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HelpTEST ID COCOU Cortisol/Cortisone, Free, 24 Hour, Urine
Reporting Name
Cortisol/Cortisone, Free, UUseful For
Screening test for Cushing syndrome (hypercortisolism)
Assisting in diagnosing acquired or inherited abnormalities of 11-beta-hydroxysteroid dehydrogenase (cortisol to cortisone ratio)
Diagnosis of pseudo-hyperaldosteronism due to excessive licorice consumption
This test has limited usefulness in the evaluation of adrenal insufficiency.
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
UrineNecessary Information
24-Hour volume (in milliliters) is required.
Specimen Required
Supplies: Urine Tubes, 10-mL (T068)
Submission Container/Tube: Plastic, urine tube (T068)
Specimen Volume: 5 mL
Collection Instructions:
1. Add 10 g of boric acid as preservative at the start of the collection.
2. Collect urine for a full 24 hours (required) and record the total volume.
Additional Information: See Urine Preservatives-Collection and Transportation for 24-Hour Urine Specimens for multiple collections.
Specimen Minimum Volume
3 mL
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| Urine | Refrigerated (preferred) | 14 days |
| Frozen | 28 days | |
| Ambient | 72 hours |
Special Instructions
Reference Values
CORTISOL
0-2 years: not established
3-8 years: 1.4-20 mcg/24 h
9-12 years: 2.6-37 mcg/24 h
13-17 years: 4.0-56 mcg/24 h
≥18 years: 3.5-45 mcg/24 h
CORTISONE
0-2 years: not established
3-8 years: 5.5-41 mcg/24 h
9-12 years: 9.9-73 mcg/24 h
13-17 years: 15-108 mcg/24 h
≥18 years: 17-129 mcg/24 h
For International System of Units (SI) conversion for Reference Values, see www.mayocliniclabs.com/order-tests/si-unit-conversion.html
Day(s) Performed
Monday through Friday
CPT Code Information
82530-Cortisol; free
82542
Clinical Information
Cortisol is a steroid hormone synthesized from cholesterol through a multienzyme pathway in the adrenal glands. It is the primary glucocorticoid in humans and acts as a gene transcription factor influencing a multitude of cellular responses in nearly all tissues. Cortisol plays a critical role in glucose metabolism, maintenance of vascular tone, immune response regulation, and in the physiologic response to stress. Its production is regulated by hypothalamic-pituitary feedback.
Only a small percentage of circulating cortisol is biologically active (free), with the majority of cortisol inactive because it is protein bound. As plasma cortisol concentrations increase, free cortisol (ie, unconjugated cortisol or hydrocortisone) also increases and is filtered by the glomeruli. Urinary free cortisol (UFC) correlates well with plasma free cortisol concentrations and reflects excretion of the circulating, biologically active, free cortisol associated with the signs and symptoms of hypercortisolism.
Urinary free cortisol testing is sensitive for the various types of adrenocortical dysfunction, particularly hypercortisolism (Cushing syndrome). Measurement of 24-hour UFC excretion by liquid chromatography tandem mass spectrometry (LC-MS/MS) is the preferred screening test for Cushing syndrome. LC-MS/MS methodology eliminates analytical interference from substances such as carbamazepine (Tegretol) and synthetic corticosteroids, which can affect immunoassay-based cortisol results.
Cortisone, a downstream metabolite of cortisol, provides an additional information for diagnosing adrenal disorders, including abnormalities of 11-beta-hydroxysteroid dehydrogenase (11-beta HSD), the enzyme that converts cortisol to cortisone. Deficiency of 11-beta HSD can cause mineralocorticoid excess because cortisol, unlike cortisone, acts as a mineralocorticoid receptor agonist. Licorice (active component glycyrrhetinic acid) inhibits 11-beta HSD and excess consumption can produce similar effects.
Cautions
Acute stress (including hospitalization and surgery), alcoholism, depression, and many drugs (eg, exogenous cortisone, anticonvulsants) can obliterate normal diurnal variation, affect response to suppression/stimulation tests, and increase baseline levels.
Liquid chromatography tandem mass spectrometry eliminates analytical interferences including carbamazepine (Tegretol) and synthetic corticosteroids.
This test has limited usefulness in the evaluation of adrenal insufficiency.
Improper collection may alter results. For example, a missed morning collection may result in false-negative tests; an extra morning collection (ie, >24 hours) may give false-positive results.
Kidney disease (decreased clearance) may cause falsely-low values.
Values may be elevated to twice normal in pregnancy.
Patients with exogenous Cushing syndrome caused by ingestion of hydrocortisone will not have suppressed cortisol and cortisone values.
Method Description
Cortisol and cortisone are extracted from supernatant by an online extraction utilizing high throughput liquid chromatography. This is followed by conventional liquid chromatography and analysis on a tandem mass spectrometer equipped with a heated nebulizer ion source. Deuterated cortisol (d4-cortisol, d7-cortisone) is added to a 0.1 mL sample as an internal standard. Cortisol, cortisone, and d4-cortisol are extracted from the specimens using online turbulent flow high-performance liquid chromatography extraction.(Unpublished Mayo method)
Report Available
2 to 7 daysSpecimen Retention Time
14 daysReject Due To
All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.Method Name
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)