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HelpTest Code CINP Cortisol, Mass Spectrometry, Serum
Reporting Name
Cortisol, S, LC-MS/MSUseful For
Second-order testing when cortisol measurement by immunoassay (eg, CORT / Cortisol, Serum) gives results that are not consistent with clinical symptoms, or if patients are known to, or suspected of, taking exogenous synthetic steroids (order SGSS / Synthetic Glucocorticoid Screen, Serum to confirm the presence of synthetic steroids)
An adjunct in the differential diagnosis of primary and secondary adrenal insufficiency
An adjunct in the differential diagnosis of Cushing syndrome
This test is not recommended for evaluating response to metyrapone; DOCS / 11- Deoxycorticosterone, Serum is more reliable.
Testing Algorithm
For more information see Steroid Pathways.
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
Serum RedOrdering Guidance
The preferred screening test for Cushing syndrome is the 24-hour urinary free cortisol excretion, order CORTU / Cortisol, Free, 24 Hour, Urine.
When patients are not taking, or are not suspected to be taking, exogenous glucocorticoids, order CORT / Cortisol, Serum.
Specimen Required
Collection Container/Tube: Red top (serum gel/SST are not acceptable)
Specimen Volume: 0.6 mL
Submission Container/Tube: Plastic vial
Collection Instructions:
1. Morning (8 a.m.) and afternoon (4 p.m.) specimens are preferred.
2. Include time of collection.
3. Centrifuge and aliquot serum into a plastic vial.
Additional Information: If multiple specimens are collected, send a separate order for each specimen.
Specimen Minimum Volume
0.25 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum Red | Refrigerated (preferred) | 28 days | |
| Ambient | 28 days | ||
| Frozen | 28 days |
Special Instructions
Reference Values
5-25 mcg/dL (a.m.)
2-14 mcg/dL (p.m.)
Pediatric reference ranges are the same as adults, as confirmed by peer-reviewed literature.
Petersen KE. ACTH in normal children and children with pituitary and adrenal diseases. I. Measurement in plasma by radioimmunoassay-basal values. Acta Paediatr Scand. 1981;70:341-345
Day(s) Performed
Monday through Friday
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
82533
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| CINP | Cortisol, S, LC-MS/MS | 87429-7 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 84279 | Cortisol, S, LC-MS/MS | 2143-6 |
| 23606 | AM Cortisol | 9813-7 |
| 23607 | PM Cortisol | 9812-9 |
Interpretation
In primary adrenal insufficiency, adrenocorticotropic hormone (ACTH) levels are increased, and cortisol levels are decreased; in secondary adrenal insufficiency both ACTH and cortisol levels are decreased.
When symptoms of glucocorticoid deficiency are present and the 8 a.m. plasma cortisol value is <10 mcg/dL (or the 24-hour urinary free cortisol value is <50 mcg/24 hours), further studies are needed to establish the diagnosis. The 3 most frequently used tests are the ACTH (cosyntropin) stimulation test, the metyrapone test, and insulin-induced hypoglycemia test. First, the basal plasma ACTH concentration should be measured, and the short cosyntropin stimulation test performed.
Cushing syndrome is characterized by increased serum cortisol levels. However, the 24-hour urinary free cortisol excretion is the preferred screening test for Cushing syndrome, specifically CORTU / Cortisol, Free, 24 Hour, Urine that utilizes liquid chromatography-tandem mass spectrometry. A normal result makes the diagnosis unlikely.
Symptoms or signs of Cushing syndrome in a patient with low serum and urine cortisol levels suggest possible exogenous synthetic steroid effects.
Clinical Reference
1. Lin CL, Wu TJ, Machacek DA, Jiang NS, Kao PC. Urinary free cortisol and cortisone determined by high-performance liquid chromatography in the diagnosis of Cushing's syndrome. J Clin Endocrinol Metab. 1997;82:151-155. doi:10.1210/jcem.82.1.3687.
2. Findling JW, Raff H. Diagnosis and differential diagnosis of Cushing's syndrome. Endocrinol Metab Clin North Am. 2001;30(3):729-747. doi:10.1016/s0889-8529(05)70209-7.
3. Buchman Al. Side effects of corticosteroid therapy. J Clin Gastroenterol. 2001;33(4):289-297. doi:10.1097/00004836-200110000-00006.
4. Dodds HM, Taylor PJ, Cannell GR, Pond SM. A high-performance liquid chromatography-electrospray-tandem mass spectrometry analysis of cortisol and metabolites in placental perfusate. Anal Biochem. 1997;247:342-347. doi:10.1006/abio.1997.2074.
5. Nordenstrom A, Falhammar H. Diagnosis and management of the patient with non-classic CAH due to 21-hydroxylase deficiency Eur J Endocrinol. 2019;180(3):R127-R145
6. Cengiz H, Demirci T, Varim C, Cetin S. Establishing a new screening 17 hydroxyprogesterone cut-off value and evaluation of the reliability of the long intramuscular ACTH stimulation test in the diagnosis of nonclassical congenital adrenal hyperplasia. Eur Rev Med Pharmacol Sci. 2021;25(16):5235-5240. doi:10.26355/eurrev_202108_26537
Report Available
2 to 5 daysMethod Name
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)