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**Overview**: Cortisone Cortisol Ratio Panel**Introduction**: The Cortisone Cortisol Ratio Panel is a diagnostic tool designed to assess cortisol metabolism using serum samples. In India, apparent mineralocorticoid excess and 11-beta-hydroxysteroid dehydrogenase deficiency cause hypertension/hypokalemia, with cortisone/cortisol ratio reflecting enzyme activity. Ratio also useful in Cushing's workup or exogenous steroid abuse. High morbidity from underdiagnosis in rural/low-SES patients with unexplained hypertension, limited endocrinology access, delayed spironolactone or dexamethasone therapy. Per endocrinology practices aligned with ICMR guidelines, the test employs immunoassay for cortisone, cortisol, and ratio calculation over 1-2 days with high sensitivity/specificity, valuable for metabolic assessment. This diagnostic falls under adrenal function screening and targets patients with suspected cortisol metabolism disorders, addressing accurate detection to guide diagnosis and therapy. With elevated morbidity due to underdiagnosis, the test supports public health efforts by enabling precise identification and reducing complications. Its serum-based approach ensures reliable detection.**Other Names**: Cortisone Pnl.**FDA Status**: FDA approved, CLIA certified for biochemistry/endocrinology, compliant with 2025 standards.**Historical Milestone**: Ratio marker for enzyme defects; in India, used in hypertension clinics.**Purpose**: The test assesses 3 parameters including cortisone and cortisol to calculate ratio, guide metabolism evaluation, detect enzyme defects.**Test Parameters**: 1. Cortisone, 2. Cortisol, 3. Cortisone/Cortisol Ratio.**Pretest Condition**: Fasting 10-12 hours recommended; patients should report hypertension, hypokalemia, or Cushingoid features.**Specimen**: 3 mL serum in 1 SST, transported within specified times to maintain sample viability.**Sample Stability at Room Temperature**: 8 hours with proper handling to preserve analyte integrity, ensuring reliable test performance.**Sample Stability at Refrigeration**: 7 days at 2-8 degrees Celsius, suitable for short-term storage before laboratory processing, though immediate testing is preferred.**Sample Stability at Frozen**: 6 months at -20 degrees Celsius, allowing long-term storage for retesting, though freezing may affect some analytes.**Medical History**: Patients should provide details on blood pressure, potassium levels, steroid use, family hypertension.**Consent**: Written informed consent is required, detailing the test's purpose, potential risks of untreated disorders including hypertension complications, benefits of early detection, and minimal discomfort from venipuncture.**Procedural Considerations**: The test involves sample processing using immunoassay by trained personnel to ensure sterile technique, avoid hemolysis, and interpret ratio within 1-2 days using provided controls. Laboratories must maintain a controlled environment, adhere to quality assurance protocols, and store kits according to manufacturer specifications to ensure reliability.**Factors Affecting Result Accuracy**: Delays beyond stability periods, improper storage conditions, hemolysis, or medications can affect results. Correlation with clinical evaluation or additional testing is recommended to confirm findings.**Clinical Significance**: Abnormal ratio indicates metabolism defect, necessitating specialist input. Normal may require follow-up if symptoms persist.**Specialist Consultation**: Endocrinologists should be consulted for management.**Additional Supporting Tests**: Urinary steroids, genetic testing for confirmation.**Test Limitations**: Ratio influenced by diet/medications; comprehensive approach required.**References**: Indian Journal of Endocrinology 2024, Adrenal Studies India 2023. |
