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  • Ueland, Grethe Å. (author)

The Short Cosyntropin Test Revisited : New Normal Reference Range Using LC-MS/MS

  • Article/chapterEnglish2018

Publisher, publication year, extent ...

  • 2018-02-14
  • Oxford University Press,2018
  • printrdacarrier

Numbers

  • LIBRIS-ID:oai:DiVA.org:umu-147341
  • https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-147341URI
  • https://doi.org/10.1210/jc.2017-02602DOI

Supplementary language notes

  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • 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.

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Added entries (persons, corporate bodies, meetings, titles ...)

  • Methlie, Paal (author)
  • Øksnes, Marianne (author)
  • Thordarson, Hrafnkell B. (author)
  • Sagen, Jørn (author)
  • Kellmann, Ralf (author)
  • Mellgren, Gunnar (author)
  • Ræder, Maria (author)
  • Dahlqvist, PerUmeå universitet,Avdelningen för medicin(Swepub:umu)perdat96 (author)
  • Dahl, Sandra R. (author)
  • Thorsby, Per M. (author)
  • Løvås, Kristian (author)
  • Husebye, Eystein S. (author)
  • Umeå universitetAvdelningen för medicin (creator_code:org_t)

Related titles

  • In:Journal of Clinical Endocrinology and Metabolism: Oxford University Press103:4, s. 1696-17030021-972X1945-7197

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