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- Title
The Short Cosyntropin Test Revisited: New Normal Reference Range Using LC-MS/MS.
- Authors
Ueland, Grethe Å; Methlie, Paal; Øksnes, Marianne; Thordarson, Hrafnkell B; Sagen, Jørn; Kellmann, Ralf; Mellgren, Gunnar; Ræder, Maria; Dahlqvist, Per; Dahl, Sandra R; Thorsby, Per M; Løvås, Kristian; Husebye, Eystein S
- Abstract
<bold>Background: </bold>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.<bold>Objective: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
ADRENOCORTICOTROPIC hormone; ADRENAL diseases; COMPARATIVE studies; HYDROCORTISONE; LIQUID chromatography; MASS spectrometry; RESEARCH methodology; MEDICAL cooperation; MENTAL health surveys; PROGESTERONE; REFERENCE values; RESEARCH; EVALUATION research; ADRENAL insufficiency; DIAGNOSIS
- Publication
Journal of Clinical Endocrinology & Metabolism, 2018, pN.PAG
- ISSN
0021-972X
- Publication type
journal article
- DOI
10.1210/jc.2017-02602