Are serum cortisol measurements by immunoassays reliable?
Main Article Content
Abstract
Routinely used automated immunoassays have been found to give unrealiable measurements of thyroid hormones in the presence of either high or low levels of thyroxine-binding globulin. Thyroid hormones are not the only analytes bound to specific binding proteins that are measured by immunoassays. Preliminary data from a series of cases, comparing IA measurements to those obtained by liquid chromatography-tandem mass spectrometry, reveal for the first time that IA measurements report falsely low (by an average of 27%) serum cortisol concentrations. Initial findings suggest that IA measurements of serum cortisol are affected by high concentrations of corticosteroid binding globulin.
Article Details
How to Cite
HAQ, Nowreen et al.
Are serum cortisol measurements by immunoassays reliable?.
Medical Research Archives, [S.l.], v. 8, n. 5, may 2020.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/2128>. Date accessed: 03 july 2024.
doi: https://doi.org/10.18103/mra.v8i5.2128.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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9. Van Deventer H, Mendu DR, Remaley AT, Soldin SJ. Inverse Log-Linear Relationship between Thyroid-Stimulating Hormone and Free Thyroxine Measured by Direct Analog Immunoassay and Tandem Mass Spectrometry. Clin Chem. 2011;57(1):122–127.
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4. Jonklaas J1, Kahric-Janicic N, Soldin OP, Soldin SJ. Correlations of free thyroid hormones measured by tandem mass spectrometry and immunoassay with thyroid-stimulating hormone across 4 patient populations. Clin Chem. 2009;55(7):1380-8.
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7. Qureshi A, Bahri A, Breen LA, Barnes SC, Powrie JK, Thomas SM, Carroll PV. The influence of the route of oestrogen administration on serum levels of cortisol-binding globulin and total cortisol. Clin Endocrinol (Oxf). 2007;66(5):632–635.
8. Brien TG. Human Corticosteroid Binding Globulin. Clin Endocrinol (Oxf) 1981;14:193–212.
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20. Wiegratz I, Jung-Hoffmann CJ, Kuhl H. Effect of Two Oral Contraceptives Constainng Ethinylestradiol and Gestondene or Norgestimate Upon Adrogen Parameters and Serum Binding Proteins. Contraception. 1995; 51(6):341–346.
2 . Parikh TP, Stolze B, Orzarda Y, Jonklaas J, Welsh K, Masika L, Hill M, DeCherney A, Soldin SJ. Diurnal cariation of steroid hormones and their reference intervals using mass spectrometric analysis. Endocrine Connections. 2018;7:1354¬¬–1361.
22. Guo T, Taylor RL, Singh RJ, Soldin SJ. Simultaneous determination of 12 steroids by isotope dilution liquid chromatography-photospray ionization tandem mass spectrometry. Clin Chim Acta. 2006;372:76–82.
23. Stolze BR, Gounden V, Gu J, Elliott EA, Masika LS, Abel BS, Merke DP, Skarulis MC, Soldin SJ. An improved micro-method for the measurement of steroid profiles by APPI-LC-MS/MS and its use in assessing diurnal effects on steroid concentrations and optimizinf the diagnosis and treatment of adrenal insufficiency and CAH. J Steroid Biochem Mol Biol. 2016;162:110–116.
24. Daniels K, Abma JC. Current Contraceptive Status Among Women Aged 15–49: United States, 2015–2017.NCHS Data Brief 2018;327:1-7N.
2. Taylor AE, Keevi1 B, Huhtaniemi IT. Mass spectrometry and immunoassay: how to measure steroid hormones today and tomorrow. European Journal of Endocrinology. 2015;173:D1–D12.
3. Monaghan PJ, Owen LJ, Trainer PJ, Brabant G, Keevil BG & Darby D. Comparison of serum cortisol measurement by immunoassay and liquid chromatography–tandem mass spectrometry in patients receiving the 11b-hydroxylase inhibitor metyrapone. Annals of Clinical Biochemistry. 2011;48:441–446.
4. Dodd AJ, Ducroq D, Neale SM, Wise MP, Mitchem KL, Armston A, Barth JH, El-Farhan N, Rees DA & Evans C. The effect of serum matrix and gender on cortisol measurements by commonly used immuno- assays. Annals of Clinical Biochemistry 2014;51:379–385.
5. Turpeinene U, Hamalainen E. Determination of cortisol in serum, saliva and urine. Best Practice & Research. Clinical Endocrinology & Metabolism 2013;27:795–801.
6. Weirman ME, Auchus RJ, Haisenleder DJ, Hall JE, Handelsman D, Hankinson S, Rosner W, Singh RJ, Sluss PM & Stanczyk FZ. Editorial: the new instructions to authors for the reporting of steroid hormone measurements. Journal of Clinical Endocrinology and Metabolism 2014;99:4375.
7. Botelho JC, Shacklady C, Cooper HC, Tai SS, Van Uytanghe K, Theinport LM & Vesper HW. Isotope-dilution liquid chromatography– tandem mass spectrometry candidate reference method for total testosterone in human serum. Clinical Chemistry 2013;59:372–380.
8. Hoofnagle AN & Wener MH. The fundamental flaws of immunoassay and potential solutions using tandem mass spectrometry. Journal of Immunological Methods 2009;347:3–11.
9. Van Deventer H, Mendu DR, Remaley AT, Soldin SJ. Inverse Log-Linear Relationship between Thyroid-Stimulating Hormone and Free Thyroxine Measured by Direct Analog Immunoassay and Tandem Mass Spectrometry. Clin Chem. 2011;57(1):122–127.
10. Welsh KJ, Soldin SJ. DIAGNOSIS OF ENDOCRINE DISEASE: How Reliable Are Free Thyroid and Total T3 Hormone Assays? Eur J Endocrinol. 2016;175(6):R255–R263.e20(1–2).
1. Gounden V, Jonklaas J, Soldin SJ. A Pilot Study: Subclinical Hypothyroidism and Free Thyroid Hormone Measurement by Immunoassay and Mass Spectrometry. Clin Chim Acta. 2014;430:121–124.
2. Araque KA, Klubo-Gwiezdzinska J, Nieman LK, Welsh K, Soldin SJ. Assessment of Thyroid Function and Harmonization: Opinion on Thyroid Hormone Harmonization. Ther Adv Endocrinol Metab. 2019;10:1–4.
3. Hannah-Shmouni F, Soldin SJ. Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism. N Engl J Med. 2017;377(14):e20(1–2).
4. Jonklaas J1, Kahric-Janicic N, Soldin OP, Soldin SJ. Correlations of free thyroid hormones measured by tandem mass spectrometry and immunoassay with thyroid-stimulating hormone across 4 patient populations. Clin Chem. 2009;55(7):1380-8.
5. Meyer EJ, Nenke MA, Rankin W, Lewis JG, Torpy DJ. Corticosteroid-Binding Globulin: A Review of Basic and Clinical Advances. 2016;48:359–371.
6. Doe RP, Zinneman HH, Flink EB, Ulstrom RA, Engst R, Lewis M, Johnson J. Significance of the Concentration of Nonprotein-Bound Plasma Cortisol Normal Subjects, Cushing’s Syndrome, Pregnancy, and During Estrogen Therapy. J Endocrinol Metab. 1960;20:1484–1492.
7. Qureshi A, Bahri A, Breen LA, Barnes SC, Powrie JK, Thomas SM, Carroll PV. The influence of the route of oestrogen administration on serum levels of cortisol-binding globulin and total cortisol. Clin Endocrinol (Oxf). 2007;66(5):632–635.
8. Brien TG. Human Corticosteroid Binding Globulin. Clin Endocrinol (Oxf) 1981;14:193–212.
9. Peterson RE, Nokes G, Chen PS Jr, Black RL. Estrogens and adrenocortical function in man. J Endocrinol Metab 1960;20:495.
20. Wiegratz I, Jung-Hoffmann CJ, Kuhl H. Effect of Two Oral Contraceptives Constainng Ethinylestradiol and Gestondene or Norgestimate Upon Adrogen Parameters and Serum Binding Proteins. Contraception. 1995; 51(6):341–346.
2 . Parikh TP, Stolze B, Orzarda Y, Jonklaas J, Welsh K, Masika L, Hill M, DeCherney A, Soldin SJ. Diurnal cariation of steroid hormones and their reference intervals using mass spectrometric analysis. Endocrine Connections. 2018;7:1354¬¬–1361.
22. Guo T, Taylor RL, Singh RJ, Soldin SJ. Simultaneous determination of 12 steroids by isotope dilution liquid chromatography-photospray ionization tandem mass spectrometry. Clin Chim Acta. 2006;372:76–82.
23. Stolze BR, Gounden V, Gu J, Elliott EA, Masika LS, Abel BS, Merke DP, Skarulis MC, Soldin SJ. An improved micro-method for the measurement of steroid profiles by APPI-LC-MS/MS and its use in assessing diurnal effects on steroid concentrations and optimizinf the diagnosis and treatment of adrenal insufficiency and CAH. J Steroid Biochem Mol Biol. 2016;162:110–116.
24. Daniels K, Abma JC. Current Contraceptive Status Among Women Aged 15–49: United States, 2015–2017.NCHS Data Brief 2018;327:1-7N.