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Published on: August 23, 2019
Cortisol measurement in patients receiving metyrapone therapy
L J Owen1, D J Halsall, B G Keevil
1Biochemistry Department, University Hospital of South Manchester, Manchester, UK. Laura.owen@uhsm.nhs.uk
Annals of Clinical Biochemistry
|October 8, 2010
Summary
Metyrapone treatment for Cushing's syndrome can lead to inaccurate cortisol measurements using immunoassays due to steroid interferences. Mass spectrometry is recommended for precise monitoring of metyrapone therapy.
Area of Science:
- Endocrinology
- Clinical Chemistry
- Pharmacology
Background:
- Current guidelines recommend monitoring metyrapone dosage for Cushing's syndrome by measuring serum cortisol levels.
- Immunoassays are commonly used in the UK for this measurement, but their accuracy may be compromised by altered steroid metabolism during treatment.
Observation:
- Two patients on metyrapone therapy showed elevated 11-deoxycortisol levels.
- Interference studies revealed that 11-deoxycortisol, 17-hydroxyprogesterone, and 21-deoxycortisol can interfere with cortisol immunoassays.
Findings:
- Liquid chromatography-tandem mass spectrometry (MS) analysis identified elevated 11-deoxycortisol in both patients, with one also showing elevated 17-hydroxyprogesterone and the other elevated androstenedione.
- While specific steroids interfered with the immunoassay, the degree of interference did not fully explain the discrepancies between immunoassay and MS results.
Implications:
- Clinicians and laboratory staff must be aware of potential interferences when using immunoassays to monitor metyrapone treatment.
- Mass spectrometry (MS) is the preferred method for accurately measuring serum cortisol concentrations in patients undergoing metyrapone therapy for Cushing's syndrome.
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