It is worth pointing out that the service provided by David Cowan and Andy
Kicman has recently expanded to provide screening by LC-MS for a large
number of xenobiotic glucocorticoids as well as the anabolic steroids for
which they are well known. I understand experience is still being gained
on what can be detected in biological material. Our urine steroid profiling
service based on GC-MS can readily detect suppression of endogenous
cortisol production, but this methodology does not reliably pick up many
synthetic glucocortioids, although we can uncover use of cortisol
(hydrocortisone) and prednisolone. For prednisolone, the metabolites are
reliably detected, so amount of steroid taken, metabolism and biological
effect can be estimated.
When a patient has been using a 'herbal' skin cream or pills that are
suspected of containing glucocorticoids, direct analysis of the material
can be fruitful, although analysis of urine, preferably collected over 24h,
remains perhaps the best general way of detecting if the patient is subject
to adrenocortical suppression. For anabolic steroid abuse, suppression of
endogenous androgen production may be evident, but the normal range is
wide, so it can never be definitive. Conclusion: if you suspect anabolic
steroid abuse, go for an anabolic steroid screen; if you suspect
glucocorticoid use, consider endogenous steroids first.
Norman Taylor
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