ArticleEndocrine2024
Determination of cortisol cut-off limits and steroid dynamics in the ACTH stimulation test: a comparative analysis using Roche Elecsys Cortisol II immunoassay and LC-MS/MS.
Article in Endocrine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 12 citations in OpenAlex.
- Cortisol levels and depression suicide risk: a combined exploration of meta-analysis and case-control study.Frontiers in psychiatry · 2025Pooled it
- Dispositional optimism and open-label placebo responses in hair cortisol concentrations and psychological distress-A randomized controlled trial.Applied psychology. Health and well-being · 2026Trial
- Open-label placebos reduce hair cortisol concentrations and psychological distress - a randomized controlled trial.Scientific reports · 2026Trial
- Changes in Adrenal Function and Insufficiency Symptoms After Cessation of Prednisolone.JAMA network open · 2025Trial
- Persistent progesterone elevation in infertility revealing non-classic P450 oxidoreductase deficiency: 2 cases.JCEM case reports · 2026Article
- Open-label placebo effects on psychological distress and hair cortisol in a randomized controlled trial - the moderating role of the five-factor personality traits.Comprehensive psychoneuroendocrinology · 2026Article
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- Cortisol assays across the physiologic spectrum: access immunoassay compared with LC-MS/MS.European journal of endocrinology · 2026Article
- A structured approach to address variability in the global management of adrenal insufficiency in Duchenne muscular dystrophy: the 2025 PJ Nicholoff steroid protocol.Frontiers in neurology · 2026Review
- Defining a serum cortisol cutoff level post-CRH stimulation for diagnosing ACTH deficiency: A retrospective study validated by a nationwide registry.Frontiers in endocrinology · 2026Article
- Dynamic testing of cortisol in consecutive patients with suspected adrenal disorders: a comparison of Elecsys Cortisol II and LC-MS/MS.Endocrine connections · 2026Article
- Significance of Exogenous Estradiol on Plasma Cortisol and Salivary Cortisol During Adrenocorticotropic Hormone Stimulation in Women With Pituitary Insufficiency.Clinical endocrinology · 2025Article
- Defining normative cortisol responses to the insulin tolerance test: A comparison of ElecsysPituitary · 2025Article
- The multiple faces of autoimmune Addison's disease in children.Frontiers in endocrinology · 2024Review
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Authors and funding
8 authors at 4 institutions in 1 country.
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Abstract
purposeMeasurement of cortisol concentrations is method dependent. The study aimed to establish assay-specific cut-off limits for cortisol after adrenocorticotropic hormone (ACTH) stimulation, comparing Roche Elecsys Cortisol II immunoassay to liquid chromatography-mass spectrometry (LC-MS/MS), and to assess the impact of patient characteristics, estrogen containing oral contraceptives as well as relation to other adrenocortical steroid hormone dynamics.
methodsOne hundred healthy participants underwent a 250 μg ACTH-test, with plasma samples analyzed using ElecsysCortI, ElecsysCortII, and LC-MS/MS. Cortisone, corticosterone, 17-OH-progesterone, dehydroepiandrosterone sulfate (DHEAS), androstenedione, and testosterone were additionally analyzed with LC-MS/MS. Cut-off limit for a normal cortisol response to the ACTH-test was defined as: 2.5th percentile-1.96 × SE.
resultsElecsysCort II measured cortisol concentrations 21% (95% CI: 19-22%) lower than ElecsysCort I. Cut-off limits for cortisol 30 and 60 min after ACTH were 426 and 485 nmol/L (ElecsysCort II) and 411 and 470 nmol/L (LC-MS/MS). Cut-offs were unaffected by gender, or body-composition. The ACTH-test resulted in significantly increased adrenocortical steroid hormones, except for decreased cortisone concentrations (both sexes), and decreased testosterone in men (1.9 nmol/L, 95% CI: 1.3-2.5). Testosterone was increased in women (0.07 nmol/L, 95% CI: 0.02-0.13).
conclusionElecsysCort II has high analytical performance and yields significantly lower cortisol concentrations than prior polyclonal immunoassays. This clinically relevant difference underscores the necessity for revised cut-off limits for improved diagnostic precision. Suggested 30-minute cortisol cutoff limits are 411 nmol/L (LC-MS/MS) and 426 nmol/L (ElecsysCort II). Adrenocortical steroids increased upon ACTH stimulation, except for cortisone in both sexes and testosterone in men, both of which decreased.
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