{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T15:51:06Z","timestamp":1788537066515,"version":"build-2803163510"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"vor","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Emilia-Romagna Region, Alessandro Liberati Young Researcher Grants","award":["PRUA 1\u20132012\u2013004"],"award-info":[{"award-number":["PRUA 1\u20132012\u2013004"]}]},{"name":"Ministry of University and Research, Progetti di Rilevante Interesse Nazionale","award":["2020ERLB52"],"award-info":[{"award-number":["2020ERLB52"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>The influence of immunoassay performance in hypercortisolism and dexamethasone suppression test (DST) settings was scarcely investigated. We evaluated the effectiveness of 2 immunoassays in detecting hypercortisolism compared to recommended liquid chromatography-tandem mass spectrometry (LC-MS\/MS), and compared immunoassay analytical performance in basal and post-DST conditions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We measured cortisol in post-DST sera of patients with suspected hypercortisolism or adrenal incidentalomas by Elecsys gen I (n = 260), and by Access (n = 217). All samples were also measured by a validated LC-MS\/MS method. We estimated hypercortisolism rate according to the established 50\u2005nmol\/L cutoff, and generated immunoassay-specific cutoffs providing &amp;gt;95% sensitivity and &amp;gt;80% specificity. Finally, we compared cortisol measurements in basal and post-DST samples.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Using the 50\u2005nmol\/L cutoff, both immunoassays detected lower rates of hypercortisolism compared with LC-MS\/MS, particularly in patients with adrenal adenomas (P &amp;lt; .050). Elecsys gen I and Access determined 6.9% and 6.4% possible false negatives, respectively. Elecsys gen I also caused 3.8% possible false positives. Optimal cutoff was 41\u2005nmol\/L for Elecsys gen I (sensitivity: 97.7%; specificity: 80.8%), and 33\u2005nmol\/L for Access (sensitivity: 97.5%; specificity: 78.3%). In basal and post-DST samples, Elecsys gen I overestimated by 32.5% and 6.1%, whereas Access underestimated by \u22124.7% and \u22125.9% compared to LC-MS\/MS cortisol measurements, respectively. Sex differences in method deviations were noted.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Both immunoassays demonstrated remarkable underdetection of hypercortisolism, suggesting the application of a method-specific cutoff. Immunoassay performance may not be uniform in basal and post-DST conditions and should be purposely examined. Accurate LC-MS\/MS methods should be preferred in hypercortisolism settings.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejendo\/lvaf141","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:05:42Z","timestamp":1752537942000},"page":"188-196","source":"Crossref","is-referenced-by-count":11,"title":["Impact of old and current immunoassays on the 1\u2005mg overnight dexamethasone suppression test: comparison with LC-MS\/MS"],"prefix":"10.1093","volume":"193","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-0393-2280","authenticated-orcid":false,"given":"Laura","family":"Rotolo","sequence":"first","affiliation":[{"name":"Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna , Bologna 40138 ,","place":["Italy"]},{"name":"Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna , Bologna 40138 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