Free and Total Plasma Cortisol Measured by Immunoassay and Mass Spectrometry Following ACTH1-24 Stimulation in the Assessment of Pituitary Patients
Free and Total Plasma Cortisol Measured by Immunoassay and Mass Spectrometry Following ACTH1-24 Stimulation in the Assessment of Pituitary Patients
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DOI：
10.1210/jc.2012-3576
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发表时间：
2013-05-01
影响因子：
5.8
通讯作者：
Doogue, Matthew P.
中科院分区：
文献类型：
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作者：
Burt, Morton G.;Mangelsdorf, Brenda L.;Doogue, Matthew P.
背景：ACTH(1-24)刺激后用免疫测定法测定血浆皮质醇来评估下丘脑-垂体-肾上腺(HPA)轴。目的：我们研究了在ACTH(1-24)刺激试验中用LC MS测定血浆总皮质醇和游离皮质醇以及免疫测定总皮质醇的应用。设计和地点：这是一项在临床研究机构进行的病例对照研究。参与者：我们研究了60名对照组和21名垂体疾病患者，其中HPA充足(n=8)或不足(n=13)。干预：参与者接受了1MUACTH(1-24)静脉注射和250 mg ACTH(1-24)肌肉注射ACTH(1-24)刺激试验。主要观察指标：ACTH(1-24)刺激的血浆总皮质醇和游离皮质醇与既往HPA测定结果一致。结果：免疫法测定的总皮质醇比LC MS法低12%。女性和年龄分别与ACTH(1-24)刺激的总皮质醇和游离皮质醇呈正相关。ACTH(1~24)治疗后30min、250mU(1~24)次ACTH治疗后30min、60min的总皮质醇、LC MS和游离皮质醇的测定结果与以往的HPA轴评估结果一致。然而，游离皮质醇比总皮质醇与诊断临界值的分离程度更大。结论：免疫分析和ACTH1-24刺激后LCMS对HPA状态的分类与先前的评估是一致的。在接近诊断阈值的患者中，游离皮质醇可能有更大的临床用途。(临床内分泌代谢酶98：1883-1890,2013)
Context: Measurement of plasma cortisol by immunoassay after ACTH(1-24) stimulation is used to assess the hypothalamic-pituitary-adrenal (HPA) axis. Liquid chromatography-tandem mass spectrometry (LCMS) has greater analytical specificity than immunoassay and equilibrium dialysis allows measurement of free plasma cortisol.Objective: We investigated the use of measuring total and free plasma cortisol by LCMS and total cortisol by immunoassay during an ACTH(1-24) stimulation test to define HPA status in pituitary patients.Design and Setting: This was a case control study conducted in a clinical research facility.Participants: We studied 60 controls and 21 patients with pituitary disease in whom HPA sufficiency (n = 8) or deficiency (n = 13) had been previously defined.Intervention: Participants underwent 1 mu g ACTH(1-24) intravenous and 250 mu g ACTH(1-24) intramuscular ACTH(1-24) stimulation tests.Main Outcome Measures: Concordance of ACTH(1-24)-stimulated total and free plasma cortisol with previous HPA assessment.Results: Total cortisol was 12% lower when measured by immunoassay than by LCMS. Female sex and older age were positively correlated with ACTH(1-24)-stimulated total and free cortisol, respectively. Measurements of total cortisol by immunoassay and LCMS and free cortisol 30 minutes after 1 mu g and 30 and 60 minutes after 250 mu g ACTH(1-24) were concordant with previous HPA axis assessment in most pituitary patients. However, free cortisol had greater separation from the diagnostic cutoff than total cortisol.Conclusions: Categorization of HPA status by immunoassay and LCMS after ACTH1-24 stimulation was concordant with previous assessment in most pituitary patients. Free cortisol may have greater clinical use in patients near the diagnostic threshold. (J Clin Endocrinol Metab 98: 1883-1890, 2013)