{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T10:32:56Z","timestamp":1776249176072,"version":"3.50.1"},"reference-count":22,"publisher":"Walter de Gruyter GmbH","issue":"0","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec id=\"j_jpem-2021-0519_abs_002\">\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>The diagnosis of adrenal insufficiency relies on clear cut-offs and accurate measurement of cortisol levels. Newer monoclonal antibody assays may increase the rate of diagnosis of adrenal insufficiency if traditional cortisol cut-off levels &lt;18\u00a0mcg\/dL (500\u00a0nmol\/L) are applied. We aimed to determine if the rate of diagnosis of adrenal insufficiency using a 1\u00a0mcg Cosyntropin stimulation test varied with the change in cortisol assay from a polyclonal to a monoclonal antibody assay.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpem-2021-0519_abs_003\">\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Cortisol levels obtained during the 1\u00a0mcg Cosyntropin stimulation test performed in the last semester of 2016 using a polyclonal antibody cortisol assay were compared to tests performed using a monoclonal antibody cortisol assay during the first semester of 2017. Cosyntropin tests included cortisol values obtained at baseline, 20\u00a0min and 30\u00a0min after IV administration of 1\u00a0mcg Cosyntropin. Peak cortisol cut-off value &lt;18\u00a0mcg\/dL was used to diagnose adrenal insufficiency.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpem-2021-0519_abs_004\">\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Stimulated cortisol values after 1\u00a0mcg Cosyntropin using the monoclonal assay in 2017 (n=38) were significantly lower (33%) compared to those obtained with the polyclonal assay in 2016 (n=27) (p-value &lt;0.001). The number of passing tests with a peak cortisol value &gt;18\u00a0mcg\/dL fell from 74% in 2016 (20 out of 27 tests) to 29% in 2017 (11 out of 38 tests).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpem-2021-0519_abs_005\">\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The change in cortisol assay substantially increased the number of patients diagnosed with adrenal insufficiency after 1\u00a0mcg Cosyntropin stimulation testing. Standardization of cortisol assays and diagnostic criteria is critical for the accurate diagnosis of adrenal insufficiency.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1515\/jpem-2021-0519","type":"journal-article","created":{"date-parts":[[2021,12,10]],"date-time":"2021-12-10T15:50:37Z","timestamp":1639151437000},"source":"Crossref","is-referenced-by-count":2,"title":["Rates of adrenal insufficiency using a monoclonal vs. polyclonal cortisol assay"],"prefix":"10.1515","volume":"0","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2874-1014","authenticated-orcid":false,"given":"Kyle P.","family":"McNerney","sequence":"first","affiliation":[{"name":"Department of Pediatrics , Division of Endocrinology, Diabetes, and Metabolism, Washington University School of Medicine\/Saint Louis Children\u2019s Hospital , Saint Louis , MO , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Maria","family":"Arbel\u00e1ez","sequence":"additional","affiliation":[{"name":"Department of Pediatrics , Division of Endocrinology, Diabetes, and Metabolism, Washington University School of Medicine\/Saint Louis Children\u2019s Hospital , Saint Louis , MO , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2021,12,13]]},"reference":[{"key":"2021122713361408709_j_jpem-2021-0519_ref_001","doi-asserted-by":"crossref","unstructured":"Johannsson, G, Falorni, A, Skrtic, S, Lennern\u00e4s, H, Quinkler, M, Monson, JP, et al.. 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