ArticleThe Journal of clinical endocrinology and metabolism2019
Plasma Free Cortisol in States of Normal and Altered Binding Globulins: Implications for Adrenal Insufficiency Diagnosis.
Article in The Journal of clinical endocrinology and metabolism, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed, 27 citations in OpenAlex.
- In vitro dexamethasone suppression of cytokine production assay and plasma total and free cortisol responses to ACTH in healthy volunteers.Scientific reports · 2025Observational
- Clinical utility of salivary cortisol for diagnosis and therapeutic monitoring in adrenal insufficiency.Endocrine · 2025Article
- Transport across the thoracic aortic wall: implications for aneurysm pathobiology, diagnosis, and treatment.American journal of physiology. Heart and circulatory physiology · 2025Review
- Current Challenges and Future Directions in the Assessment of Glucocorticoid Status.Endocrine reviews · 2024Review
- Reversible suppression of hypothalamo-pituitary-adrenal axis in Addison's disease due to ethinyl oestradiol-induced increase in total cortisol.Endocrinology, diabetes & metabolism case reports · 2024Article
- From liver to hormones: The endocrine consequences of cirrhosis.World journal of gastroenterology · 2024Review
- Effects of electro-mechanical uncouplers, hormonal stimulation and pacing rate on the stability and function of cultured rabbit myocardial slices.Frontiers in bioengineering and biotechnology · 2024Article
- Expanding the use of salivary cortisol as a non-invasive outpatient test in the dynamic evaluation of suspected adrenal insufficiency.Endocrine connections · 2023Article
- Overdiagnosis of adrenal insufficiency in children with biliary atresia.Clinical pediatric endocrinology : case reports and clinical investigations : official journal of the Japanese Society for Pediatric Endocrinology · 2023Article
- Adrenal Insufficiency in Cirrhosis.Journal of the Endocrine Society · 2022Review
- The procalcitonin-to-cortisol ratio is a potential prognostic predictor in sepsis with abdominal source: a retrospective observational study.World journal of emergency medicine · 2022Article
- Long-term corticosteroid use, adrenal insufficiency and the need for steroid-sparing treatment in adult severe asthma.Journal of internal medicine · 2021Review
- Oral Contraceptive Disturbed the Recovery of the Adrenal Function after Adrenalectomy in Cushing Syndrome.Internal medicine (Tokyo, Japan) · 2021Article
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Authors and funding
10 authors at 3 institutions in 1 country.
Funding
Abstract
contextAccurate diagnosis of adrenal insufficiency is critical because there are risks associated with overdiagnosis and underdiagnosis. Data using liquid chromatography tandem mass spectrometry (LC/MS/MS) free cortisol (FC) assays in states of high or low cortisol-binding globulin (CBG) levels, including cirrhosis, critical illness, and oral estrogen use, are needed.
designCross-sectional.
objectiveDetermine the relationship between CBG and albumin as well as total cortisol (TC) and FC in states of normal and abnormal CBG. Establish the FC level by LC/MS/MS that best predicts TC of <18 μg/dL (497 nmol/L) (standard adrenal insufficiency diagnostic cutoff) in healthy individuals. SUBJECTS: This study included a total of 338 subjects in four groups: healthy control (HC) subjects (n = 243), patients with cirrhosis (n = 38), intensive care unit patients (ICU) (n = 26), and oral contraceptive (OCP) users (n = 31). MAIN OUTCOME MEASURE(S): FC and TC by LC/MS/MS, albumin by spectrophotometry, and CBG by ELISA.
resultsTC correlated with FC in the ICU (R = 0.91), HC (R = 0.90), cirrhosis (R = 0.86), and OCP (R = 0.70) groups (all P < 0.0001). In receiver operator curve analysis in the HC group, FC of 0.9 μg/dL (24.8 nmol/L) predicted TC of <18 μg/dL (497 nmol/L; 98% sensitivity, 91% specificity; AUC, 0.98; P < 0.0001). Decreasing the cutoff to 0.7 μg/dL led to a small decrease in sensitivity (92%) with similar specificity (91%).
conclusionsA cutoff FC of <0.9 μg/dL (25 nmol/L) in this LC/MS/MS assay predicts TC of <18 μg/dL (497 nmol/L) with excellent sensitivity and specificity. This FC cutoff may be helpful in ruling out adrenal insufficiency in patients with binding globulin derangements.
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