Mass Spectrometry Based Cutoffs for Cortisol After Stimulation Tests
Mass Spectrometry Based Cutoffs for Cortisol After Stimulation Tests
There are two main stimulation tests used to decide if a patient has cortisol deficiency. It
 is the "synacthen test", were we stimulate the patient with intramuscular or intravenous
 synacthen ( ACTH) to see how much cortisol the adrenals are capable of producing, and it is
 the "Insulin hypoglycemia test" were we give the patient insulin to provoke a hypoglycemia,
 and look at the adrenal response to that stimulus. The cut off values for a normal response
 is based on old immunological assays no longer in use. Assays with a lot of interference and
 cross reactivity leading to measurement of higher values for cortisol than what we measure on
 the highly specific LCMS/MS ( Liquid chromatography mass spectrometry methode) that we are
 using for cortisol today. So, there is a need for new cut off values for a normal response to
 such tests. The purpose of this study is to produce such new cutoff values by performing the
 test in 120 healthy controls. We also want to perform the test in patient groups normally
 going trough this tests according to the same protocol as the control persons, to evaluate
 the new cutoffs in different patient groups.
120 healthy controls will perform an intravenous synacthen test in our out patient clinic. We
 register anthropometric data, and take basal blood screening to assure they are healthy. We
 take basal blood and saliva samples right before start of the test ( called 0-samples). Then
 they get intravenous synacthen, and we take new samples at 30 minutes and 60 minutes. They
 are observed during the procedure. We will then calculate a new cut off value for cortisol
 after the test, based on the 2.5 percentile for cortisol in this population. We will also
 calculate the same for 17-OH-progesterone, a parameter we also look at after synacthen test
 in som patient groups ( patients with hirsutism, who are suspicious of having an enzyme
 defect in the cortisol synthesis cascade). The saliva samples will also be analyzed for
 cortisol and 17-OH-progesterone, to evaluate if it is possible to use saliva instead of blood
 samples in synacthen tests in the future. The advantage of using saliva samples is that they
 can be used also in patients with elevated amount of cortisol binding globulin (CBG), because
 it measure the free hormone that is biological active ( not both the free and the protein
 bound, as we measure in serum samples). This is important in patients on estrogens , and in
 pregnant women, that have large amount of CBG.
Inclusion Criteria:

 -  Healthy individuals not using any corticosteroids .

 -  Patients with clinical suspicion of primary or secondary adrenal insufficiency.
 -Patient suspicious of having an enzyme defect ( 21 hydroxylase deficiency) giving
 hirsutism.

 Exclusion Criteria:

 -Use of corticosteroids.