The use of mass spectrometry to improve the diagnosis and the management of the HPA axis

Liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) is becoming a standard analytical tool in the clinical laboratory for the measurement of small molecules, including steroid hormones. Endocrinologists are coming to acknowledge the superior quality of measurement that is achievable by LC-MS/MS through the enhanced analytical specificity and high sensitivity that this technique offers over conventional immunoassay (IA) methodologies. Additionally, LC-MS/MS overcomes many of the problems encountered in immunoassays, such as anti-reagent antibody interferences and cross-reactivity with structurally related compounds. The potential benefits of applying LC-MS/MS for the assessment of the hypothalamic-pituitary-adrenal (HPA) axis are beginning to be realised. This review critically evaluates recent developments in the application of LC-MS/MS for measurement of glucocorticoids and mineralocorticoids towards the diagnosis and management of HPA axis disorders and aims to address the current unmet need in this expanding field of endocrinology for which future studies into the potential applications of LC-MS/MS should be directed.