Ann Lab Med.  2018 Jan;38(1):59-62. 10.3343/alm.2018.38.1.59.

Chinese Pediatric Reference Intervals for Serum Cortisol on IMMULITE 2000

• Wang LL
• Zhang LY
• Wang HY
• Wen HK
• Tao HQ
• Zhao XW

• KMID: 2397604
• DOI: http://doi.org/10.3343/alm.2018.38.1.59

Abstract

Clinical interpretation of the test results for cortisol based on continuous reference intervals with appropriate partitions improves pediatric diagnosis; however, these values are available only for Caucasians. To develop the pediatric reference intervals for Chinese population, we examined the serum cortisol levels in 1,143 healthy Chinese children aged 4-18 years (566 boys and 577 girls), using an IMMULITE 2000 Immunoassay System (Siemens Healthcare GmbH). Phlebotomy was performed at 7-9 a.m. for 284 boys and 287 girls and at 1-3 p.m. for the others. They were divided into four age groups according to the Clinical and Laboratory Standards Institute guideline EP28-A3c, with the last group further stratified according to sampling time. Separate reference intervals of 49.6-323.7, 70.9-395.3, and 90.1-448.7 nmol/L were established for children aged 4-8, 9-12, and 13-15 years, respectively. Further, reference intervals of 118.2-464.7 and 71.4-446.7 nmol/L were established for morning and afternoon cortisol levels, respectively, in children aged 16-18 years. Further studies are necessary to transfer and validate these reference intervals in other analytical systems and pediatric populations, and to allow for broader applications.

Keyword

Cortisol; Reference interval; Pediatrics; Chinese

MeSH Terms

Asian Continental Ancestry Group*
Child
Delivery of Health Care
Diagnosis
Female
Humans
Hydrocortisone*
Immunoassay
Pediatrics
Phlebotomy
Hydrocortisone

Reference

1. de Kloet ER, Sarabdjitsingh RA. Everything has rhythm: focus on glucocorticoid plusatility. Endocrinol. 2008; 149:3241–3243.

2. Rovnaghi CR, Kala AF, Allen SL, Anand KJS. Interpretation of cortisol concentrations and reference intervals from the CALIPER database. Clin Chem. 2014; 60:418–419. PMID: 24363368.

3. Karbasy K, Ariadne P, Gaglione S, Nieuwesteeg M, Adeli K. Advances in pediatric reference intervals for biochemical markers: Establishment of the CALIPER database in healthy children and adolescents. J Med Biochem. 2015; 34:23–30. PMID: 28356820.

4. CLSI. Defining, establishing, and verifying reference intervals in the clinical laboratory; approved guideline – third edition. CLSI document EP28-A3c. Wayne, PA: Clinical and Laboratory Standards Institute;2008. p. 8–28.

5. Group of COTF. The body mass index reference norm for screening overweight and obesity in Chinese children and adolescents. Zhonghua Liu Xing Bing Xue Za Zhi. 2004; 25:97–102. (in Chinese). PMID: 15132858.

6. Gunnar M, Quevedo K. The neurobiology of stress and development. Annu Rev Psychol. 2007; 27:199–220.

7. Bailey D, Colantonio D, Kyriakopoulou L, Cohen AH, Chan MK, Armbruster D, et al. Marked biological variance in endocrine and biochemical markers in childhood: establishment of pediatric reference intervals using healthy community children from the CALIPER cohort. Clin Chem. 2013; 59:1393–1405. PMID: 23637247.

8. Knutsson U, Dahlgren J, Marcus C, Rosberg S, Bronnegard M, Stierna P, et al. Circadian cortisol rhythms in healthy boys and girls: relationship with age, growth, body composition, and pubertal development. J Clin Endocrinol Metab. 1997; 82:536–540. PMID: 9024250.

9. Netherton C, Goodyer I, Tamplin A, Herbert J. Salivary cortisol and dehydroepiandrosterone in relation to puberty and gender. Psychoneuroendocrinology. 2004; 29:125–140. PMID: 14604596.

10. Soldin OP, Hoffman EG, Waring MA, Soldin SJ. Pediatric reference intervals for FSH, LH, estradiol, T3, free T3, cortisol, and growth hormone on the DPC IMMULITE 1000. Clin Chim Acta. 2005; 355:205–210. PMID: 15820497.

11. Tsai SL, Seiler KJ, Jaccobson J. Morning cortisol levels affected by sex and pubertal status in children and young adults. J Clin Res Pediatr Endocrinol. 2013; 5:85–89. PMID: 23748059.

12. Stroud LR, Papandonatos GP, Williamson DE, Dahl RE. Sex differences in cortisol response to corticotropin releasing hormone challenge over puberty: Pittsburgh Pediatric Neurobehavioral Studies. Psychoneuroendocrinology. 2011; 36:1226–1238. PMID: 21489699.

13. Scheifelbein VL, Susman EJ. Cortisol levels and longitudinal cortisol change as predictors of anxiety in adolescents. J Early Adolesc. 2006; 26:397–413.