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HelpTest Code CCFR Cortisol/Cortisone, Free, Random, Urine
Specimen Required
Supplies: Urine tube, 10 mL (T068)
Collection Container/Tube: Clean, plastic urine container with no metal cap or glued insert
Submission Container/Tube: Plastic, 10-mL urine tube or clean, plastic aliquot container with no metal cap or glued insert
Specimen Volume: 10 mL
Collection Instructions: Collect a random urine specimen.
Useful For
Investigating suspected Cushing syndrome (hypercortisolism), when a 24-hour collection is prohibitive (ie, pediatric patients).
Assisting in diagnosing acquired or inherited abnormalities of 11-beta-hydroxy steroid dehydrogenase (cortisol to cortisone ratio)
Diagnosis of pseudohyperaldosteronism due to excessive licorice consumption
This test has limited usefulness in the evaluation of adrenal insufficiency.
This test is not useful for evaluation of hypocorticalism.
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| COCOR | Cortisol, Random, U | No | Yes |
| CRETR | Creatinine, Random, U | Yes, (order RCTUR) | Yes |
Method Name
COCOR: Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
CRETR: Enzymatic Colorimetric Assay
Reporting Name
Cortisol/Cortisone, Free, Random, USpecimen Type
UrineSpecimen Minimum Volume
5 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Urine | Refrigerated (preferred) | 14 days | |
| Frozen | 28 days | ||
| Ambient | 72 hours |
Reference Values
CORTISOL
Males
0-2 years: 3.0-120 mcg/g creatinine
3-8 years: 2.2-89 mcg/g creatinine
9-12 years: 1.4-56 mcg/g creatinine
13-17 years: 1.0-42 mcg/g creatinine
≥18 years: 1.0-119 mcg/g creatinine
Females
0-2 years: 3.0-120 mcg/g creatinine
3-8 years: 2.2-89 mcg/g creatinine
9-12 years: 1.4-56 mcg/g creatinine
13-17 years: 1.0-42 mcg/g creatinine
≥18 years: 0.7-85 mcg/g creatinine
CORTISONE
0-2 years: 25-477 mcg/g creatinine
3-8 years: 11-211 mcg/g creatinine
9-12 years: 5.8-109 mcg/g creatinine
13-17 years: 5.4-102 mcg/g creatinine
18-29 years: 5.7-153 mcg/g creatinine
30-39 years: 6.6-176 mcg/g creatinine
40-49 years: 7.6-203 mcg/g creatinine
50-59 years: 8.8-234 mcg/g creatinine
60-69 years: 10-270 mcg/g creatinine
≥70 years: 12-311 mcg/g creatinine
Use the conversion factors below to convert each analyte from mcg/g creatinine to nmol/mol creatinine:
Conversion factors
Cortisol: mcg/g creatinine x 312=nmol/mol creatinine
Cortisone: mcg/g creatinine x 314=nmol/mol creatinine
Cortisol molecular weight=362.5
Cortisone molecular weight=360.4
Creatinine molecular weight=113.12
Interpretation
Most patients with Cushing syndrome have increased urinary excretion of cortisol and/or cortisone. Further studies, including suppression or stimulation tests, measurement of serum corticotrophin concentrations, and imaging are usually necessary to confirm the diagnosis and determine the etiology.
Values in the normal range may occur in patients with mild Cushing syndrome or with periodic hormonogenesis. In these cases, continuing follow-up and repeat testing are necessary to confirm the diagnosis.
Patients with Cushing syndrome due to intake of synthetic glucocorticoids should have both suppressed cortisol and cortisone. In these circumstances a synthetic glucocorticoid screen might be ordered (SGSU / Synthetic Glucocorticoid Screen, Random, Urine).
Suppressed cortisol and cortisone values may also be observed in primary adrenal insufficiency and hypopituitarism. However, random urine specimens are not useful for evaluation of hypocorticalism.
Patients with 11-beta HSD deficiency may have cortisone to cortisol ratios less than 1, whereas a ratio of 2 or 3:1 is seen in normal patients. Excessive licorice consumption and use of carbenoxolone, a synthetic derivative of glycyrrhizinic acid used to treat gastroesophageal reflux disease, also may suppress the ratio to less than 1.
Clinical Reference
1. Taylor RL, Machacek D, Singh RJ. Validation of a high-throughput liquid chromatography-tandem mass spectrometry method for urinary cortisol and cortisone. Clin Chem. 2002;48:1511-1519
2. Findling JW, Raff H. Diagnosis and differential diagnosis of Cushing's syndrome. Endocrinol Metab Clin North Am. 2001;30:729-747
3. Boscaro M, Barzon L, Fallo F, Sonino N. Cushing's syndrome. Lancet. 2001;357:783-791
4. Suzuki S, Minamidate T, Shiga A, et al. Steroid metabolites for diagnosing and predicting clinicopathological features in cortisol-producing adrenocortical carcinoma. BMC Endocr Disord. 2020;20(1):173. doi:10.1186/s12902-020-00652-y
Day(s) Performed
Monday through Friday
Report Available
2 to 6 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
82542
82530 - Cortisol
82570 - Creatinine
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| CCFR | Cortisol/Cortisone, Free, Random, U | In Process |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 10328 | Cortisol/Creatinine Ratio | 11155-9 |
| CRETR | Creatinine, Random, U | 2161-8 |
| 10329 | Cortisone/Creatinine Ratio | 30511-0 |