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HelpTest Code CRAV Cortisol, Right Adrenal Vein, Serum
Reporting Name
Cortisol, RAVPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
SerumOrdering Guidance
For confirming the presence of synthetic steroids, order SGSS / Synthetic Glucocorticoid Screen, Serum.
Specimen Required
Supplies: Sarstedt Aliquot Tube 5 mL (T914)
Collection Container/Tube: Red top
Specimen Volume: 1.5 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
0.5 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Refrigerated (preferred) | 28 days | |
| Ambient | 28 days | ||
| Frozen | 28 days |
Reference Values
No established reference values
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 |
|---|---|---|
| CRAV | Cortisol, RAV | 2143-6 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 6345 | Cortisol, RAV | 2143-6 |
Report Available
2 to 5 daysMethod Name
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
Useful For
Testing cortisol levels in the right adrenal vein
Second-order testing when cortisol measurement by immunoassay gives results that are not consistent with clinical symptoms, or if patients are known to, or suspected of, taking exogenous synthetic steroids
An adjunct in the differential diagnosis of primary and secondary adrenal insufficiency
An adjunct in the differential diagnosis of Cushing syndrome
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. Anna Nordenström and Henrik Falhammar. Diagnosis and management of the patient with non-classic CAH due to 21-hydroxylase deficiency European Journal of Endocrinology (2019) 180, 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 Aug;25(16):5235-5240. doi: 10.26355/eurrev_202108_26537. PMID: 34486698