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

Ueland, Grethe Åstrøm; Methlie, Paal; Øksnes, Marianne; Thordarson, Hrafnkell; Sagen, Jørn V.; Kellmann, Ralf; Ræder, Maria B.; Dahlqvist, Per; Dahl, Sandra Rinne; Thorsby, Per Medbøe; Løvås, Kristian; Husebye, Eystein S.

doi:10.1210/jc.2017-02602

Cited by 52 publications

(50 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Few data are available on cortisol concentrations measured with R2 in healthy subjects; to our knowledge, the only study to date was carried out by Ueland et al They enrolled 121 volunteers (M=F, mean age 40 years) to undergo SDCT and evaluated stimulated cortisol cut-off for R2 and LC-MS/MS (using a different spectrometer from ours). They found that the 2.5th percentile of cortisol values at 30 and 60 min following SDCT were 440 and 548 nmol/L (15.9 and 19.8 μg/dL) by R2, and 412 and 485 nmol/L (14.9 and 17.6 μg/dL) by LC-MS/MS, respectively [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Minding the gap between cortisol levels measured with second-generation assays and current diagnostic thresholds for the diagnosis of adrenal insufficiency: a single-center experience

et al. 2020

View full text Add to dashboard Cite

Purpose The current cut-offs for the diagnosis of adrenal insufficiency (AI) have been established using outdated immunoassays. We compared the cortisol concentrations measured with Roche Cortisol I (R1), the newly available Roche Cortisol II (R2), and liquid chromatography tandem mass spectrometry (LC-MS/MS), the gold standard procedure to measure steroids in patients undergoing the corticotropin (ACTH) test. Methods We enrolled 30 patients (age 47 ± 21 years) referred to undergo the ACTH test (1 or 250 μg). Cortisol was measured at 0, 30, and 60 min after stimulation with R1, R2, and LC-MS/MS. AI was diagnosed for R1-stimulated peak cortisol concentrations < 500 nmol/L. Results Mean cortisol concentrations measured with R2 and LC-MS/MS were comparable, while mean cortisol concentrations measured by R1 were higher than those of both R2 and LC-MS/MS (respectively, basal 411 ± 177, 287 ± 119, and 295 ± 119 nmol/L; at 30 min, 704 ± 204, 480 ± 132, and 500 ± 132 nmol/L; at 60 min, 737 ± 301, 502 ± 196, and 519 ± 201 nmol/L, p ≤ 0.01 for R1 vs. both R2 and LC-MS/MS at each point). Considering the 500 nmol/L cortisol peak cut-off, AI was diagnosed in 5/30 patients using R1 and in 12/30 using R2 (+ 140%). Based on the correlation between R1 and R2, the threshold of 500 nmol/L became 351 nmol/L (12.7 μg/dL) when cortisol was measured with R2, and 368 nmol/L (13.3 μg/dL) with LC-MS/MS. Conclusions The use of more specific cortisol assays results in lower cortisol concentrations. This could lead to misdiagnosis and overtreatment when assessing AI with the ACTH test if a different cut-off for cortisol peak is not adopted.

show abstract

Section: Discussionmentioning

confidence: 99%

Minding the gap between cortisol levels measured with second-generation assays and current diagnostic thresholds for the diagnosis of adrenal insufficiency: a single-center experience

et al. 2020

View full text Add to dashboard Cite

show abstract

“…As a common cut-off for the diagnosis of (primary) adrenal insufficiency, a peak cortisol concentration of less than 500 nmol/l (18 µg/dl) after stimulation is historically widely accepted [27]. However, cutoff levels for cortisol and other adrenal steroids after stimulation with cosyntropin may differ significantly based on the method used for detection (Liquid chromatography tandem mass spectrometry (LC-MS/MS) vs. immunoassay) [32]. Clinicians are strongly urged to consult with the local clinical chemist to verify the assay-specific definitions of normal cortisol responses to stimulation.…”

Section: Diagnosis Of Primary Adrenal Insufficiencymentioning

confidence: 99%

An Update on Addison’s Disease

Barthel

Benker

Berens

et al. 2018

Exp Clin Endocrinol Diabetes

View full text Add to dashboard Cite

Addison’s disease – the traditional term for primary adrenal insufficiency (PAI) – is defined as the clinical manifestation of chronic glucocorticoid- and/or mineralocorticoid deficiency due to failure of the adrenal cortex which may result in an adrenal crisis with potentially life-threatening consequences. Even though efficient and safe pharmaceutical preparations for the substitution of endogenous gluco- and mineralocorticoids are established in therapy, the mortality in patients with PAI is still increased and the health-related quality of life (HRQoL) is often reduced.PAI is a rare disease but recent data report an increasing prevalence. In addition to the common “classical” causes of PAI like autoimmune, infectious, neoplastic and genetic disorders, other iatrogenic conditions – mostly pharmacological side effects (e. g., adrenal haemorrhage associated with anticoagulants, drugs affecting glucocorticoid synthesis, action or metabolism and some of the novel anti-cancer checkpoint inhibitors) are contributing factors to this phenomenon.Due to the rarity of the disease and often non-specific symptoms at least in the early stages, PAI is frequently not considered resulting in a delayed diagnosis. Successful therapy is mainly based on adequate patient education as a cornerstone in the prevention and management of adrenal crisis. A focus of current research is in the development of pharmacokinetically optimized glucocorticoid preparations as well as regenerative therapies.

show abstract

“…However a recent study proved that one should use assay specific cutoff values. We used the Roche assay for which a cut off value of 550 nmol/L is reasonable [6].…”

Section: Discussionmentioning

confidence: 99%

Hypothalamic–pituitary–adrenal axis suppression by inhaled or nasal corticosteroids in HIV-infected patients

et al. 2020

View full text Add to dashboard Cite

Background Inhaled or nasal corticosteroids can cause suppression of the hypothalamic-pituitary-adrenal (HPA) axis. Early detection is important because this suppression can be associated with significant morbidity. Objective To explore the adverse effect of hypothalamic-pituitary-adrenal suppression by local corticosteroids in HIV-infected patients. Method Ambulatory HIV-infected patients were selected if they used both antiretroviral treatment and inhaled or nasal corticosteroid. Suppression of hypothalamic-pituitary-adrenal axis was defined as a morning plasma cortisol below 80 nmol/L or a cortisol below 550 nmol/L during a 250 mcg adrenocorticotropic hormone-stimulation test. Results Twelve patients were tested; four of them were taking a CYP3A4 inhibitor. All patients had a normal morning plasma cortisol. Suppression of the hypothalamicpituitary-adrenal axis during the ACTH stimulation test was identified in three of the twelve patients. None of these three individuals were taking a CYP3A4 inhibitor. Conclusion Hypothalamic-pituitary-adrenal axis suppression is frequently identified in patients on inhaled or nasal corticosteroids. CYP3A4 inhibitors such as ritonavir or cobicistat may increase the chance of this adverse effect. In this study we did not identify HPA axis suppression in patients taking CYP3A4 inhibitors. This may be related to the fact that 2 of these 4 patients used beclomethasone, a corticosteroid not metabolized by CYP3A4. ClinicalTrials.gov Identifier NCT02501486.

show abstract

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

Cited by 52 publications

References 21 publications

Minding the gap between cortisol levels measured with second-generation assays and current diagnostic thresholds for the diagnosis of adrenal insufficiency: a single-center experience

Minding the gap between cortisol levels measured with second-generation assays and current diagnostic thresholds for the diagnosis of adrenal insufficiency: a single-center experience

An Update on Addison’s Disease

Hypothalamic–pituitary–adrenal axis suppression by inhaled or nasal corticosteroids in HIV-infected patients

Contact Info

Product

Resources

About