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The Short Cosyntrop...
The Short Cosyntropin Test Revisited : New Normal Reference Range Using LC-MS/MS
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Ueland, Grethe Å. (författare)
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Methlie, Paal (författare)
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Øksnes, Marianne (författare)
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Thordarson, Hrafnkell B. (författare)
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Sagen, Jørn (författare)
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Kellmann, Ralf (författare)
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Mellgren, Gunnar (författare)
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Ræder, Maria (författare)
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- Dahlqvist, Per (författare)
- Umeå universitet,Avdelningen för medicin
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Dahl, Sandra R. (författare)
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Thorsby, Per M. (författare)
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Løvås, Kristian (författare)
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Husebye, Eystein S. (författare)
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(creator_code:org_t)
- 2018-02-14
- 2018
- Engelska.
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Ingår i: Journal of Clinical Endocrinology and Metabolism. - : Oxford University Press. - 0021-972X .- 1945-7197. ; 103:4, s. 1696-1703
- Relaterad länk:
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https://academic.oup...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- Background: The cosyntropin test is used to diagnose adrenal insufficiency (AI) and nonclassical congenital adrenal hyperplasia (NCCAH). Current cutoffs for cortisol and 17-hydroxyprogesterone (17-OHP) are derived from nonstandardized immunoassays. Liquid chromatography tandem mass spectrometry (LC-MS/MS) offers direct measurement of steroids, prompting the need to re-establish normal ranges. Objective: The goal of this study was to define cutoff values for cortisol and 17-OHP in serum by LC-MS/MS 30 and 60 minutes after intravenous administration of 250 µg tetracosactide acetate to healthy volunteers and to compare the results with LC-MS/MS with routine immunoassays. Methods: Cosyntropin testing was performed in healthy subjects (n = 138) and in patients referred for evaluation of adrenocortical function (n = 94). Steroids were assayed by LC-MS/MS and compared with two immunoassays used in routine diagnostics (Immulite and Roche platforms). The cutoff level for cortisol was defined as the 2.5% percentile in healthy subjects not using oral estrogens (n = 121) and for 17-OHP as the 97.5% percentile. Results: Cortisol cutoff levels for LC-MS/MS were 412 and 485 nmol/L at 30 and 60 minutes, respectively. Applying the new cutoffs, 13 of 60 (22%) subjects who had AI according to conventional criteria now had a normal test result. For 17-OHP, the cutoff levels were 8.9 and 9.0 nmol/L at 30 and 60 minutes, respectively. Conclusions: LC-MS/MS provides cutoff levels for cortisol and 17-OHP after cosyntropin stimulation that are lower than those based on immunoassays, possibly because cross-reactivity between steroid intermediates and cortisol is eliminated. This reduces the number of false-positive tests for AI and false-negative tests for NCCAH.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Endokrinologi och diabetes (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Endocrinology and Diabetes (hsv//eng)
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Ueland, Grethe Å ...
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Methlie, Paal
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Øksnes, Marianne
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Thordarson, Hraf ...
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Sagen, Jørn
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Kellmann, Ralf
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visa fler...
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Mellgren, Gunnar
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Ræder, Maria
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Dahlqvist, Per
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Dahl, Sandra R.
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Thorsby, Per M.
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Løvås, Kristian
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Husebye, Eystein ...
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visa färre...
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Umeå universitet