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HelpTest Code COCOU Cortisol/Cortisone, Free, 24 Hour, Urine
Additional Codes
EPIC: LAB60285
Sunquest: COCOUM
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.
Method Name
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
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 |
Reject Due To
All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.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
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| COCOU | Cortisol/Cortisone, Free, U | 101319-2 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 8546 | Cortisol, U | 14158-0 |
| 10327 | Cortisone, U | 14044-2 |
| TM93 | Collection Duration (h) | 13362-9 |
| VL47 | Volume (mL) | 3167-4 |
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.