Useful For
Suggests clinical disorders or settings where the test may be helpful
Screening test for Cushing syndrome (hypercortisolism)
Assisting in diagnosing acquired or inherited abnormalities of 11-beta-hydroxy steroid dehydrogenase (cortisol to cortisone ratio)
Diagnosis of pseudo-hyperaldosteronism due to excessive licorice consumption
This test has limited usefulness in the evaluation of adrenal insufficiency.
Special Instructions
Library of PDFs including pertinent information and forms related to the test
Method Name
A short description of the method used to perform the test
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Yes
Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test
Cortisol/Cortisone, Free, U
Aliases
Lists additional common names for a test, as an aid in searching
Cortisol
Cortisol, Free
Cortisol/Cortisone, Free
Cortison
Cortisone
Free Urinary Cortisol
Urinary Free Cortisol
Specimen Type
Describes the specimen type validated for testing
Urine
Necessary Information
ORDER QUESTIONS AND ANSWERS
Question ID |
Description |
Answers |
TM93 |
Collection Duration |
|
VL47 |
Urine Volume |
|
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Special Instructions
Library of PDFs including pertinent information and forms related to the test
Urine Preservative Collection Options
Ambient | No |
Refrigerate | OK |
Frozen | OK |
50% Acetic Acid | OK |
Boric Acid | Preferred |
Diazolidinyl Urea | No |
6M Hydrochloric Acid | No |
6M Nitric Acid | No |
Sodium Carbonate | No |
Thymol | No |
Toluene | No |
Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.
Specimen Type |
Temperature |
Time |
Special Container |
Urine |
Refrigerated (preferred) |
14 days |
|
|
Frozen |
28 days |
|
|
Ambient |
72 hours |
|
Useful For
Suggests clinical disorders or settings where the test may be helpful
Screening test for Cushing syndrome (hypercortisolism)
Assisting in diagnosing acquired or inherited abnormalities of 11-beta-hydroxy steroid dehydrogenase (cortisol to cortisone ratio)
Diagnosis of pseudo-hyperaldosteronism due to excessive licorice consumption
This test has limited usefulness in the evaluation of adrenal insufficiency.
Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
CORTISOL
0-2 years: not established
3-8 years: 1.4-20 mcg/24 hours
9-12 years: 2.6-37 mcg/24 hours
13-17 years: 4.0-56 mcg/24 hours
> or =18 years: 3.5-45 mcg/24 hours
CORTISONE
0-2 years: not established
3-8 years: 5.5-41 mcg/24 hours
9-12 years: 9.9-73 mcg/24 hours
13-17 years: 15-108 mcg/24 hours
> or =18 years: 17-129 mcg/24 hours
Use the factors below to convert each analyte from mcg/24 hours to nmol/24 hours:
Conversion factors
Cortisol: mcg/24 hours x 2.76=nmol/24 hours (molecular weight=362.5)
Cortisone: mcg/24 hours x 2.78=nmol/24 hours (molecular weight=360)
For SI unit Reference Values, see https://www.mayocliniclabs.com/order-tests/si-unit-conversion.html
Interpretation
Provides information to assist in interpretation of the test results
Most patients with Cushing syndrome have increased 24-hour urinary excretion of cortisol and/or cortisone. Further studies, including suppression or stimulation tests, measurement of serum corticotropin (adrenocorticotropic hormone) 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 (call 800-533-1710).
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. Further, many normal individuals also may exhibit a very low 24-hour urinary cortisol excretion with considerable overlap with the values observed in pathological hypocorticalism. Therefore, without other tests, 24-hour urinary cortisol measurements cannot be relied upon for the diagnosis of hypocorticalism.
Patients with 11-beta HSD deficiency may have cortisone to cortisol ratios <1, whereas a ratio of 2:1 to 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 <1.
Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Acute stress (including hospitalization and surgery), alcoholism, depression, and many drugs (eg, exogenous cortisone, anticonvulsants) can obliterate normal diurnal variation, affect response to suppression/stimulation tests, and increase baseline levels.
This methodology (liquid chromatography-tandem mass spectrometry) eliminates analytical interferences including carbamazepine (Tegretol) and synthetic corticosteroids.
This test has limited usefulness in the evaluation of adrenal insufficiency.
Improper collection may alter results. For example, a missed morning collection may result in false-negative tests; an extra morning collection (ie, >24 hours) may give false-positive results.
Renal disease (decreased clearance) may cause falsely low values.
Values may be elevated to twice normal in pregnancy.
Patients with exogenous Cushing syndrome caused by ingestion of hydrocortisone will not have suppressed cortisol and cortisone values.
Clinical Reference
Recommendations for in-depth reading of a clinical nature
1. Findling JW, Raff H: Diagnosis and differential diagnosis of Cushing's syndrome. Endocrinol Metab Clin North Am 2001;30:729-747
2. Boscaro M, Barzon L, Fallo F, Sonino N: Cushing's syndrome. Lancet 2001;357:783-791
3. 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
Special Instructions
Library of PDFs including pertinent information and forms related to the test
Method Description
Describes how the test is performed and provides a method-specific reference
Deuterated cortisol (d3-cortisol) is added to a 0.1-mL urine specimen as an internal standard. Cortisol, cortisone, and d3-cortisol are extracted from the specimens using online turbulent-flow HPLC and analyzed by liquid chromatography-tandem mass spectrometry using multiple-reaction monitoring in positive mode. The following ion pairs are used for analysis: Cortisol (363.0/121.1); Cortisone (361.0/163.0); d3-Cortisol (366.0/121.2). A calibration curve, generated from stripped urine spiked standards, is included with each batch of patient specimens.(Taylor RL, Machacek DA, Singh RJ: Validation of a high-throughput liquid chromatography-tandem mass spectrometry method for urinary cortisol and cortisone. Clin Chem 2002;48:1511-1519)
PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information
No
Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.
2 to 5 days
Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
14 days
Rochester
Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.
- Authorized users can sign in to Test Prices for detailed fee information.
- Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
- Prospective clients should contact their Regional Manager. For assistance, contact Customer Service.
Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.
This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.
Test Id |
Test Order Name |
Order LOINC Value
|
COCOU |
Cortisol/Cortisone, Free, U |
101319-2 |
Result Id |
Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
8546 |
Cortisol, U |
14158-0 |
10327 |
Cortisone, U |
14044-2 |
TM93 |
Collection Duration |
13362-9 |
VL47 |
Urine Volume |
3167-4 |
Test Setup Resources
Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.
Excel |
Pdf
SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.
SI Normal Reports |
SI Abnormal Reports