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New Cutoffs for the Biochemical Diagnosis of Adrenal Insufficiency after ACTH Stimulation using Specific Cortisol Assays

CONTEXT: The normal cortisol response 30 or 60 minutes after cosyntropin (ACTH([1–24])) is considered to be ≥18 μg/dL (500 nmol/L). This threshold is based on older serum cortisol assays. Specific monoclonal antibody immunoassays or LC-MS/MS may have lower thresholds for a normal response. OBJECTIVE...

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Autores principales: Javorsky, Bradley R, Raff, Hershel, Carroll, Ty B, Algeciras-Schimnich, Alicia, Singh, Ravinder Jit, Colón-Franco, Jessica M, Findling, James W
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7975762/
https://www.ncbi.nlm.nih.gov/pubmed/33768189
http://dx.doi.org/10.1210/jendso/bvab022
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author Javorsky, Bradley R
Raff, Hershel
Carroll, Ty B
Algeciras-Schimnich, Alicia
Singh, Ravinder Jit
Colón-Franco, Jessica M
Findling, James W
author_facet Javorsky, Bradley R
Raff, Hershel
Carroll, Ty B
Algeciras-Schimnich, Alicia
Singh, Ravinder Jit
Colón-Franco, Jessica M
Findling, James W
author_sort Javorsky, Bradley R
collection PubMed
description CONTEXT: The normal cortisol response 30 or 60 minutes after cosyntropin (ACTH([1–24])) is considered to be ≥18 μg/dL (500 nmol/L). This threshold is based on older serum cortisol assays. Specific monoclonal antibody immunoassays or LC-MS/MS may have lower thresholds for a normal response. OBJECTIVE: To calculate serum cortisol cutoff values for adrenocorticotropic hormone (ACTH) stimulation testing with newer specific cortisol assays. METHODS: Retrospective analysis of ACTH stimulation tests performed in ambulatory and hospitalized patients suspected of adrenal insufficiency (AI). Serum samples were assayed for cortisol in parallel using Elecsys I and Elecsys II immunoassays, and when volume was available, by Access immunoassay and LC-MS/MS. RESULTS: A total of 110 patients were evaluated. Using 18 μg/dL as the cortisol cutoff after ACTH stimulation, 14.5%, 29%, 22.4%, and 32% of patients had a biochemical diagnosis of AI using the Elecsys I, Elecsys II, Access, and LC-MS/MS assays, respectively. Deming regressions of serum cortisol were used to calculate new cortisol cutoffs based on the Elecsys I cutoff of 18 μg/dL. For 30-minute values, new cutoffs were 14.6 μg/dL for Elecsys II, 14.8 μg/dL for Access, and 14.5 μg/dL for LC-MS/MS. Baseline cortisol <2 μg/dL was predictive of subnormal stimulated cortisol values. CONCLUSION: To reduce false positive ACTH stimulation testing, we recommend a new serum cortisol cutoff of 14 to 15 μg/dL depending on the assay used (instead of the historical value of 18 μg/dL with older polyclonal antibody assays). Clinicians should be aware of the new cutoffs for the assays available to them when evaluating patients for AI.
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spelling pubmed-79757622021-03-24 New Cutoffs for the Biochemical Diagnosis of Adrenal Insufficiency after ACTH Stimulation using Specific Cortisol Assays Javorsky, Bradley R Raff, Hershel Carroll, Ty B Algeciras-Schimnich, Alicia Singh, Ravinder Jit Colón-Franco, Jessica M Findling, James W J Endocr Soc Clinical Research Articles CONTEXT: The normal cortisol response 30 or 60 minutes after cosyntropin (ACTH([1–24])) is considered to be ≥18 μg/dL (500 nmol/L). This threshold is based on older serum cortisol assays. Specific monoclonal antibody immunoassays or LC-MS/MS may have lower thresholds for a normal response. OBJECTIVE: To calculate serum cortisol cutoff values for adrenocorticotropic hormone (ACTH) stimulation testing with newer specific cortisol assays. METHODS: Retrospective analysis of ACTH stimulation tests performed in ambulatory and hospitalized patients suspected of adrenal insufficiency (AI). Serum samples were assayed for cortisol in parallel using Elecsys I and Elecsys II immunoassays, and when volume was available, by Access immunoassay and LC-MS/MS. RESULTS: A total of 110 patients were evaluated. Using 18 μg/dL as the cortisol cutoff after ACTH stimulation, 14.5%, 29%, 22.4%, and 32% of patients had a biochemical diagnosis of AI using the Elecsys I, Elecsys II, Access, and LC-MS/MS assays, respectively. Deming regressions of serum cortisol were used to calculate new cortisol cutoffs based on the Elecsys I cutoff of 18 μg/dL. For 30-minute values, new cutoffs were 14.6 μg/dL for Elecsys II, 14.8 μg/dL for Access, and 14.5 μg/dL for LC-MS/MS. Baseline cortisol <2 μg/dL was predictive of subnormal stimulated cortisol values. CONCLUSION: To reduce false positive ACTH stimulation testing, we recommend a new serum cortisol cutoff of 14 to 15 μg/dL depending on the assay used (instead of the historical value of 18 μg/dL with older polyclonal antibody assays). Clinicians should be aware of the new cutoffs for the assays available to them when evaluating patients for AI. Oxford University Press 2021-02-18 /pmc/articles/PMC7975762/ /pubmed/33768189 http://dx.doi.org/10.1210/jendso/bvab022 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Clinical Research Articles
Javorsky, Bradley R
Raff, Hershel
Carroll, Ty B
Algeciras-Schimnich, Alicia
Singh, Ravinder Jit
Colón-Franco, Jessica M
Findling, James W
New Cutoffs for the Biochemical Diagnosis of Adrenal Insufficiency after ACTH Stimulation using Specific Cortisol Assays
title New Cutoffs for the Biochemical Diagnosis of Adrenal Insufficiency after ACTH Stimulation using Specific Cortisol Assays
title_full New Cutoffs for the Biochemical Diagnosis of Adrenal Insufficiency after ACTH Stimulation using Specific Cortisol Assays
title_fullStr New Cutoffs for the Biochemical Diagnosis of Adrenal Insufficiency after ACTH Stimulation using Specific Cortisol Assays
title_full_unstemmed New Cutoffs for the Biochemical Diagnosis of Adrenal Insufficiency after ACTH Stimulation using Specific Cortisol Assays
title_short New Cutoffs for the Biochemical Diagnosis of Adrenal Insufficiency after ACTH Stimulation using Specific Cortisol Assays
title_sort new cutoffs for the biochemical diagnosis of adrenal insufficiency after acth stimulation using specific cortisol assays
topic Clinical Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7975762/
https://www.ncbi.nlm.nih.gov/pubmed/33768189
http://dx.doi.org/10.1210/jendso/bvab022
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