Mass spectrometry theory and application to adrenal diseases

Mol Cell Endocrinol. 2013 May 22;371(1-2):201-7. doi: 10.1016/j.mce.2012.12.026. Epub 2013 Jan 16.


The diagnosis and management of adrenal diseases hinge upon accurate determination of hormone concentrations in blood and other body fluids. The advent of immunoassays for various steroid hormones has enabled the remarkable progress in adrenal disease over the last several decades, with some limitation. Sequential immunoassay of single analytes is a tedious process, which requires aliquots for each assay. In many complex adrenal diseases, including adrenal cancer and congenital adrenal hyperplasia, the patterns or ratios of multiple steroids rather than the value of any one steroid is more relevant. Although gas chromatography/mass spectrometry of urinary steroid metabolites has been employed to profile steroid production, throughput is slow, and availability is sparse. Recent generations of liquid chromatography-tandem mass spectrometry instruments (LC-MS/MS) provide the throughput and sensitivity required to measure many steroids simultaneously using small samples for commercial and research uses. Even in the best hands, however, LC-MS/MS suffers from limitations and requires diligent attention to detail during method development and implementation. This article reviews the theory, instrumentation principles and terminology, and practical application of mass spectrometry to clinical adrenal disorders.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adrenal Cortex Hormones / blood*
  • Adrenal Gland Diseases* / blood
  • Adrenal Gland Diseases* / diagnosis
  • Adrenal Gland Diseases* / metabolism
  • Chromatography, High Pressure Liquid*
  • Humans
  • Steroids / analysis
  • Steroids / blood
  • Tandem Mass Spectrometry / instrumentation*
  • Tandem Mass Spectrometry / methods*


  • Adrenal Cortex Hormones
  • Steroids