Simultaneous measurement of cortisol, cortisone, dexamethasone and additional exogenous corticosteroids by rapid and sensitive LC-MS/MS analysis. Molecules. 2022;28(1):248. Published 2022 Dec 28. doi:10.3390/molecules28010248
Method Description
Describes how the test is performed and provides a method-specific reference
The synthetic glucocorticoids (betamethasone, budesonide, dexamethasone, fludrocortisone, megestrol acetate, methylprednisolone, prednisolone, prednisone, triamcinolone acetonide) as well as cortisol and cortisone are extracted from 0.5 mL of urine or serum using an acetonitrile protein precipitation followed by liquid/liquid extraction of the supernatant. Cortisol-d4, triamcinolone-d1 acetonide-d6, dexamethasone-d4, and cortisone-d7, are added to each sample before the acetonitrile protein precipitation and serve as the internal standards. The reconstituted sample extract is injected onto a high performance liquid chromatography system and analyzed by liquid chromatography tandem mass spectrometry.(Taylor RL, Grebe SK, Singh RJ. Quantitative, highly sensitive liquid chromatography-tandem mass spectrometry method for detection of synthetic corticosteroids. Clin Chem. 2004;50[12]:2345-52. doi:10.1373/clinchem.2004.033605)
PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information
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.
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
Indicates the location of the laboratory that performs the test
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.
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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.
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 |
|---|---|---|
| SGSU | Synthetic Glucocorticoid Screen, U | 46959-3 |
| 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.
|
|---|---|---|
| 23562 | Betamethasone | 46946-0 |
| 23563 | Budesonide | 46947-8 |
| 23564 | Dexamethasone | 46948-6 |
| 23565 | Fludrocortisone | 46949-4 |
| 23569 | Megestrol Acetate | 46953-6 |
| 23570 | Methylprednisolone | 46954-4 |
| 23571 | Prednisolone | 46955-1 |
| 23572 | Prednisone | 46956-9 |
| 23574 | Triamcinolone Acetonide | 46958-5 |