ArticleJournal of the Endocrine Society2021
New Cutoffs for the Biochemical Diagnosis of Adrenal Insufficiency after ACTH Stimulation using Specific Cortisol Assays.
Article in Journal of the Endocrine Society, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05149638 (Re-assessment of Diagnostic Cortisol Values for Adrenal Insufficiency Using a Highly Specific Cortisol Assay), which is not on this map. Cited by 91 papers.
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The trial behind it
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Re-assessment of Diagnostic Cortisol Values for Adrenal Insufficiency Using a Highly Specific Cortisol Assay
Who cites it
91 citing papers in PubMed, 149 citations in OpenAlex.
- Postoperative fluid restriction to prevent delayed hyponatremia after endoscopic transsphenoidal surgery.Neuro-oncology · 2025Trial
- Adrenal Suppression From Vamorolone and Prednisone in Duchenne Muscular Dystrophy: Results From the Phase 2b Clinical Trial.The Journal of clinical endocrinology and metabolism · 2025Trial
- Chronic Central Adrenal Insufficiency in a Patient With Remote Traumatic Brain Injury and an Apparently Adequate Standard-Dose ACTH Response: A Case Report.Clinical case reports · 2026Article
- Liver cirrhosis is associated with altered glucocorticoid metabolism related to disease severity.Journal of internal medicine · 2026Article
- Adult nonclassic P450 oxidoreductase deficiency diagnosed 11 years after reproductive-endocrine suspicion.JCEM case reports · 2026Article
- Glucocorticoids: an enemy or a friend for the dermatologist? recommendations for proper use and safe discontinuation.Endocrine · 2026Review
- The 40Journal of clinical research in pediatric endocrinology · 2026Article
- Limited Diagnostic Utility of Cortisol and Growth Hormone Levels Obtained during Hypoglycemia in Children.Hormone research in paediatrics · 2026Article
- 11-deoxycortisol, other hormones and pituitary function characteristics in the diagnosis of adrenal insufficiency in the overnight oral metyrapone test.Endocrine connections · 2026Article
- Rare coexistence of aldosterone resistance and adrenal insufficiency in asymptomatic infant with persistent hyperkalaemia: A case report.World journal of clinical pediatrics · 2026Article
- ACTH Stimulation Testing Is Often Unnecessary After Appropriate Patient Preparation Prior to Screening Cortisol Measurement.Clinical endocrinology · 2026Article
- Morning cortisol and central adrenal insufficiency: new thresholds from low-dose ACTH test and second-generation assay.Journal of endocrinological investigation · 2026Article
- Surreptitious Glucocorticoid-Containing Supplements Causing Severe Adrenal Insufficiency in Hospitalized Patients.Mayo Clinic proceedings · 2026Article
- Article
- Cortisol assays across the physiologic spectrum: access immunoassay compared with LC-MS/MS.European journal of endocrinology · 2026Article
- Pitfalls in the management of undiagnosed secondary adrenal insufficiency: a case report and review of the literature.Journal of medical case reports · 2026Review
- Neonatologists' practices in screening and managing corticosteroid-induced adrenal insufficiency in the NICU- a multicenter study.Journal of perinatology : official journal of the California Perinatal Association · 2026Review
- Cortisol Testing to Diagnose Adrenal Insufficiency Following Adrenalectomy for Mild Autonomous Cortisol Secretion.The Journal of clinical endocrinology and metabolism · 2026Article
- Diagnostic utility of morning serum cortisol in predicting short synacthen test outcomes in outpatients with suspected adrenal insufficiency.BMC endocrine disorders · 2026Article
- Adrenal Insufficiency During Treatment With Immune-Checkpoint Inhibitors: How to Simplify the Diagnostic Pathway?Clinical endocrinology · 2026Observational
31 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
contextThe normal cortisol response 30 or 60 minutes after cosyntropin (ACTH
objectiveTo calculate serum cortisol cutoff values for adrenocorticotropic hormone (ACTH) stimulation testing with newer specific cortisol assays.
methodsRetrospective 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.
resultsA 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.
conclusionTo 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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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.