Assessment of salivary free cortisol levels by liquid chromatography with tandem mass spectrometry (LC-MS/MS) in patients treated with mitotane.

Cinzia Carrozza, Alfredo Pontecorvi, Silvia Persichilli, Rosa Lapolla, Jacopo Gervasoni, Carlo Antonio Rota, Pietro Locantore, Cecilia Zuppi, 33182, DI MEDICINA E CHIRURGIA "A.GEMELLI" FACOLTA', ROMA - Dipartimento di Medicina e chirurgia traslazionale, 33183, DI MEDICINA E CHIRURGIA "A.GEMELLI" FACOLTA', cliniche intensivologiche e perioperatorie ROMA - Dipartimento di Scienze biotecnologiche di base

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OBJECTIVE: Mitotane is an adrenocytolytic agent used in adrenocortical carcinoma, inducing adrenal insufficiency, requiring replacement treatment. Such therapy is not easy to monitor because of mitotane interference. Salivary cortisol reflects a free fraction of plasma cortisol and may be useful in such patients. DESIGN: The aim of our study was to evaluate salivary cortisol by HPLC coupled to tandem-mass spectrometry (LC-MS/MS) and by an electrochemiluminescence immunoassay (ECLIA) in patients treated with mitotane. We enrolled 6 patients receiving mitotane and 2 Addison disease patients as negative controls and determined salivary cortisol rhythm. We also determined the salivary cortisol rhythm in 8 healthy subjects. Salivary samples (n=112) were assayed by ECLIA, using Roche Modular E170, and by LC-MS/MS. RESULTS: The mean values obtained by ECLIA were significantly higher than those obtained by LC-MS/MS in the mitotane group (p<0.001). In fact, in the group measured by LC-MS/MS, we observed several peaks eluting at a retention time different from the cortisol group, presumably due to cortisol-like analogues. In Addison disease, since steroidogenesis is absent, salivary cortisol values measured by the two methods did not show any significant difference (p=0.61). CONCLUSIONS: Salivary cortisol measured by LC-MS/MS is a selective method, excluding cortisol analogues accumulating in treated patients. Therefore, LC-MS/MS offers an effective system to monitor replacement therapy in mitotane treated patients
Lingua originaleEnglish
pagine (da-a)344-349
Numero di pagine6
RivistaHormones (Athens)
Stato di pubblicazionePubblicato - 2012


  • LC-MS/MS
  • Mitotane
  • Salivary free cortisol


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