Endocrine Abstracts (2017) 49 EP1043 | DOI: 10.1530/endoabs.49.EP1043

Salivary and serum cortisol levels by liquid chromatography tandem mass spectrometry after standard dose ACTH test in the diagnosis of central hypopituitarism

Valentina Morelli1, Elisa Polledri2, Rosa Mercadante2, Beatrice Sonzogni1, Giovanna Mantovani1, Serena Palmieri1, Elena Malchiodi1, Elisa Verrua1, Anna Maria Barbieri1, Emanuele Ferrante3, Maura Arosio1, Silvia Fustinoni2 & Iacopo Chiodini1


1Unit of Endocrinology and Metabolic Disease, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; 2Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy; 3Unit of Internal Medicine 1, ASST Santi Paolo e Carlo, San Carlo Borromeo Hospital, Milan, Italy.


Objective: The diagnosis of central hypoadrenalism (HPAI) is a major clinical challenge. The gold standard procedure remains insuline tolerance test (ITT). Liquid chromatography tandem mass spectrometry (LC-MS/MS) is considered the best procedure for the evaluation of cortisol levels. This study aimed to evaluate cut-offs of serum (TM-SeC) and salivary cortisol (SaC) by LC-MS/MS and serum cortisol by ECLIA assay (E-SeC) after Standard dose ACTH test (SDCT) in diagnosing HPAI.

Design: In this study we performed SDCT in 52 consecutive patients (F/M, 33/19, age 42.9±13 yrs) referred to our Center to evaluate at specific time points E-SeC, TM-SeC and SaC. In the same group of patients we also evaluated E-SeC after ITT, to diagnose HPAI (using a cut off<500 nmol/l).

Results: HPAI was diagnosed in 8 out of 52 patients (five patients operated on for a pituitary macroadenoma, and 3 with a pituitary microadenoma). Using the diagnosis of HPAI made by ITT as reference test, we found that after SDCT an E-SeC>348 nmol/l at 0-min, >671 nmol/l at 30-min or >756 nmol/l at 60-min excluded HPAI, whereas an E-SeC <155 nmol/l at 0-min, <436 nmol/l at 30-min or <527 nmol/l at 60-min confirmed HPAI. By using LC-MS/MS we found that after SDCT a TM-SeC >378 nmol/l at 0-min, >1012 nmol/l at 30-min or >1021 nmol/l at 60-min excluded HPAI, whereas a TM-SeC <149 nmol/l at 0-min, <334 nmol/l at 30-min or <351 nmol/l at 60-min confirmed HPAI. Similarly by LC-MS/MS we found that after SDCT a SaC >7.4 nmol/l at 0-min, >15.8 nmol/l at 30-min or >23.3 nmol/l at 60 min excluded HPAI, whereas a SaC<1.7 nmol/l at 0-min, < 4.7;nmol/l at 30-min or <7.3 nmol/l at 60-min confirmed HPAI.

Conclusions: We can conclude that even evaluating TM-SeC and SaC, after SDCT there is large gray area of indeterminate results.