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Assay-specific cutoffs for serum cortisol responses to 250 mcg cosyntropin IV in adults

Assay-specific cutoffs for serum cortisol responses to 250 mcg cosyntropin IV in adults
Cortisol assay method 30 minutes,
mcg/dL (nmol/L)		 60 minutes,
mcg/dL (nmol/L)
Mass spectrometry 13.5 to 15.2 (368 to 420) 17.6 (486)
Monoclonal immunoassay (eg, Roche Cortisol II, Abbott Architect) 12.7 to 16.3 (351 to 450) 17.6 (486)
Polyclonal immunoassay (eg, Beckman Access, Siemens Advia Centaur XP, IMMULITE) 13.8 to 17.2 (382 to 474) 18.1 to 18.6 (500 to 514)
For testing performed in the morning. Cutoffs were determined by a variety of statistical methods. Healthy subject/patient characteristics varied between studies. A cortisol cutoff of 18 mcg/dL (497 nmol/L) has historically be used with older cortisol assays[8].
IV: intravenous.

Courtesy of Hershel Raff, PhD.

References:
  1. Grassi G, Morelli V, Ceriotti F, et al. 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. Hormones (Athens) 2020; 19:425.
  2. Javorsky BR, Raff H, Carroll TB, et al. New cutoffs for the biohemical diagnosis of adrenal insufficiency after ACTH stimulation using specific cortisol assays. J Endocr Soc 2021; 5:bvab022.
  3. El-Farhan N, Pickett A, Ducroq D, et al. Method-specific serum cortisol responses to the adrenocorticotrophin test: Comparison of gas chromatography-mass spectrometry and five automated immunoassays. Clin Endocrinol (Oxf) 2013; 78:673.
  4. Ueland GA, Methlie P, Oksnes M, et al. The short cosyntropin test revisited: New normal reference range using LC-MS/MS. J Clin Endocrinol Metab 2018; 103:1696.
  5. Elder CJ, Harrison, RF, Cross AS, et al. Use of salivary cortisol and cortisone in the high- and low-dose synacthen test. Clin Endocrinol (Oxf) 2018; 88:772.
  6. Nolan BJ, Sorbello J, Brown N, et al. Characterization of the serum and salivary cortisol response to the intravenous 250 µg ACTH 1-24 stimulation test. Endocrine 2018; 59:520.
  7. Klose M, Lange M, Rasmussen AK, et al. Factors influencing the adrenocorticotropin test: role of contemporary cortisol assays, body composition, and oral contraceptive agents. J Clin Endocrinol Metab 2007; 92:1326.
  8. Grinspoon SK, Biller BM. Clinical review 62: Laboratory assessment of adrenal insufficiency. J Clin Endocrinol Metab 1994; 79:923.
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