Historically, mass spectrometry had been of limited use in clinical laboratories; however, the combination of electron spray ionisation (ESI) methods with tandem mass spectrometry has opened up this technology to the clinical laboratory arena. Tandem mass spectrometry found its way into clinical laboratories in the early 1990s, with the analysis of acylcarnitines and amino acids from neonatal blood spots. During the past decade, liquid chromatography tandem mass spectrometry (LC-MS/MS) has played an increasingly important role in clinical analysis.
Over this time LC-MS/MS has had to overcome a number of challenges and there are still others remaining. It is now routinely used in laboratories with applications for therapeutic drug monitoring (TDM), endocrinology, toxicology and pharmacology. The majority of LC-MS/MS methods used in the clinical lab can be placed under the IVD test category, since they were "home brewed." The labs implementing this technology are expected to develop the test and undertake a thorough validation before putting these tests into routine use. The introduction of MS also brings with it’s own set of MS specific issues that need to be monitored and addressed.
Due to the increased sensitivity, specificity and versatility of MS, endocrinology has been an area that has seen significant improvements in its transition to MS based methods. Advancements in Mass Spectrometry-based methods allow measurement of multiple steroids within a single sample and in matrices other than serum/plasma, including dried blood spots (DBS) and saliva. Also, recent developments have made the quantitation of free steroid hormones less laborious.
This talk will present an overview of the advantages and limitations of MS-based methods in endocrinology for clinical laboratories. The associated challenges and processes to overcome them will be discussed.