La correcta aproximación clínica a un amplio grupo de situaciones depende en gran medida de la disponibilidad de resultados analíticos de esteroides sexuales que sean exactos y reproducibles, ...obtenidos con métodos con la especificidad y sensibilidad analíticas adecuadas. En este sentido, los inmunoanálisis quimioluminiscentes actuales presentan limitaciones analíticas con repercusiones clínicas importantes. El documento de posicionamiento revisa el estado actual en la estandarización de los métodos de medida de estradiol y testosterona y su repercusión en distintas situaciones clínicas. Se incluye asimismo una serie de recomendaciones a seguir para introducir en los sistemas nacionales de salud los análisis de esteroides por espectrometría de masas, metodología recomendada desde hace más de una década por las sociedades internacionales.
Context:
Cushing's syndrome (CS) is challenging to diagnose. Increased prevalence of CS in specific patient populations has been reported, but routine screening for CS remains questionable. To ...decrease the diagnostic delay and improve disease outcomes, simple new screening methods for CS in at-risk populations are needed.
Objective:
To develop and validate a simple scoring system to predict CS based on clinical signs and an easy-to-use biochemical test.
Design:
Observational, prospective, multicenter.
Setting:
Referral hospital.
Patients:
A cohort of 353 patients attending endocrinology units for outpatient visits.
Interventions:
All patients were evaluated with late-night salivary cortisol (LNSC) and a low-dose dexamethasone suppression test for CS.
Main Outcome Measures:
Diagnosis or exclusion of CS.
Results:
Twenty-six cases of CS were diagnosed in the cohort. A risk scoring system was developed by logistic regression analysis, and cutoff values were derived from a receiver operating characteristic curve. This risk score included clinical signs and symptoms (muscular atrophy, osteoporosis, and dorsocervical fat pad) and LNSC levels. The estimated area under the receiver operating characteristic curve was 0.93, with a sensitivity of 96.2% and specificity of 82.9%.
Conclusions:
We developed a risk score to predict CS in an at-risk population. This score may help to identify at-risk patients in non-endocrinological settings such as primary care, but external validation is warranted.
A prediction model for Cushing's syndrome diagnosis in at-risk populations was developed based on clinical variables and late night salivary cortisol levels.
The proper clinical approach to a wide range of disorders relies on the availability of accurate, reproducible laboratory results for sexual steroids measured using methods with a high specificity ...and sensitivity. The chemiluminescent immunoassays currently available have analytical limitations with significant clinical implications. This position statement reviews the current limitations of laboratory techniques for the measurement of estradiol and testosterone and their impact on diverse clinical scenarios. A set of recommendations are provided to incorporate steroid hormone analysis by mass spectrometry in national health systems. International societies have recommended this methodology for a decade.
Accurate measurement of sex steroids, particularly testosterone and estradiol, is relevant for the diagnosis and treatment of a wide range of conditions. Unfortunately, current chemiluminescent ...immunoassays have analytical limitations with important clinical consequences. This document reviews the current state of clinical assays for estradiol and testosterone measurements and their potential impact in different clinical situations. It also includes a series of recommendations and necessary steps to introduce steroid analysis by mass spectrometry into national health systems, a methodology recommended for more than a decade by international societies.
La correcta aproximación clínica a un amplio grupo de situaciones depende en gran medida de la disponibilidad de resultados analíticos de esteroides sexuales que sean exactos y reproducibles, obtenidos con métodos con la especificidad y sensibilidad analíticas adecuadas. En este sentido, los inmunoanálisis quimioluminiscentes actuales presentan limitaciones analíticas con repercusiones clínicas importantes. El documento de posicionamiento revisa el estado actual en la estandarización de los métodos de medida de estradiol y testosterona y su repercusión en distintas situaciones clínicas. Se incluye asimismo una serie de recomendaciones a seguir para introducir en los sistemas nacionales de salud los análisis de esteroides por espectrometría de masas, metodología recomendada desde hace más de una década por las sociedades internacionales.
Summary
Introduction
Thyroglobulin (Tg), the most common marker to determine remission of differentiated thyroid carcinoma (DTC), can take 18 months or longer to be undetectable. We hypothesized that ...Tg stimulated after surgery and immediately before radioiodine treatment (baseline‐stimulated Tg) could be a good predictor of remission at 18–24 months. The aim of this study was to evaluate the role of baseline‐stimulated Tg as early prognostic marker of DTC.
Patients and methods
Retrospective study of 133 patients with DTC from 1998 to 2010 (age at diagnosis 47·4 ± 16·8, follow‐up 5·09 ± 3·2 years). Initial subset analysis was performed after excluding patients with positive TgAb, who were later included in the second. Baseline‐stimulated Tg was divided into tertiles. Multivariate logistic regression analysis included baseline Tg and other known prognostic markers and receiver operating characteristic (ROC) curve to identify the best cut‐off level of baseline Tg were performed.
Results
Baseline‐stimulated Tg in the highest tertile was the only predictive variable of persistence of disease at 18–24 months in the initial analysis (OR 45·3, P < 0·01). In the second analysis, the predictive variables were baseline‐stimulated Tg (OR 39·6, P < 0·001), presence of TgAb (OR 23·4, P < 0·005) and uptake outside of the thyroid bed post‐treatment whole body scan (WBS; OR 5·3, P < 0·05) were predictive of persistence of disease. The ROC curve showed that baseline‐stimulated Tg below 8·55 μg/l identified 95% of disease‐free patients at 18–24 months after initial treatment.
Conclusions
Baseline‐stimulated Tg is a good predictor of remission of disease at 18–24 months after initial treatment and could be a useful marker to stratify risk immediately after surgery.
Prolactin measurement is very common in standard clinical practice. It is indicated not only in the study of pituitary adenomas, but also when there are problems with fertility, decreased libido, or ...menstrual disorders, among other problems. Inadequate interpretation of prolactin levels without contextualizing the laboratory results with the clinical, pharmacological, and gynecological/urological history of patients leads to erroneous diagnoses and, thus, to poorly based studies and treatments. Macroprolactinemia, defined as hyperprolactinemia due to excess macroprolactin (an isoform of a greater molecular weight than prolactin but with less biological activity), is one of the main causes of such erroneous diagnoses, resulting in poor patient management when not recognized. There is no unanimous agreement as to when macroprolactin screening is required in patients with hyperprolactinemia. At some institutions, macroprolactin testing by polyethylene glycol (PEG) precipitation is routinely performed in all patients with hyperprolactinemia, while others use a clinically based approach. There is also no consensus on how to express the results of prolactin/macroprolactin levels after PEG, which in some cases may lead to an erroneous interpretation of the results. The objectives of this study were: 1. To establish the strategy for macroprolactin screening by serum precipitation with PEG in patients with hyperprolactinemia: universal screening versus a strategy guided by the alert generated by the clinician based on the absence or presence of clinical symptoms or by the laboratory when hyperprolactinemia is detected. 2. To create a consensus document that standardizes the reporting of prolactin results after precipitation with PEG to minimize errors in the interpretation of the results, in line with international standards.
Resumen
La correcta aproximación clínica a un amplio grupo de situaciones depende en gran medida de la disponibilidad de resultados analíticos de esteroides sexuales que sean exactos y reproducibles, ...obtenidos con métodos con la especificidad y sensibilidad analíticas adecuadas. En este sentido, los inmunoanálisis quimioluminiscentes actuales presentan limitaciones analíticas con repercusiones clínicas importantes. El documento de posicionamiento revisa el estado actual en la estandarización de los métodos de medida de estradiol y testosterona y su repercusión en distintas situaciones clínicas. Se incluye asimismo una serie de recomendaciones a seguir para introducir en los sistemas nacionales de salud los análisis de esteroides por espectrometría de masas, metodología recomendada desde hace más de una década por las sociedades internacionales.
Accurate measurement of sex steroids, particularly testosterone and estradiol, is relevant for the diagnosis and treatment of a wide range of conditions. Unfortunately, current chemiluminescent ...immunoassays have analytical limitations with important clinical consequences. This document reviews the current state of clinical assays for estradiol and testosterone measurements and their potential impact in different clinical situations. It also includes a series of recommendations and necessary steps to introduce steroid analysis by mass spectrometry into national health systems, a methodology recommended for more than a decade by international societies.
The proper clinical approach to a wide range of disorders relies on the availability of accurate, reproducible laboratory results for sexual steroids measured using methods with a high specificity ...and sensitivity. The chemiluminescent immunoassays currently available have analytical limitations with significant clinical implications. This position statement reviews the current limitations of laboratory techniques for the measurement of estradiol and testosterone and their impact on diverse clinical scenarios. A set of recommendations are provided to incorporate steroid hormone analysis by mass spectrometry in national health systems. International societies have recommended this methodology for a decade.
Macroprolactin: From laboratory to clinical practice Biagetti, Betina; Ferrer Costa, Roser; Alfayate Guerra, Rocío ...
Endocrinología, diabetes y nutrición.,
January 2022, 2022-Jan, 2022-01-00, 20220101, Letnik:
69, Številka:
1
Journal Article
Recenzirano
Prolactin measurement is very common in standard clinical practice. It is indicated not only in the study of pituitary adenomas, but also when there are problems with fertility, decreased libido, or ...menstrual disorders, among other problems.
Inadequate interpretation of prolactin levels without contextualizing the laboratory results with the clinical, pharmacological, and gynecological/urological history of patients leads to erroneous diagnoses and, thus, to poorly based studies and treatments.
Macroprolactinemia, defined as hyperprolactinemia due to excess macroprolactin (an isoform of a greater molecular weight than prolactin but with less biological activity), is one of the main causes of such erroneous diagnoses, resulting in poor patient management when not recognized.
There is no unanimous agreement as to when macroprolactin screening is required in patients with hyperprolactinemia. At some institutions, macroprolactin testing by polyethylene glycol (PEG) precipitation is routinely performed in all patients with hyperprolactinemia, while others use a clinically based approach. There is also no consensus on how to express the results of prolactin/macroprolactin levels after PEG, which in some cases may lead to an erroneous interpretation of the results.
The objectives of this study were:
1. To establish the strategy for macroprolactin screening by serum precipitation with PEG in patients with hyperprolactinemia: universal screening versus a strategy guided by the alert generated by the clinician based on the absence or presence of clinical symptoms or by the laboratory when hyperprolactinemia is detected.
2. To create a consensus document that standardizes the reporting of prolactin results after precipitation with PEG to minimize errors in the interpretation of the results, in line with international standards.
La medición de la prolactina es muy frecuente en la práctica clínica habitual. Está indicada no solo en el estudio de los adenomas hipofisarios, sino también cuando hay problemas de fertilidad, disminución de la libido o trastornos menstruales, entre otros.
Una interpretación incorrecta de la concentración de la prolactina sin contextualizar los resultados analíticos con la historia clínica, farmacológica y gineco/urológica de los pacientes lleva a diagnósticos erróneos y, por lo tanto, a estudios y tratamientos mal fundamentados.
La macroprolactinemia, definida como la hiperprolactinemia debida al exceso de macroprolactina (isoforma de mayor peso molecular que la prolactina pero con menor actividad biológica), es una de las causas principales de estos diagnósticos erróneos, con el consecuente mal manejo del paciente, cuando no se reconoce.
No hay un acuerdo unánime en relación a cuando hay que realizar el cribado de macroprolactina en los pacientes con hiperprolactinemia. En algunos centros el estudio de macroprolactina mediante la precipitación con polietilenglicol (PEG) se realiza de forma rutinaria en todos los pacientes con hiperprolactinemia, mientras que en otros se realiza un enfoque basado en la clínica. Asimismo, no existe un consenso en la forma de expresar los resultados de la concentración de la prolactina/macroprolactina post PEG, lo que en algunos casos puede derivar en una interpretación errónea de los resultados.
Los objetivos de este documento son:
1. Establecer la estrategia de cribado de macroprolactina mediante precipitación del suero con PEG en pacientes con hiperprolactinemia: cribado universal vs estrategia guiada en función de la alerta originada por el clínico en base a la ausencia o presencia de sintomatología clínica o por el laboratorio ante la presencia de hiperprolactinemia.
2. Crear un documento de consenso que estandarice el informe de los resultados de la prolactina tras su precipitación con PEG para reducir errores en la interpretación de los resultados, siguiendo los estándares internacionales.
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