Test Catalog

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 the listed synthetic glucocorticoids (see Interpretation)

 

Confirming the cause of secondary adrenal insufficiency

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

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Synthetic Glucocorticoid Screen, U

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

Ordering Guidance

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, Random, 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

0.6 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.

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 (preferred) 14 days

Useful For
Suggests clinical disorders or settings where the test may be helpful

Confirming the presence of the listed synthetic glucocorticoids (see Interpretation)

 

Confirming the cause of secondary adrenal insufficiency

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.

 

The fluticasone propionate analyte is reported with this test and is also available separately, see 17BFP / Fluticasone 17-Beta-Carboxylic Acid, Random, Urine for more information.

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

Fluticasone propionate: 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 urine 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

The fluticasone propionate analyte is reported with this test and is also available separately; see 17BFP / Fluticasone 17-Beta-Carboxylic Acid, Random, Urine for more information.

 

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 glucocorticoid because adrenal suppression may persist for some time after the exogenous steroid is discontinued.

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 Sep;83(3):153-179

2. Bijlsma JW, van Everdingen AA, Huisman M, De Nijs R, Jacobs JW: 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

6. 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

7. 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 May;67(5):593-601.e3. doi: 10.1016/j.annemergmed.2015.08.001

Method Description
Describes how the test is performed and provides a method-specific reference

The synthetic glucocorticoids are extracted from 0.5 mL of urine using an acetonitrile protein precipitation followed by methylene chloride liquid extraction of the solvent. Cortisol-9, 11, 12, 12-d, and triamcinolone-d1 acetonide-d6 are added to each sample before the liquid extraction and serve as the internal standards. Then, 17 mcL of the reconstituted sample extract is injected into 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 S, Silvestro L, Haag A, Sorgel F: A confirmatory HPLC-MS/MS method for ten synthetic corticosteroids in bovine urines. J Mass Spectrom. 1996 December;31[12]:1351-1363; 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 Nov;48(Pt 6):542-9. doi: 10.1258/acb.2011.010250)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

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.

Tuesday, Thursday

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.

3 to 9 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

3 months

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

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.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their Regional Manager. For assistance, contact Customer Service.

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. This test 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.

80299

LOINC® Information

Test Id Test Order Name Order LOINC Value
SGSU Synthetic Glucocorticoid Screen, U 46959-3
Result Id Test Result Name Result LOINC Value
Result LOINC Value Tooltip
23562 Betamethasone 46946-0
23563 Budesonide 46947-8
23564 Dexamethasone 46948-6
23565 Fludrocortisone 46949-4
23568 Fluticasone Propionate 46952-8
23569 Megestrol Acetate 46953-6
23570 Methylprednisolone 46954-4
23571 Prednisolone 46955-1
23572 Prednisone 46956-9
23574 Triamcinolone Acetonide 46958-5

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports