Test Catalog

Test Id : CORT

Cortisol, Serum

Useful For
Suggests clinical disorders or settings where the test may be helpful

Discrimination between primary and secondary adrenal insufficiency

 

Differential diagnosis of Cushing syndrome

 

This test is not recommended for evaluating response to metyrapone.

Method Name
A short description of the method used to perform the test

Immunoenzymatic Assay

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, S

Aliases
Lists additional common names for a test, as an aid in searching

Corticosteroids

Cortisol

Cortisol, Serum

Cortrosyn Stimulation Test

Dexamethasone Suppression Test

Diurnal Corticoids

Compound F

8545

Specimen Type
Describes the specimen type validated for testing

Serum

Ordering Guidance

The preferred screening test for Cushing syndrome measures 24-hour urinary free cortisol. Order CORTU / Cortisol, Free, 24 Hour, Urine.

 

For confirming the presence of synthetic steroids, order SGSS / Synthetic Glucocorticoid Screen, Serum.

 

For patients taking exogenous glucocorticoids, order CORTU / Cortisol, Free, 24 Hour, Urine.

 

For evaluating response to metyrapone, order DCORT / 11-Deoxycortisol, Serum.

 

For evaluation of congenital adrenal hyperplasia, the following tests provide better, accurate, and specific determination of the enzyme deficiency:

-DCORT / 11-Deoxycortisol, Serum

-OHPG / 17-Hydroxyprogesterone, Serum

-DHEA_ / Dehydroepiandrosterone (DHEA), Serum

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Collection Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 0.6 mL

Collection Instructions:

1. Morning (8 a.m.) and afternoon (4 p.m.) specimens are preferred.

2. Serum gel tubes should be centrifuged within 2 hours of collection.

3. Red-top tubes should be centrifuged and the serum aliquoted into a plastic vial within 2 hours of collection.

Additional Information:

1. Include time of collection.

2. If multiple specimens are collected, send separate order for each specimen.

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory

0.5 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis Reject
Gross lipemia OK

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 7 days
Frozen 7 days

Useful For
Suggests clinical disorders or settings where the test may be helpful

Discrimination between primary and secondary adrenal insufficiency

 

Differential diagnosis of Cushing syndrome

 

This test is not recommended for evaluating response to metyrapone.

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Cortisol, the main glucocorticoid (representing 75%-90% of the plasma corticoids) plays a central role in glucose metabolism and in the body's response to stress.

 

Cortisol levels are regulated by adrenocorticotropic hormone (ACTH), which is synthesized by the pituitary gland in response to corticotropin-releasing hormone (CRH). CRH is released in a cyclic fashion by the hypothalamus, resulting in diurnal peaks (6 a.m.-8 a.m.) and troughs (11 p.m.) in plasma ACTH and cortisol levels.

 

The majority of cortisol circulates bound to cortisol-binding globulin (CBG-transcortin) and albumin. Normally, less than 5% of circulating cortisol is free (unbound). The free cortisol is the physiologically active form and is filterable by the renal glomerulus.

 

Although hypercortisolism is uncommon, the signs and symptoms are common (eg, obesity, high blood pressure, increased blood glucose concentration). The most common cause of increased plasma cortisol levels in women is a high circulating concentration of estrogen (eg, estrogen therapy, pregnancy) resulting in increased concentration of cortisol-binding globulin.

 

Spontaneous Cushing syndrome results from overproduction of glucocorticoids as a result of either primary adrenal disease (adenoma, carcinoma, or nodular hyperplasia) or an excess of ACTH (from a pituitary tumor or an ectopic source). ACTH-dependent Cushing syndrome due to a pituitary corticotroph adenoma is the most frequently diagnosed subtype; most commonly seen in women in the third through fifth decades of life. The onset is insidious and usually occurs 2 to 5 years before a clinical diagnosis is made.

 

Causes of hypocortisolism are:

-Addison disease-primary adrenal insufficiency

-Secondary adrenal insufficiency:

--Pituitary insufficiency

--Hypothalamic insufficiency

-Congenital adrenal hyperplasia-defects in enzymes involved in cortisol synthesis

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.

a.m.: 7-25 mcg/dL

p.m.: 2-14 mcg/dL

 

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

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 less than 10 mcg/dL (or the 24-hour urinary free cortisol value is <50 mcg/24 hours), further studies are needed to establish the diagnosis. First, the basal plasma ACTH concentration should be measured, followed by the short cosyntropin stimulation test.

 

For the cosyntropin (ACTH)-stimulation test, serum cortisol is measured before and at various time intervals after an ACTH injection. The criteria for a normal response are:-An increase in serum cortisol to a peak value of at least 15 mcg/dL post-cosyntropin-Usually also associated with an increase in serum cortisol of at least 7 mcg/dL above the baseline (if baseline cortisol is >15 mcg/dL this criterion does not apply)-Basal serum cortisol greater than 5 mcg/dL (criterion applies when blood drawn before 9 a.m.)

 

False normal responses may be present in patients on oral estrogen therapy or in patients with mild secondary adrenal insufficiency.

 

Other frequently used tests are the metyrapone and insulin-induced hypoglycemia test. Consult the Endocrine Testing Center at 800-533-1710 for testing information and interpretation of test results.

 

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, which utilizes liquid chromatography/tandem mass spectrometry (LC-MS/MS). A normal result makes the diagnosis unlikely.

 

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, consider testing by LC-MS/MS; see CINP / Cortisol, Mass Spectrometry, Serum. For confirming the presence of synthetic steroids, order SGSS / Synthetic Glucocorticoid Screen, Serum.

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 cortisones, anticonvulsants) can obliterate normal diurnal variation, affect response to suppression/stimulation tests, and cause elevated baseline levels.

 

Patients taking prednisone may have falsely increased cortisol levels because prednisone is converted to prednisolone after ingestion and prednisolone has 41% cross-reactivity.

 

Cortisol levels may be increased in pregnancy and with exogenous estrogens.

 

Some patients with depressive disorders have a hyperactive hypothalamic-pituitary-adrenal axis, similar to Cushing syndrome.

 

A low plasma cortisol level does not give conclusive indication of congenital adrenal hyperplasia. See Ordering Guidance for alternative testing.

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(3):729-747

2. Buchman AL: Side effects of corticosteroid therapy. J Clin Gastroenterol. 2001;33(4):289-294

3. Rifai N, Horvath AR, Wittwer CT. eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018

4. Javorsky B, Carroll T, Algeciras-Schimnich A, Singh R, Colon-Franco J, Findling J: SAT-390 new cortisol threshold for diagnosis of adrenal insufficiency after cosyntropin stimulation testing using the Elecsys cortisol II, access cortisol, and LC-MS/MS assays. J Endocr Soc. 2019;3(Suppl 1):SAT-390. doi: 10.1210/js.2019-SAT-390

Method Description
Describes how the test is performed and provides a method-specific reference

The Access cortisol assay is a competitive binding immunoenzymatic assay. A specimen is added to a reaction vessel with rabbit antibody to cortisol, cortisol-alkaline phosphatase conjugate, and paramagnetic particles coated with goat anti-rabbit capture antibody. Cortisol in the specimen competes with the cortisol-alkaline phosphatase conjugate for binding sites on a limited amount of specific anti-cortisol antibody. Resulting antigen:antibody complexes bind to the capture antibody on the solid phase. After incubation in a reaction vessel, materials bound to the solid phase are held in a magnetic field while unbound materials washed away. Then the chemiluminescent substrate Lumi-Phos 530* is added to the reaction vessel and light generated by the reaction is measured with a luminometer. The light production is inversely proportional to the amount of cortisol in the specimen. The amount of analyte in the specimen is determined from stored, multi-point calibration curve.(Package insert: Access Cortisol. Beckman Coulter; 2011)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Friday

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.

1 to 3 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

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

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 has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

82533

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
CORT Cortisol, S 87429-7
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.
CORTP Cortisol, S 83088-5
CAM AM Result 9813-7
CPM PM Result 9812-9

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 | Create a PDF

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

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