Iatrogenic Cushing syndrome in 24-hour urine free cortisol measurement

Clin Chim Acta. 2022 Sep 1:534:173-175. doi: 10.1016/j.cca.2022.07.019. Epub 2022 Aug 2.

Abstract

Cushing syndrome (CS) is caused by an excess of glucocorticoids that results in a variety of symptoms such as central obesity, moon facies, hirsutism, and reddish-purple stretch marks. Cortisol is the most potent endogenous glucocorticoid, and measuring the total amount excreted in the urine over a 24-hour period is useful to screen for CS caused by a tumor. However, most cases of CS are believed to be caused by exogenous glucocorticoids, such as prednisone and prednisolone, which are administered for anti-inflammatory and immunosuppressive treatments. This is often referred to as iatrogenic (drug-related or exogenous) CS. We modified an LC-MS/MS method for urine free cortisol to detect the presence of prednisone and prednisolone in patient samples. We wanted to understand the potential prevalence of exogenous CS in our patient population.

Keywords: Cortisone; Cushing syndrome; Exogenous Cushing syndrome; LC-MS/MS; Prednisolone; Prednisone; Urine free cortisol.

MeSH terms

  • Chromatography, Liquid / methods
  • Cushing Syndrome* / chemically induced
  • Cushing Syndrome* / diagnosis
  • Glucocorticoids
  • Humans
  • Hydrocortisone
  • Iatrogenic Disease
  • Prednisolone
  • Prednisone
  • Tandem Mass Spectrometry / methods

Substances

  • Glucocorticoids
  • Prednisolone
  • Prednisone
  • Hydrocortisone