TY - JOUR
T1 - Cosyntropin-stimulated serum free cortisol in healthy, adrenally insufficient, and mildly cirrhotic populations
AU - Rauschecker, Mitra
AU - Abraham, Smita Baid
AU - Abel, Brent S.
AU - Wesley, Robert
AU - Saverino, Elizabeth
AU - Trivedi, Apurva
AU - Heller, Theo
AU - Nieman, Lynnette K.
N1 - Publisher Copyright:
© 2016 by the Endocrine Society.
PY - 2016/3
Y1 - 2016/3
N2 - Context: Serum free cortisol (SFF) responses to cosyntropin simulation test (CST) may more accurately assess adrenal function than total cortisol (TF). Objective: The objective of the study was to evaluate the diagnostic utility of SFF responses during a 250-=g CST. Design:Werecruited healthy volunteers (HV; n=27), patients with primary and secondary adrenal insufficiency (n = 19 and n = 24, respectively), and subjects with Child-Pugh class A cirrhosis (CH; n = 15). Each received 250 =g cosyntropin with measurement of ACTH and corticosteroid binding globulin (CBG) at time 0 and TF and SFF at 0, 30, and 60 minutes. Salivary cortisol was measured at all time points in CH subjects. Results: Peak SFF and TF were significantly higher in HVs vs both AI groups (P .05). Peak SFF and TF (6.8 =g/dL vs 2.2 =g/dL; [188 nmol/L vs 62 nmol/L]; P .01) were significantly higher in the secondary adrenal insufficiency vs primary adrenal insufficiency patients. The optimal peak SFF criterion to identify adrenal insufficiency patients vs HV was 0.9 =g/dL (25 nmol/L) (sensitivity of 95%, specificity of 100%). Mean CBG and albumin levels were similar among all four groups. CH patients had a higher peak SFF than HV (2.4 vs 2.0 =g/dL; P =.02. In the CH patients, peak salivary cortisol levels correlated well with peak SFF (rs=0.84, P=.005). CBG levels were similar among the groups. Conclusion: We provide normative data for SFF values in HV and AI during the CST. Normal CBG levels in mild cirrhosis did not affect the interpretation of the CST.
AB - Context: Serum free cortisol (SFF) responses to cosyntropin simulation test (CST) may more accurately assess adrenal function than total cortisol (TF). Objective: The objective of the study was to evaluate the diagnostic utility of SFF responses during a 250-=g CST. Design:Werecruited healthy volunteers (HV; n=27), patients with primary and secondary adrenal insufficiency (n = 19 and n = 24, respectively), and subjects with Child-Pugh class A cirrhosis (CH; n = 15). Each received 250 =g cosyntropin with measurement of ACTH and corticosteroid binding globulin (CBG) at time 0 and TF and SFF at 0, 30, and 60 minutes. Salivary cortisol was measured at all time points in CH subjects. Results: Peak SFF and TF were significantly higher in HVs vs both AI groups (P .05). Peak SFF and TF (6.8 =g/dL vs 2.2 =g/dL; [188 nmol/L vs 62 nmol/L]; P .01) were significantly higher in the secondary adrenal insufficiency vs primary adrenal insufficiency patients. The optimal peak SFF criterion to identify adrenal insufficiency patients vs HV was 0.9 =g/dL (25 nmol/L) (sensitivity of 95%, specificity of 100%). Mean CBG and albumin levels were similar among all four groups. CH patients had a higher peak SFF than HV (2.4 vs 2.0 =g/dL; P =.02. In the CH patients, peak salivary cortisol levels correlated well with peak SFF (rs=0.84, P=.005). CBG levels were similar among the groups. Conclusion: We provide normative data for SFF values in HV and AI during the CST. Normal CBG levels in mild cirrhosis did not affect the interpretation of the CST.
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U2 - 10.1210/jc.2015-2285
DO - 10.1210/jc.2015-2285
M3 - Article
AN - SCOPUS:84960885655
SN - 0021-972X
VL - 101
SP - 1075
EP - 1081
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 3
ER -