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Implementation of a Reference Interferometer for Nanodetection
Published on: April 26, 2014
The Short Cosyntropin Test Revisited: New Normal Reference Range Using LC-MS/MS.
Grethe Å Ueland1,2,3, Paal Methlie1,2,3, Marianne Øksnes1,2,3
1Department of Clinical Science, University of Bergen, Bergen, Norway.
New liquid chromatography tandem mass spectrometry (LC-MS/MS) cutoffs for the cosyntropin test improve diagnosis of adrenal insufficiency (AI) and nonclassical congenital adrenal hyperplasia (NCCAH). These precise LC-MS/MS ranges reduce false positives and negatives in steroid testing.
Area of Science:
- Endocrinology
- Clinical Chemistry
- Diagnostic Medicine
Background:
- Current cosyntropin test cutoffs for adrenal insufficiency (AI) and nonclassical congenital adrenal hyperplasia (NCCAH) rely on nonstandardized immunoassays.
- Liquid chromatography tandem mass spectrometry (LC-MS/MS) offers direct steroid measurement, necessitating updated reference ranges.
Purpose of the Study:
- To establish serum cortisol and 17-hydroxyprogesterone (17-OHP) cutoff values using LC-MS/MS after cosyntropin stimulation.
- To compare LC-MS/MS results with those from routine immunoassays.
Main Methods:
- Cosyntropin testing performed on 138 healthy volunteers and 94 patients.
- Steroids assayed by LC-MS/MS and compared with two common immunoassays.
- Cutoff levels determined using percentile calculations in healthy subjects.
Main Results:
- LC-MS/MS cortisol cutoffs were 412 and 485 nmol/L at 30 and 60 minutes, respectively.
- New cutoffs reclassified 22% of subjects with AI to normal.
- LC-MS/MS 17-OHP cutoff levels were 8.9 and 9.0 nmol/L at 30 and 60 minutes.
Conclusions:
- LC-MS/MS provides lower, more accurate cutoff levels for cortisol and 17-OHP post-cosyntropin stimulation.
- Elimination of immunoassay cross-reactivity enhances diagnostic precision.
- This method reduces false-positive AI diagnoses and false-negative NCCAH diagnoses.
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