ArticleHormones (Athens, Greece)2020
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.
Article in Hormones (Athens, Greece), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers.
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Who cites it
27 citing papers in PubMed, 42 citations in OpenAlex.
- The 40Journal of clinical research in pediatric endocrinology · 2026Article
- Avoiding false-positive adrenal insufficiency diagnoses in children: insights from cortisol kinetics during pediatric low-dose ACTH stimulation test.European journal of pediatrics · 2026Article
- Morning cortisol and central adrenal insufficiency: new thresholds from low-dose ACTH test and second-generation assay.Journal of endocrinological investigation · 2026Article
- Article
- Cortisol assays across the physiologic spectrum: access immunoassay compared with LC-MS/MS.European journal of endocrinology · 2026Article
- Plasma cortisol cut-off concentrations using the dexamethasone suppression test in patients with adrenal incidentalomas.Frontiers in endocrinology · 2026Observational
- Lowering the dexamethasone suppression test cut-off: is it time yet?Journal of endocrinological investigation · 2025Review
- Defining normative cortisol responses to the insulin tolerance test: A comparison of ElecsysPituitary · 2025Article
- Article
- Circadian Biomarkers in Humans: Methodological Insights into the Detection of Melatonin and Cortisol.Biomolecules · 2025Review
- Glucocorticoid-induced adrenal insufficiency after therapy with intravenous methylprednisolone in patients with moderate-to-severe and active Graves' orbitopathy: assessment with a low-dose corticotropin test.Journal of endocrinological investigation · 2024Article
- Article
- Evaluation of serum cortisol measurement by Ortho Vitro after stimulation by ACTH or insulin hypoglycaemia.Clinical chemistry and laboratory medicine · 2024Article
- Peak Serum Cortisol Cutoffs to Diagnose Adrenal Insufficiency Across Different Cortisol Assays in ChildrenJournal of clinical research in pediatric endocrinology · 2023Article
- Acton-Prolongatum Stimulated Blood Steroid Profile in Apparently Healthy Asian Indian Women of Reproductive-Age Group.Indian journal of clinical biochemistry : IJCB · 2023Article
- ACTH Stimulation Test for the Diagnosis of Secondary Adrenal Insufficiency: Light and Shadow.Biomedicines · 2023Review
- Perioperative Evaluation and Management of Patients on Glucocorticoids.Journal of the Endocrine Society · 2022Review
- Recalibrating Interpretations of Aldosterone Assays Across the Physiologic Range: Immunoassay and Liquid Chromatography-Tandem Mass Spectrometry Measurements Under Multiple Controlled Conditions.Journal of the Endocrine Society · 2022Article
- Cortisol values during the standard-dose cosyntropin stimulation test: Personal experience with Elecsys cortisol II assay.Frontiers in endocrinology · 2022Article
- 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
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Authors and funding
9 authors at 2 institutions in 1 country.
Funding
Abstract
purposeThe 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.
methodsWe 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.
resultsMean 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.
conclusionsThe 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.
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