Serum free cortisol as an ancillary tool in the interpretation of the low-dose 1-μg ACTH test.

Abstract:

OBJECTIVE:Serum free cortisol, rather than serum total cortisol (TC), determines glucocorticoid activity in vivo, but how the considerable inter-subject variation in ambient serum free cortisol affects the outcome of dynamic hypothalamic-pituitary-adrenal (HPA) assessment in noncritically ill subjects is unknown. DESIGN, PATIENTS AND MEASUREMENTS:We performed the low-dose 1-μg ACTH test in 75 subjects referred for HPA evaluation. Serum TC was determined by a chemiluminescence method, and serum free cortisol was measured by the same method following equilibrium dialysis. In a subset of these patients, salivary cortisol was also measured. RESULTS:Mean fraction of free cortisol was 5·07 ± 4·08% (±SD; range 1·77-10·1%). Although no correlation was seen between TC and the fraction (%) of free serum cortisol, a positive correlation existed between baseline total and free cortisol (R = 0·539 P = 0·01), as well as between peak ACTH-stimulated total and free cortisol (R = 0·619; P = 0·01). There was no correlation between baseline salivary cortisol and serum free cortisol and between peak ACTH-stimulated salivary and serum free cortisol. Using the lowest attained peak serum free cortisol in subjects whose TC response to ACTH was normal (≥ 500 nM), the minimal 'pass' level for normal serum free cortisol response to 1 μg ACTH was set at 25·0 nM. Five of the 19 subjects showing subnormal TC response to 1 μg ACTH had normal serum free cortisol response. CONCLUSIONS:Discrepancies between the peak free and TC were noted mostly for subjects whose ACTH-stimulated TC peaked between 440 and 580 nm. At this range, the measurement of serum free cortisol allows further refinement of the assessment of borderline responses to 1-μg ACTH.

journal_name

Clin Endocrinol (Oxf)

journal_title

Clinical endocrinology

authors

Limor R,Tordjman K,Marcus Y,Greenman Y,Osher E,Sofer Y,Stern N

doi

10.1111/j.1365-2265.2011.04080.x

subject

Has Abstract

pub_date

2011-09-01 00:00:00

pages

294-300

issue

3

eissn

0300-0664

issn

1365-2265

journal_volume

75

pub_type

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