Serum Cortisol: An Up-To-Date Assessment of Routine Assay Performance

Hawley, James; Owen, Laura; Lockhart, Stephen; Monaghan, Phillip J.; Armston, Annie; Chadwick, Claire; Wilshaw, Heather; Freire, Marcelo; Perry, Leslie; Keevil, Brian

doi:10.1373/clinchem.2016.255034

Cited by 71 publications

(51 citation statements)

References 19 publications

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“…Current evidence stems from highly heterogeneous studies of mostly moderate quality. Of note, only two of 71 included studies have used LC‐MS/MS, which, however, is now considered state of the art for the measurement of cortisol . Large prospective studies, entailing rigorous patient selection, stratification and standardized outcome measurement by LC‐MS/MS, are needed to clarify how the adrenal gland responds to surgery and which factors shape this response.…”

Section: Discussionmentioning

confidence: 99%

“…Of note, only two of 71 included studies have used LC-MS/ MS, which, however, is now considered state of the art for the measurement of cortisol. 121 Large prospective studies, entailing rigorous patient selection, stratification and standardized outcome measurement by LC-MS/MS, are needed to clarify how the adrenal gland responds to surgery and which factors shape this response. Such data would help to inform and tailor the current guidelines on glucocorticoid stress dose cover in hypoadrenal patients undergoing surgery.…”

Section: Con Clus Ionsmentioning

confidence: 99%

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The cortisol stress response induced by surgery: A systematic review and meta‐analysis

Prete

Yan

Al-Tarrah

et al. 2018

Clinical Endocrinology

116

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SummaryObjective: Surgery is a stressor that can be categorized by duration and severity and induces a systemic stress response that includes increased adrenal cortisol production. However, the precise impact of surgical stress on the cortisol response remains to be defined. Design:We performed a systematic review and meta-analysis to assess the cortisol stress response induced by surgery and to stratify this response according to different parameters. Methods:We conducted a comprehensive search in several databases from 1990 to 2016. Pairs of reviewers independently selected studies, extracted data and evaluated the risk of bias. Cortisol concentrations were standardized, pooled in metaanalysis and plotted over time. Results:We included 71 studies reporting peri-operative serum cortisol measurements in 2953 patients. The cortisol response differed substantially between moderately/highly invasive and minimally invasive surgical procedures. Minimally invasive procedures did not show a peri-operative cortisol peak, whereas more invasive surgeries caused a cortisol surge that was more pronounced in older subjects, womenand patients undergoing open surgery and general anaesthesia. The duration of the procedure and the use of etomidate for induction of anaesthesia did not affect the cortisol response. Conclusions:The peri-operative cortisol stress response is dynamic and influenced by patient-specific, surgical and anaesthetic features. However, the available evidence is derived from highly heterogeneous studies, with only two of 71 studies measuring cortisol by mass spectrometry, which currently prevents a precise and reproducible definition of this response. K E Y W O R D Sadrenal cortex, adrenal insufficiency, cortisol, hydrocortisone, pituitary-adrenal system, stress, surgery | 555 PRETE ET al. | INTRODUC TI ONThe controlled trauma of a surgical insult activates adaptive changes in the neuro-hormonal system and the inflammation response.1 The primary mechanism responsible for cortisol hypersecretion in response to stress is executed by the afferent nerve signals derived from the surgical site, which in turn stimulate the hypothalamus to release corticotropin-releasing hormone and arginine vasopressin.

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Section: Discussionmentioning

confidence: 99%

Section: Con Clus Ionsmentioning

confidence: 99%

The cortisol stress response induced by surgery: A systematic review and meta‐analysis

Prete

Yan

Al-Tarrah

et al. 2018

Clinical Endocrinology

116

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“…cortisol), are given in literature [9,17]. In a recent comparison made between four immunoassays and one routine LC-MS/MS method with a candidate reference LC-MS/MS method (cRMP), Hawley et al [18] reported results that demonstrated a high variability in routine immunoassays in cohorts with well known interferences (pregnant women, patients on metyrapone or prednisolone). Only the routine LC-MS/MS method aligned extremely well with cRMP.…”

mentioning

confidence: 99%

Mass spectrometry or immunoassay: est modus in rebus

Antonelli

Marinova

Artusi

et al. 2017

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…In April 2016, Calgary Laboratory Services introduced a new cortisol assay, the Roche Diagnostics Cortisol II which has improved specificity for cortisol compared to its predecessor assay. 4,5 Given that the previous LNSC measurements were performed on the older assay and that the newer cortisol II assay exhibits greater cross-reactivity with pure exogenous glucocorticoids, it was decided to further investigate the LNSC results using the new cortisol II assay. Analysis of frozen and freshly collected LNSC specimens by the cortisol II assay demonstrated a cortisol concentration well in excess of previous measurements, requiring a 1:10 dilution to obtain a measurement within the assay's linear range ( Table 1).…”

mentioning

confidence: 99%

Factitious ACTH‐dependent, apparent hypercortisolism: The problem with late‐night salivary cortisol measurements collected at home

Kline

Buse

Gugten

et al. 2017

Clinical Endocrinology

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require any direct input from the patient. Once established, the alert remains in place long term and simply needs to be updated when the patient changes address. Such a system could potentially be rolled-out to cover the whole of the UK.Automated alerts, established through electronic records and shared between ambulance and acute trusts, share the burden of the responsibility between patients, their families, and health care professionals.It potentially "engineers-out" some of the human error that can arise in adrenal crisis recognition and response, provided address and comorbidity details are kept up to date. Healthcare professionals can now play a more proactive role in improving the safety of steroid-dependent patients, rather than placing the onus wholly on patients and families to address adrenal crisis appropriately. Electronic record sharing offers a "belt and braces" approach, so that patient/relative-supplied information in the event of acute illness is supported by robust automated alerts. ORCID Anna L. Mitchell

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Serum Cortisol: An Up-To-Date Assessment of Routine Assay Performance

Cited by 71 publications

References 19 publications

The cortisol stress response induced by surgery: A systematic review and meta‐analysis

The cortisol stress response induced by surgery: A systematic review and meta‐analysis

Mass spectrometry or immunoassay: est modus in rebus

Factitious ACTH‐dependent, apparent hypercortisolism: The problem with late‐night salivary cortisol measurements collected at home

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