Clinical Chemistry Podcast

Adrenal steroid analysis plays an important role in the diagnosis of Cushing's syndrome, disorders of steroidogenesis, and adrenal tumors.  The analytical sensitivity and specificity for steroid assays have evolved over time from individual immunoassays to multiplexed mass spectrometry-based methods.  This transition has highlighted a need for simultaneous measurement of multiple steroids and their various metabolites to achieve the best diagnostic accuracy.  Therefore, metabolomic profiling performed by liquid chromatography, high-resolution accurate-mass mass spectrometry might be poised to make a substantial impact on endocrine laboratory testing.  The December 2017 Issue of Clinical Chemistry describes such a method used to determine sex- and age-based reference intervals and to perform a limited assay evaluation in patients with different adrenal diseases.

Exposure to lead in adults is typically via occupational or environmental exposures. The incidence of lead poisoning have declined worldwide due to improved industrial safety measures and the limited use of lead in paint, pipes, and canned goods. Though an increasing number of lead intoxications have been caused by the use of contaminated illicit drugs, including opium, marijuana and amphetamine, this may be due to impurities introduced during manufacturing or from deliberate addition to increase the weight for a higher selling price. A Clinical Case Study in the December 2017 issue of Clinical Chemistry discusses a series of adult patients who presented with similar symptoms and were discovered to have extremely elevated blood lead concentrations.

Sepsis is a life-threatening condition associated with significant mortality and healthcare cost.  There is increasing evidence supporting the use procalcitonin as a biomarker for diagnosis of bacterial sepsis and as a guide to discontinue antibiotic therapy.  However, concerns about the efficacy, safety, and availability of procalcitonin exist.  A Q&A article in the September 2017 issue of Clinical Chemistry asked experts with different roles in this field to share their thoughts on the challenges of procalcitonin-guided diagnosis and antibiotic therapy.