DATE: March 22, 2018
TIME: 10:30AM PDT, 1:30PM EDT
Cortisol plays a central role in the diagnosis of adrenal excess/insufficiency and in the assessment of stress adaptation and related diseases. The hydrophobic nature and the episodic/ circadian pattern of section challenge the clinical diagnostic accuracy of cortisol measurement. Commonly used automated immunoassays suffer cross-reactivity with other steroid analogues and exhibit significant inter-assay variability. Recently introduced liquid chromatography tandem mass spectrometry (LC-MS/MS) method, with superior specificity and sensitivity, provides a reliable alternative for measuring serum total and serum/urine free cortisol and is the method of choice for measuring salivary cortisol. However, assay standardization and the subsequent validations of reference ranges and cutoff values for dynamic testing remain to be established for LC-MS/MS-based cortisol assays. Rapid in-suite cortisol testing facilitates the use of adrenal vein sampling (AVS) for the differential diagnosis of primary aldosteronism; and real-time monitoring of cortisol levels will enable wider and better use of cortisol as stress biomarker in response to environmental and behavioral triggers. The recent technical advancements in cortisol biosensors and the development of integrated ambient ionization-miniature MS system hold the promises of realizing point-of-care (POC) cortisol monitoring and of potentially broad clinical applications.