Cortisone, 24-Hour Urine

Test Code

37554

CPT Codes
82542, 82570

Includes

Creatinine

CPT code 81050 may be added at an additional charge for volume measurement

Preferred Specimen

2 mL of 24-hour urine in 24-hour urine collection container, no preservative

Minimum Volume

0.5 mL

Other Acceptable Specimens

2 mL of 24-hour urine in 25 mL 6N HCl, or 10 mL conc. glacial acetic acid, or 10 g Boric acid

Instructions

Collect urine with 10 grams of boric acid or keep urine refrigerated during collection if preservative is not used. Record 24-hour urine volume on test requisition and urine vial.

Note: Reference ranges do not apply to random urine samples.

Transport Temperature

Refrigerated (cold packs)

Specimen Stability

Room temperature: 14 days
Refrigerated: 21 days
Frozen: 90 days

Methodology
Liquid Chromatography/Tandem Mass Spectrometry (LC/MS/MS)

Setup Schedule

Monday-Friday Night
Report available: 3 Days

Reference Range

Cortisone, 24-Hour Urine

Adults

23-195 mcg/24 h

Creatinine, 24-Hour Urine

<3 Years	Not established
3-8 Years	0.10-0.80 g/24 hours
9-12 Years	0.20-1.40 g/24 hours
13-17 Years	0.40-1.90 g/24 hours
>17 Years	0.50-2.15 g/24 hours

Clinical Significance

This test, when used in conjunction with the measurement of 24-hour urine cortisol, may help in the diagnosis of apparent mineralocorticoid excess (AME) syndrome [1].

Cortisone is an inactive metabolite of cortisol converted by 11-beta-hydroxysteroid dehydrogenase type 2 (11-beta-HSD2) in the kidney. In patients with AME syndrome, deficiency of 11-beta-HSD2 impairs the deactivation of cortisol to cortisone. Consequently, accumulated cortisol activates mineralocorticoid receptors and leads to clinical manifestations resembling primary aldosteronism. Patients with AME typically present with low-renin hypertension, hypokalemia, and metabolic alkalosis. Similarly, ingestion of certain compounds that inhibit 11-beta-HSD2 activity, such as glycyrrhetinic acid (in licorice), carbenoxolone, and phthalates, may also reduce the conversion of cortisol to cortisone. Therefore, a high cortisol-to-cortisone ratio measured in 24-hour urine may help in identifying disorders caused by impaired activity of 11-beta-HSD2 [1, 2].

This test should be used in conjunction with 24-hour urine cortisol testing to evaluate the activity of 11-beta-HSD2 [1]. High serum cortisol-to-cortisone ratios in addition to low cortisone levels may also be helpful in the diagnosis of AME syndrome [2].

The results of this test should be interpreted in the context of pertinent clinical and family history and physical examination findings.

References
1. Young WF, Jr., et al. Endocrine Reviews. 2017;38(2):103-122.
2. Carvajal CA, et al. J Clin Endocrinol Metab. 2020;105(4):dgz315.

The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.