Cosyntropin-stimulated serum free cortisol in healthy, adrenally insufficient, and mildly cirrhotic populations

Mitra Rauschecker, Smita Baid Abraham, Brent S. Abel, Robert Wesley, Elizabeth Saverino, Apurva Trivedi, Theo Heller, Lynnette K. Nieman

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Context: Serum free cortisol (SFF) responses to cosyntropin simulation test (CST) may more accurately assess adrenal function than total cortisol (TF). Objective: The objective of the study was to evaluate the diagnostic utility of SFF responses during a 250-=g CST. Design:Werecruited healthy volunteers (HV; n=27), patients with primary and secondary adrenal insufficiency (n = 19 and n = 24, respectively), and subjects with Child-Pugh class A cirrhosis (CH; n = 15). Each received 250 =g cosyntropin with measurement of ACTH and corticosteroid binding globulin (CBG) at time 0 and TF and SFF at 0, 30, and 60 minutes. Salivary cortisol was measured at all time points in CH subjects. Results: Peak SFF and TF were significantly higher in HVs vs both AI groups (P .05). Peak SFF and TF (6.8 =g/dL vs 2.2 =g/dL; [188 nmol/L vs 62 nmol/L]; P .01) were significantly higher in the secondary adrenal insufficiency vs primary adrenal insufficiency patients. The optimal peak SFF criterion to identify adrenal insufficiency patients vs HV was 0.9 =g/dL (25 nmol/L) (sensitivity of 95%, specificity of 100%). Mean CBG and albumin levels were similar among all four groups. CH patients had a higher peak SFF than HV (2.4 vs 2.0 =g/dL; P =.02. In the CH patients, peak salivary cortisol levels correlated well with peak SFF (rs=0.84, P=.005). CBG levels were similar among the groups. Conclusion: We provide normative data for SFF values in HV and AI during the CST. Normal CBG levels in mild cirrhosis did not affect the interpretation of the CST.

Original languageEnglish (US)
Pages (from-to)1075-1081
Number of pages7
JournalJournal of Clinical Endocrinology and Metabolism
Issue number3
StatePublished - Mar 2016

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical


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