(If you have previously received this, please ignore the repeat posting)
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 believe they are still gaining experience on
detection levels of glucocorticoids in biological material. Our urine
steroid profiling service based on GC-MS can readily detect suppression of
endogenous cortisol production, but our standard method does not reliably
pick up many synthetic glucocortioids, although it can uncover use of
cortisol (hydrocortisone) and prednisolone. For prednisolone, the
metabolites are reliably distinguished from cortisol metabolites, 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 analysis of
endogenous steroids first.
Norman Taylor
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