Cargando…

The use of liquid chromatography-tandem mass spectrometry in newborn screening for congenital adrenal hyperplasia: improvements and future perspectives

Newborn screening for congenital adrenal hyperplasia using 17-hydroxyprogesterone by immunoassay remains controversial despite screening been available for almost 40 years. Screening is confounded by poor immunoassay specificity, fetal adrenal physiology, stress, and illness which can result in a la...

Descripción completa

Detalles Bibliográficos
Autores principales: de Hora, Mark, Heather, Natasha, Webster, Dianne, Albert, Benjamin, Hofman, Paul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10578435/
https://www.ncbi.nlm.nih.gov/pubmed/37850096
http://dx.doi.org/10.3389/fendo.2023.1226284
_version_ 1785121519021588480
author de Hora, Mark
Heather, Natasha
Webster, Dianne
Albert, Benjamin
Hofman, Paul
author_facet de Hora, Mark
Heather, Natasha
Webster, Dianne
Albert, Benjamin
Hofman, Paul
author_sort de Hora, Mark
collection PubMed
description Newborn screening for congenital adrenal hyperplasia using 17-hydroxyprogesterone by immunoassay remains controversial despite screening been available for almost 40 years. Screening is confounded by poor immunoassay specificity, fetal adrenal physiology, stress, and illness which can result in a large number of false positive screening tests. Screening programmes apply higher screening thresholds based on co-variates such as birthweight or gestational age but the false positive rate using immunoassay remains high. Mass spectrometry was first applied to newborn screening for congenital adrenal hyperplasia over 15 years ago. Elevated 17-hydroxprogesterone by immunoassay can be retested with a specific liquid chromatography tandem mass spectrometry assay that may include additional steroid markers. Laboratories register with quality assurance programme providers to ensure accurate steroid measurements. This has led to improvements in screening but there are additional costs and added laboratory workload. The search for novel steroid markers may inform further improvements to screening. Studies have shown that 11-oxygenated androgens are elevated in untreated patients and that the adrenal steroidogenesis backdoor pathway is more active in babies with congenital adrenal hyperplasia. There is continual interest in 21-deoxycortisol, a specific marker of 21-hydroxylase deficiency. The measurement of androgenic steroids and their precursors by liquid chromatography tandem mass spectrometry in bloodspots may inform improvements for screening, diagnosis, and treatment monitoring. In this review, we describe how liquid chromatography tandem mass spectrometry has improved newborn screening for congenital adrenal hyperplasia and explore how future developments may inform further improvements to screening and diagnosis.
format Online
Article
Text
id pubmed-10578435
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-105784352023-10-17 The use of liquid chromatography-tandem mass spectrometry in newborn screening for congenital adrenal hyperplasia: improvements and future perspectives de Hora, Mark Heather, Natasha Webster, Dianne Albert, Benjamin Hofman, Paul Front Endocrinol (Lausanne) Endocrinology Newborn screening for congenital adrenal hyperplasia using 17-hydroxyprogesterone by immunoassay remains controversial despite screening been available for almost 40 years. Screening is confounded by poor immunoassay specificity, fetal adrenal physiology, stress, and illness which can result in a large number of false positive screening tests. Screening programmes apply higher screening thresholds based on co-variates such as birthweight or gestational age but the false positive rate using immunoassay remains high. Mass spectrometry was first applied to newborn screening for congenital adrenal hyperplasia over 15 years ago. Elevated 17-hydroxprogesterone by immunoassay can be retested with a specific liquid chromatography tandem mass spectrometry assay that may include additional steroid markers. Laboratories register with quality assurance programme providers to ensure accurate steroid measurements. This has led to improvements in screening but there are additional costs and added laboratory workload. The search for novel steroid markers may inform further improvements to screening. Studies have shown that 11-oxygenated androgens are elevated in untreated patients and that the adrenal steroidogenesis backdoor pathway is more active in babies with congenital adrenal hyperplasia. There is continual interest in 21-deoxycortisol, a specific marker of 21-hydroxylase deficiency. The measurement of androgenic steroids and their precursors by liquid chromatography tandem mass spectrometry in bloodspots may inform improvements for screening, diagnosis, and treatment monitoring. In this review, we describe how liquid chromatography tandem mass spectrometry has improved newborn screening for congenital adrenal hyperplasia and explore how future developments may inform further improvements to screening and diagnosis. Frontiers Media S.A. 2023-10-02 /pmc/articles/PMC10578435/ /pubmed/37850096 http://dx.doi.org/10.3389/fendo.2023.1226284 Text en Copyright © 2023 de Hora, Heather, Webster, Albert and Hofman https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Endocrinology
de Hora, Mark
Heather, Natasha
Webster, Dianne
Albert, Benjamin
Hofman, Paul
The use of liquid chromatography-tandem mass spectrometry in newborn screening for congenital adrenal hyperplasia: improvements and future perspectives
title The use of liquid chromatography-tandem mass spectrometry in newborn screening for congenital adrenal hyperplasia: improvements and future perspectives
title_full The use of liquid chromatography-tandem mass spectrometry in newborn screening for congenital adrenal hyperplasia: improvements and future perspectives
title_fullStr The use of liquid chromatography-tandem mass spectrometry in newborn screening for congenital adrenal hyperplasia: improvements and future perspectives
title_full_unstemmed The use of liquid chromatography-tandem mass spectrometry in newborn screening for congenital adrenal hyperplasia: improvements and future perspectives
title_short The use of liquid chromatography-tandem mass spectrometry in newborn screening for congenital adrenal hyperplasia: improvements and future perspectives
title_sort use of liquid chromatography-tandem mass spectrometry in newborn screening for congenital adrenal hyperplasia: improvements and future perspectives
topic Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10578435/
https://www.ncbi.nlm.nih.gov/pubmed/37850096
http://dx.doi.org/10.3389/fendo.2023.1226284
work_keys_str_mv AT dehoramark theuseofliquidchromatographytandemmassspectrometryinnewbornscreeningforcongenitaladrenalhyperplasiaimprovementsandfutureperspectives
AT heathernatasha theuseofliquidchromatographytandemmassspectrometryinnewbornscreeningforcongenitaladrenalhyperplasiaimprovementsandfutureperspectives
AT websterdianne theuseofliquidchromatographytandemmassspectrometryinnewbornscreeningforcongenitaladrenalhyperplasiaimprovementsandfutureperspectives
AT albertbenjamin theuseofliquidchromatographytandemmassspectrometryinnewbornscreeningforcongenitaladrenalhyperplasiaimprovementsandfutureperspectives
AT hofmanpaul theuseofliquidchromatographytandemmassspectrometryinnewbornscreeningforcongenitaladrenalhyperplasiaimprovementsandfutureperspectives
AT dehoramark useofliquidchromatographytandemmassspectrometryinnewbornscreeningforcongenitaladrenalhyperplasiaimprovementsandfutureperspectives
AT heathernatasha useofliquidchromatographytandemmassspectrometryinnewbornscreeningforcongenitaladrenalhyperplasiaimprovementsandfutureperspectives
AT websterdianne useofliquidchromatographytandemmassspectrometryinnewbornscreeningforcongenitaladrenalhyperplasiaimprovementsandfutureperspectives
AT albertbenjamin useofliquidchromatographytandemmassspectrometryinnewbornscreeningforcongenitaladrenalhyperplasiaimprovementsandfutureperspectives
AT hofmanpaul useofliquidchromatographytandemmassspectrometryinnewbornscreeningforcongenitaladrenalhyperplasiaimprovementsandfutureperspectives