Mitra Rauschecker1, Smita Baid Abraham1, Brent S Abel1, Robert Wesley1, Elizabeth Saverino1, Apurva Trivedi1, Theo Heller1, Lynnette K Nieman1. 1. Program in Reproductive and Adult Endocrinology (M.R., S.B.A., B.S.A., E.S., L.K.N.), The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Biostatistics and Clinical Epidemiology Service (R.W.), Clinical Center, and Translational Hepatology Unit (A.T., T.H.), Liver Diseases Branch, The National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892.
Abstract
CONTEXT: Serum free cortisol (SFF) responses to cosyntropin simulation test (CST) may more accurately assess adrenal function than total cortisol (TF). OBJECTIVE: The objective of the study was to evaluate the diagnostic utility of SFF responses during a 250-μg CST. DESIGN: We recruited healthy volunteers (HV; n = 27), patients with primary and secondary adrenal insufficiency (n = 19 and n = 24, respectively), and subjects with Child-Pugh class A cirrhosis (CH; n = 15). Each received 250 μg cosyntropin with measurement of ACTH and corticosteroid binding globulin (CBG) at time 0 and TF and SFF at 0, 30, and 60 minutes. Salivary cortisol was measured at all time points in CH subjects. RESULTS: Peak SFF and TF were significantly higher in HVs vs both AI groups (P < .05). Peak SFF and TF (6.8 μg/dL vs 2.2 μg/dL; [188 nmol/L vs 62 nmol/L]; P < .01) were significantly higher in the secondary adrenal insufficiency vs primary adrenal insufficiency patients. The optimal peak SFF criterion to identify adrenal insufficiency patients vs HV was 0.9 μg/dL (25 nmol/L) (sensitivity of 95%, specificity of 100%). Mean CBG and albumin levels were similar among all four groups. CH patients had a higher peak SFF than HV (2.4 vs 2.0 μg/dL; P = .02. In the CH patients, peak salivary cortisol levels correlated well with peak SFF (rs = 0.84, P = .005). CBG levels were similar among the groups. CONCLUSION: We provide normative data for SFF values in HV and AI during the CST. Normal CBG levels in mild cirrhosis did not affect the interpretation of the CST.
CONTEXT: Serum free cortisol (SFF) responses to cosyntropin simulation test (CST) may more accurately assess adrenal function than total cortisol (TF). OBJECTIVE: The objective of the study was to evaluate the diagnostic utility of SFF responses during a 250-μg CST. DESIGN: We recruited healthy volunteers (HV; n = 27), patients with primary and secondary adrenal insufficiency (n = 19 and n = 24, respectively), and subjects with Child-Pugh class A cirrhosis (CH; n = 15). Each received 250 μg cosyntropin with measurement of ACTH and corticosteroid binding globulin (CBG) at time 0 and TF and SFF at 0, 30, and 60 minutes. Salivary cortisol was measured at all time points in CH subjects. RESULTS: Peak SFF and TF were significantly higher in HVs vs both AI groups (P < .05). Peak SFF and TF (6.8 μg/dL vs 2.2 μg/dL; [188 nmol/L vs 62 nmol/L]; P < .01) were significantly higher in the secondary adrenal insufficiency vs primary adrenal insufficiencypatients. The optimal peak SFF criterion to identify adrenal insufficiencypatients vs HV was 0.9 μg/dL (25 nmol/L) (sensitivity of 95%, specificity of 100%). Mean CBG and albumin levels were similar among all four groups. CH patients had a higher peak SFF than HV (2.4 vs 2.0 μg/dL; P = .02. In the CH patients, peak salivary cortisol levels correlated well with peak SFF (rs = 0.84, P = .005). CBG levels were similar among the groups. CONCLUSION: We provide normative data for SFF values in HV and AI during the CST. Normal CBG levels in mild cirrhosis did not affect the interpretation of the CST.
Authors: John G Lewis; Christopher J Bagley; Peter A Elder; Anthony W Bachmann; David J Torpy Journal: Clin Chim Acta Date: 2005-09 Impact factor: 3.786
Authors: Nienke Molenaar; A B Johan Groeneveld; Hilde M Dijstelbloem; Margriet F C de Jong; Armand R J Girbes; Annemieke C Heijboer; Albertus Beishuizen Journal: Intensive Care Med Date: 2011-08-18 Impact factor: 17.440
Authors: J T Ho; H Al-Musalhi; M J Chapman; T Quach; P D Thomas; C J Bagley; J G Lewis; D J Torpy Journal: J Clin Endocrinol Metab Date: 2005-11-01 Impact factor: 5.958
Authors: Laura E Dichtel; Melanie Schorr; Claudia Loures de Assis; Elizabeth M Rao; Jessica K Sims; Kathleen E Corey; Puja Kohli; Patrick M Sluss; Michael J McPhaul; Karen K Miller Journal: J Clin Endocrinol Metab Date: 2019-10-01 Impact factor: 5.958