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Assessment of ACTH assay variability: a multicenter study
ObjectiveMeasurement of plasma ACTH plays a pivotal role in the diagnosis and treatment of several endocrine disorders. Little is known, however, on the variability of ACTH assay results and its impact on clinical practice. The aim of the present study was to assess the performance of routine plasma...
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Published in: | European journal of endocrinology 2011-04, Vol.164 (4), p.505-512 |
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container_title | European journal of endocrinology |
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creator | Pecori Giraldi, Francesca Saccani, Andrea Cavagnini, Francesco |
description | ObjectiveMeasurement of plasma ACTH plays a pivotal role in the diagnosis and treatment of several endocrine disorders. Little is known, however, on the variability of ACTH assay results and its impact on clinical practice. The aim of the present study was to assess the performance of routine plasma ACTH measurements.DesignTwenty-five fresh-frozen plasma samples collected from patients with either high, low, or normal ACTH concentrations were measured using seven different assays by 35 different laboratories. Assay precision, method agreement, and result classification were estimated.ResultsInter- and intra-assay coefficient of variation varied considerably with some assays achieving 20%. Overall method agreement was good (mean ratio versus target value 1.02) but subject to exceedingly large excursion (lower and upper limits of agreement at 0.13 and 1.91 respectively). Both differences between assays and between laboratories contributed to variability of method agreement. Assays correctly classified most patients with normal and high ACTH concentrations (90% (95% CI 82–97%) and 95% (95% CI 86–100%) respectively), whereas only 60% (95% CI 52–67%) of measurements from patients with low ACTH values were assigned correctly.ConclusionsField ACTH assays have to be interpreted with caution as they are burdened by high variability and often fail to correctly identify patients with suppressed ACTH secretion. The endocrine community has to include ACTH assays among those requiring standardization. |
doi_str_mv | 10.1530/EJE-10-0962 |
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Little is known, however, on the variability of ACTH assay results and its impact on clinical practice. The aim of the present study was to assess the performance of routine plasma ACTH measurements.DesignTwenty-five fresh-frozen plasma samples collected from patients with either high, low, or normal ACTH concentrations were measured using seven different assays by 35 different laboratories. Assay precision, method agreement, and result classification were estimated.ResultsInter- and intra-assay coefficient of variation varied considerably with some assays achieving <10%, others consistently achieving >20%. Overall method agreement was good (mean ratio versus target value 1.02) but subject to exceedingly large excursion (lower and upper limits of agreement at 0.13 and 1.91 respectively). Both differences between assays and between laboratories contributed to variability of method agreement. Assays correctly classified most patients with normal and high ACTH concentrations (90% (95% CI 82–97%) and 95% (95% CI 86–100%) respectively), whereas only 60% (95% CI 52–67%) of measurements from patients with low ACTH values were assigned correctly.ConclusionsField ACTH assays have to be interpreted with caution as they are burdened by high variability and often fail to correctly identify patients with suppressed ACTH secretion. The endocrine community has to include ACTH assays among those requiring standardization.</description><identifier>ISSN: 0804-4643</identifier><identifier>EISSN: 1479-683X</identifier><identifier>DOI: 10.1530/EJE-10-0962</identifier><identifier>PMID: 21252174</identifier><language>eng</language><publisher>Bristol: BioScientifica</publisher><subject>Adrenocorticotropic Hormone - blood ; Biological and medical sciences ; Biological Assay - standards ; Clinical Study ; Endocrinopathies ; Fundamental and applied biological sciences. 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Little is known, however, on the variability of ACTH assay results and its impact on clinical practice. The aim of the present study was to assess the performance of routine plasma ACTH measurements.DesignTwenty-five fresh-frozen plasma samples collected from patients with either high, low, or normal ACTH concentrations were measured using seven different assays by 35 different laboratories. Assay precision, method agreement, and result classification were estimated.ResultsInter- and intra-assay coefficient of variation varied considerably with some assays achieving <10%, others consistently achieving >20%. Overall method agreement was good (mean ratio versus target value 1.02) but subject to exceedingly large excursion (lower and upper limits of agreement at 0.13 and 1.91 respectively). Both differences between assays and between laboratories contributed to variability of method agreement. Assays correctly classified most patients with normal and high ACTH concentrations (90% (95% CI 82–97%) and 95% (95% CI 86–100%) respectively), whereas only 60% (95% CI 52–67%) of measurements from patients with low ACTH values were assigned correctly.ConclusionsField ACTH assays have to be interpreted with caution as they are burdened by high variability and often fail to correctly identify patients with suppressed ACTH secretion. The endocrine community has to include ACTH assays among those requiring standardization.</description><subject>Adrenocorticotropic Hormone - blood</subject><subject>Biological and medical sciences</subject><subject>Biological Assay - standards</subject><subject>Clinical Study</subject><subject>Endocrinopathies</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Reproducibility of Results</subject><subject>Vertebrates: endocrinology</subject><issn>0804-4643</issn><issn>1479-683X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><recordid>eNp9kT1Pw0AMhk8IRMvHxI6yIAYUOCeXL7aqKhRUiaVIbJFzuaOHkqacE1D-PVe1BcTAZA-PX1uPGTsDfg1RyG8mjxMfuM-zONhjQxBJ5sdp-LLPhjzlwhexCAfsiOiNc3A9P2SDAIIogEQMWTYiUkS1WrZeo73ReD71kAh77wOtwcJUpu1vPfTqrmqNdJiyHrVd2Z-wA40VqdNtPWbPd5P5eOrPnu4fxqOZXwjBW78I3UEKk4ADTwoUOoNCR8BDhLKUWYhRBpEog1LrEkWsszIAlEImqSwQ0ig8Zpeb3JVt3jtFbV4bkqqqcKmajvI0FlkcQ5o68mpDStsQWaXzlTU12j4Hnq9V5U7Vul-rcvT5NrcralV-szs3DrjYAkgSK21xKQ39cIInPA7XQcGGW5jXxaexKi9MQ9I4V0Ybib-37x7lhmAz9If97-IvtreQHA</recordid><startdate>20110401</startdate><enddate>20110401</enddate><creator>Pecori Giraldi, Francesca</creator><creator>Saccani, Andrea</creator><creator>Cavagnini, Francesco</creator><general>BioScientifica</general><general>European Society of Endocrinology</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20110401</creationdate><title>Assessment of ACTH assay variability: a multicenter study</title><author>Pecori Giraldi, Francesca ; Saccani, Andrea ; Cavagnini, Francesco</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b440t-b3479ea720107ba4f91bf5103a1ddc93a59154d2dffda46f9d21ac4c78cba1853</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adrenocorticotropic Hormone - blood</topic><topic>Biological and medical sciences</topic><topic>Biological Assay - standards</topic><topic>Clinical Study</topic><topic>Endocrinopathies</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Humans</topic><topic>Medical sciences</topic><topic>Reproducibility of Results</topic><topic>Vertebrates: endocrinology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pecori Giraldi, Francesca</creatorcontrib><creatorcontrib>Saccani, Andrea</creatorcontrib><creatorcontrib>Cavagnini, Francesco</creatorcontrib><creatorcontrib>Study Group on the Hypothalamo-Pituitary-Adrenal Axis of the Italian Society of Endocrinology</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of endocrinology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pecori Giraldi, Francesca</au><au>Saccani, Andrea</au><au>Cavagnini, Francesco</au><aucorp>Study Group on the Hypothalamo-Pituitary-Adrenal Axis of the Italian Society of Endocrinology</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessment of ACTH assay variability: a multicenter study</atitle><jtitle>European journal of endocrinology</jtitle><addtitle>Eur J Endocrinol</addtitle><date>2011-04-01</date><risdate>2011</risdate><volume>164</volume><issue>4</issue><spage>505</spage><epage>512</epage><pages>505-512</pages><issn>0804-4643</issn><eissn>1479-683X</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>ObjectiveMeasurement of plasma ACTH plays a pivotal role in the diagnosis and treatment of several endocrine disorders. Little is known, however, on the variability of ACTH assay results and its impact on clinical practice. The aim of the present study was to assess the performance of routine plasma ACTH measurements.DesignTwenty-five fresh-frozen plasma samples collected from patients with either high, low, or normal ACTH concentrations were measured using seven different assays by 35 different laboratories. Assay precision, method agreement, and result classification were estimated.ResultsInter- and intra-assay coefficient of variation varied considerably with some assays achieving <10%, others consistently achieving >20%. Overall method agreement was good (mean ratio versus target value 1.02) but subject to exceedingly large excursion (lower and upper limits of agreement at 0.13 and 1.91 respectively). Both differences between assays and between laboratories contributed to variability of method agreement. Assays correctly classified most patients with normal and high ACTH concentrations (90% (95% CI 82–97%) and 95% (95% CI 86–100%) respectively), whereas only 60% (95% CI 52–67%) of measurements from patients with low ACTH values were assigned correctly.ConclusionsField ACTH assays have to be interpreted with caution as they are burdened by high variability and often fail to correctly identify patients with suppressed ACTH secretion. The endocrine community has to include ACTH assays among those requiring standardization.</abstract><cop>Bristol</cop><pub>BioScientifica</pub><pmid>21252174</pmid><doi>10.1530/EJE-10-0962</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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source | Oxford University Press Journals |
subjects | Adrenocorticotropic Hormone - blood Biological and medical sciences Biological Assay - standards Clinical Study Endocrinopathies Fundamental and applied biological sciences. Psychology Humans Medical sciences Reproducibility of Results Vertebrates: endocrinology |
title | Assessment of ACTH assay variability: a multicenter study |
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