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Urinary free cortisol assessment by liquid chromatography tandem mass spectrometry: a case study of ion suppression due to unacquainted administration of piperacillin

INTRODUCTION: Liquid chromatography coupled to atmospheric pressure ionization tandem mass spectrometry (LC-ESI-MS/MS) is currently considered the reference method for quantitative determination of urinary free cortisol (UFC). One of the major drawbacks of this measurement is a particular form of ma...

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Autores principales: Danese, Elisa, Salvagno, Gian Luca, Guzzo, Alessandra, Scurati, Samuele, Fava, Cristiano, Lippi, Giuseppe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Croatian Society of Medical Biochemistry and Laboratory Medicine 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5696746/
https://www.ncbi.nlm.nih.gov/pubmed/29180920
http://dx.doi.org/10.11613/BM.2017.031001
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author Danese, Elisa
Salvagno, Gian Luca
Guzzo, Alessandra
Scurati, Samuele
Fava, Cristiano
Lippi, Giuseppe
author_facet Danese, Elisa
Salvagno, Gian Luca
Guzzo, Alessandra
Scurati, Samuele
Fava, Cristiano
Lippi, Giuseppe
author_sort Danese, Elisa
collection PubMed
description INTRODUCTION: Liquid chromatography coupled to atmospheric pressure ionization tandem mass spectrometry (LC-ESI-MS/MS) is currently considered the reference method for quantitative determination of urinary free cortisol (UFC). One of the major drawbacks of this measurement is a particular form of matrix effect, conventionally known as ion suppression. MATERIALS AND METHODS: We describe here the case of a 66-year-old-patient referred to the daily service of general medicine for intravenous antibiotic administration due to a generalized Staphylococcus aureus infection and for routine 24 hours UFC monitoring in the setting of glucocorticoid replacement therapy. RESULTS: The observation of 10-fold decrease of internal standard of cortisol signal led us to hypothesize the presence of an ion suppression effect due to a co-eluting endogenous compound. Screening analysis of tandem mass spectrometry (MS/MS) spectra of the interfering molecule, along with in vitro confirmation analyses, were suggestive of the presence of high concentration of piperacillin. The problem was then easily solved with minor modifications of the chromatographic technique. CONCLUSIONS: According to our findings, antibiotic therapy with piperacillin/tazobactam should be regarded as an important interference in UFC assessment, which may potentially affect detection capability, precision and accuracy of this measurement. This case report emphasizes that accurate anamnesis and standardization of all phases of urine collection are essential aspects for preventing potential interference in laboratory testing.
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spelling pubmed-56967462017-11-27 Urinary free cortisol assessment by liquid chromatography tandem mass spectrometry: a case study of ion suppression due to unacquainted administration of piperacillin Danese, Elisa Salvagno, Gian Luca Guzzo, Alessandra Scurati, Samuele Fava, Cristiano Lippi, Giuseppe Biochem Med (Zagreb) Pre-analytical Mysteries INTRODUCTION: Liquid chromatography coupled to atmospheric pressure ionization tandem mass spectrometry (LC-ESI-MS/MS) is currently considered the reference method for quantitative determination of urinary free cortisol (UFC). One of the major drawbacks of this measurement is a particular form of matrix effect, conventionally known as ion suppression. MATERIALS AND METHODS: We describe here the case of a 66-year-old-patient referred to the daily service of general medicine for intravenous antibiotic administration due to a generalized Staphylococcus aureus infection and for routine 24 hours UFC monitoring in the setting of glucocorticoid replacement therapy. RESULTS: The observation of 10-fold decrease of internal standard of cortisol signal led us to hypothesize the presence of an ion suppression effect due to a co-eluting endogenous compound. Screening analysis of tandem mass spectrometry (MS/MS) spectra of the interfering molecule, along with in vitro confirmation analyses, were suggestive of the presence of high concentration of piperacillin. The problem was then easily solved with minor modifications of the chromatographic technique. CONCLUSIONS: According to our findings, antibiotic therapy with piperacillin/tazobactam should be regarded as an important interference in UFC assessment, which may potentially affect detection capability, precision and accuracy of this measurement. This case report emphasizes that accurate anamnesis and standardization of all phases of urine collection are essential aspects for preventing potential interference in laboratory testing. Croatian Society of Medical Biochemistry and Laboratory Medicine 2017-10-15 2017-10-15 /pmc/articles/PMC5696746/ /pubmed/29180920 http://dx.doi.org/10.11613/BM.2017.031001 Text en ©Croatian Society of Medical Biochemistry and Laboratory Medicine. This is an Open Access article distributed under the terms of the Creative Commons Attribution (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Pre-analytical Mysteries
Danese, Elisa
Salvagno, Gian Luca
Guzzo, Alessandra
Scurati, Samuele
Fava, Cristiano
Lippi, Giuseppe
Urinary free cortisol assessment by liquid chromatography tandem mass spectrometry: a case study of ion suppression due to unacquainted administration of piperacillin
title Urinary free cortisol assessment by liquid chromatography tandem mass spectrometry: a case study of ion suppression due to unacquainted administration of piperacillin
title_full Urinary free cortisol assessment by liquid chromatography tandem mass spectrometry: a case study of ion suppression due to unacquainted administration of piperacillin
title_fullStr Urinary free cortisol assessment by liquid chromatography tandem mass spectrometry: a case study of ion suppression due to unacquainted administration of piperacillin
title_full_unstemmed Urinary free cortisol assessment by liquid chromatography tandem mass spectrometry: a case study of ion suppression due to unacquainted administration of piperacillin
title_short Urinary free cortisol assessment by liquid chromatography tandem mass spectrometry: a case study of ion suppression due to unacquainted administration of piperacillin
title_sort urinary free cortisol assessment by liquid chromatography tandem mass spectrometry: a case study of ion suppression due to unacquainted administration of piperacillin
topic Pre-analytical Mysteries
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5696746/
https://www.ncbi.nlm.nih.gov/pubmed/29180920
http://dx.doi.org/10.11613/BM.2017.031001
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