Influence of spironolactone on neonatal screening for congenital adrenal hyperplasia
Itaru Teraia, Kimiaki Yamanoa, Naoshi Ichiharaa, Junri Araia, Kunihiko Kobayashib
a Division of Clinical
Pathology Hokkaido Institute of Public Health
Sapporo 060 Japan, b Department of Paediatrics
Hokkaido University School of Medicine
Sapporo Japan
Correspondence to: Dr Itaru Terai. Email: terai{at}iph.pref.hokkaido.jp
Accepted 12 June
1999
AIM
To determine if
the diuretic spironolactone cross reacts with 17
-hydroxyprogesterone
(17OHP) in an enzyme linked immunosorbent assay (ELISA) kit used for
the mass screening of congenital adrenal hyperplasia.
METHODSConcentrations
of 17OHP on a blood filter paper disc were measured using an ELISA kit
(kit C-7: ENZAPLATE N-17 -OHP-7; Chiron, Tokyo, Japan). The cross
reactivity of spironolactone and its metabolites with 17OHP was
determined. The concentrations of spironolactone and its metabolites in
blood were measured using HPLC (high performance liquid chromatography).
RESULTSSpironolactone
cross reacted with 17OHP using kit C-7 (0.01%), by increasing 17OHP
concentration in a dose dependent manner. The blood concentration of
spironolactone and its metabolites was nearly 900 ng/ml, high enough to
show an additive effect on the 17OHP concentration. About 12% of the
false positive cases screened using the kit were due to the
administration of spironolactone.
CONCLUSIONSSpironolactone
interferes with 17OHP concentrations, leading to false positive test
results for CAH.
Keywords: screening; congenital adrenal hyperplasia; 17
-hydroxyprogesterone;
spironolactone
© 1999 by Archives of Disease in Childhood
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