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Accuracy of immunoassay and mass spectrometry urinary free cortisol in the diagnosis of Cushing’s syndrome

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Abstract

Purpose

Urinary free cortisol (UFC) determination by highly specific methods as mass spectrometry instead of commercially available antibody-based immunoassays is increasingly recommended. However, clinical comparisons of both analytical approaches in the screening of Cushing’s syndrome (CS) are not available. The aim of this study was to evaluate the diagnostic value of mass spectrometry versus immunoassay measurements of 24 h-UFC in the screening of CS.

Methods

Cross-sectional study of 33 histologically confirmed CS patients: 25 Cushing’s disease, 5 adrenal CS and 3 ectopic CS; 92 non-CS patients; and 35 healthy controls. UFC by immunoassay (UFCxIA) and mass spectrometry (UFCxMS), urinary free cortisone (UFCo) and UFC:UFCo ratio were measured, together with creatinine-corrected values. Sensitivity, specificity, AUC and Landis and Koch concordance index were determined.

Results

AUC for UFCxIA and UFCxMS were 0.77 (CI 0.68–0.87) and 0.77 (CI 0.67–0.87) respectively, with a kappa coefficient 0.60 and strong Landis and Koch concordance index. The best calculated cutoff values were 359 nmol/24 h for UFCxIA (78 % sensitivity, 62 % specificity) and 258.1 nmol/24 h for UCFxMS (53 % sensitivity, 86 % specificity). The upper limit of UFCxIA and UCFxMS reference ranges were 344.7 and 169.5 nmol/24 h respectively. Sensitivity and specificity for CS diagnosis at these cutpoints were 84 and 56 % for UFCxIA and 81 and 54 % for UFCxMS.

Conclusions

According to our data, both methods present a very similar diagnostic value. However, results suggest that lower cutoff points for mass spectrometry may be necessary in order to improve clinical sensitivity.

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Acknowledgments

The authors are indebted to Dr. María Jesús Martínez de Osaba for her expert advice and insights that inspired this work.

Funding

The study did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

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Author notes

    Authors and Affiliations

    1. Group of Endocrine Disorders, IDIBAPS, Barcelona, Spain

      G. Aranda, F. A. Hanzu, M. Mora & I. Halperin

    2. Department of Endocrinology and Nutrition, Hospital Clinic, Barcelona, Spain

      G. Aranda, M. Careaga, F. A. Hanzu, I. Patrascioiu, P. Ríos, M. Mora & I. Halperin

    3. Centro de Investigación en Red, CIBERDEM, Barcelona, Spain

      F. A. Hanzu, M. Mora & I. Halperin

    4. University of Barcelona, Barcelona, Spain

      F. A. Hanzu, M. Mora & I. Halperin

    5. Biochemistry and Molecular Genetics Service, Hospital Clinic Universitari, IDIBAPS, CIBERehd, Villarroel 170, 08036, Barcelona, Spain

      B. Morales-Romero, W. Jiménez & G. Casals

    6. Biomedicine Department, University of Barcelona, Barcelona, Spain

      W. Jiménez

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    1. G. Aranda
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    Correspondence to G. Casals.

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    The authors declare that they have no conflict of interest.

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    M. Careaga, F. A. Hanzu, I. Halperin and G. Casals have contributed equally to this work.

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    Aranda, G., Careaga, M., Hanzu, F.A. et al. Accuracy of immunoassay and mass spectrometry urinary free cortisol in the diagnosis of Cushing’s syndrome. Pituitary 19, 496–502 (2016). https://doi.org/10.1007/s11102-016-0730-5

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    • DOI: https://doi.org/10.1007/s11102-016-0730-5

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