Impact of Repeated Glucocorticoid Oral Administration on the Urinary Steroid Profile.

Abstract

The detection of endogenous anabolic androgenic steroids (EAAS) is performed with the Steroidal Module of the Athlete Biological Passport (ABP). Glucocorticoids (GC) could be a confounding factor to the ABP Steroidal Module because they inhibit the hypothalamic-pituitary-adrenal axis, and ABP metabolites have partial adrenal origin. In previous studies, single-dose systemic GC administrations have been shown to reduce the urinary ratios A/T and 5αdiol/E. In this work, the impact of repeated oral doses of GCs on the urinary steroid profile (SP) has been evaluated. The treatments administered consisted of multiple oral administrations of methylprednisolone (12 mg/24 h for 3 days, n = 8) and dexamethasone (2 mg/12 h for 5 days, n = 8). Urine samples were collected before, during, and after the GC treatments, and the SP was measured in all samples using gas chromatography-tandem mass spectrometry. The multiple-dose oral administration of GCs resulted in a treatment-dependent reduction of the excretion rates of some urinary metabolites (5αAdiol, A, and Etio) and the urinary SP ratios A/T and 5αAdiol/E. The T/E ratio was not significantly affected. Overall, although the consumption of GC could result in atypical profiles for A/T and 5αAdiol/E ratios, according to the cost/benefit assessment, GC should not be considered a confounding factor to the urinary SP because misunderstandings would only take place in very specific situations and, in those cases, the analysis by isotope ratio mass spectrometry of the urine triggering the atypical profile would demonstrate the endogenous origin of the SP metabolites.