J Mass Spectrom Adv Clin Lab. 2022 Aug;25 44-52
Introduction: Preoperative diagnostic workup of adrenal tumors is based on imaging and hormone analyses, but charged with uncertainties. Steroid profiling by liquid chromatography tandem mass spectrometry (LC-MS/MS) in 24-h urine has shown potential to discriminate benign and malignant adrenal tumors. Our aim was to develop and validate a specific and accurate LC-MS/MS method for the quantification of deconjugated urinary marker steroids, to evaluate their pre-analytical stability and to apply the method to clinical samples of patients with adrenal tumors.
Methods: A method for the quantification of 11 deconjugated steroids (5-pregnenetriol, dehydroepiandrosterone, cortisone, cortisol, α-cortolone, tetrahydro-11-deoxycortisol, etiocholanolone, pregnenolone, pregnanetriol, pregnanediol, and 5-pregnenediol) in human urine was developed and validated based on international guidelines. Steroids were enzymatically deconjugated and extracted by solid phase extraction before LC-MS/MS quantification in positive electrospray ionization mode.
Results: Excellent linearity with R2 > 0.99 and intra- and inter-day precisions of < 10.1 % were found. Relative matrix effects were between 96.4 % and 101.6 % and relative recovery was between 98.2 % and 115.0 %. Sufficient pre-freeze stability for all steroids in urine was found at 20-25 °C for seven days and at 4-6 °C for up to 28 days. Samples were stable during long-term storage at -20 °C and -80 °C for 6 months.
Conclusions: A sensitive and robust LC-MS/MS method for the quantification of 11 urinary steroids was developed and validated according to international guidelines. Pre-analytical matrix stability was evaluated and the suitability of the method for the analysis of clinical samples and prospective validation studies was shown.
Keywords: 5-PD, 5-pregnen-3β,20α-diol; 5-PT, 5-pregnen-3β,17,20α-triol; ACA, adrenocortical adenoma; ACC, adrenocortical carcinoma; Adrenal tumors; Adrenocortical carcinoma; DHEA, dehydroepiandrosterone; Etio, etiocholanolone; IS, internal standard; LC-MS/MS, liquid chromatography tandem mass spectrometry; LC–MS/MS; LLOQ, lower limit of quantification; MRM, multiple reaction monitoring; Mass spectrometry; PD, 5β-pregnan-3α,20α-diol; PT, 5β-pregnan-3α,17,20α-triol; QC, quality control; R2, coefficient of determination; SPE, solid phase extraction; Steroid profiling; ULOQ, upper limit of quantification; Urinary steroids