A specialized diagnostic process that goes beyond measuring total circulating cortisol to quantify the activity of the enzymes responsible for cortisol production, activation, and clearance into inactive metabolites. This mapping reveals how an individual processes cortisol, identifying whether the issue lies in production, peripheral tissue activation (e.g., by 11β-HSD1), or efficient detoxification (e.g., by 5α- and 5β-reductases). It offers a superior clinical resolution for understanding chronic stress and HPA axis function compared to simple total cortisol measurement.
Origin
This advanced concept stems from the integration of molecular endocrinology and clinical chemistry, recognizing that the effect of cortisol is dictated not just by its concentration but also by its local tissue availability and clearance rate. The term “mapping” emphasizes the comprehensive visualization of the entire metabolic cascade, a capability made possible by advanced analytical techniques like mass spectrometry. It refines the diagnostic approach to adrenal health.
Mechanism
The mapping mechanism involves measuring specific cortisol metabolites, such as tetrahydrocortisol (THF), allotetrahydrocortisol (aTHF), and tetrahydrocortisone (THE), typically in a 24-hour urine or dried urine sample. The ratios of these metabolites indicate the functional status of key enzymes, providing insight into genetic polymorphisms or environmental factors affecting cortisol processing. This allows for precise, targeted interventions to normalize the cortisol clearance pathways, supporting overall hormonal equilibrium.
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