24 h urinary free cortisol in large-scale epidemiological studies: Short-term and long-term stability and sources of variability

Judith G M Rosmalen, Ido P Kema, Stefan Wüst, Claude van der Ley, Sipke T Visser, Harold Snieder, Stephan J L Bakker

OnderzoeksoutputAcademicpeer review

25 Citaten (Scopus)


Background: Function of the hypothalamus-pituitary-adrenal (HPA) axis has been associated with several somatic and psychiatric health problems. The amount of free cortisol excreted in the urine during 24 h (24-h UFC) has often been used as a proxy for HPA-axis function. Reference values for 24-h UFC and their stability in the short and long term, as well as sources of variability, are largely lacking.

Methods: This study was performed in a general population cohort. Participants collected 24-h UFC on two consecutive days (T1), and repeated this collection approximately 2 years later (T2). Cortisol in urine was measured using LC-MS/MS. Height and weight were measured at the research facilities; glomerular filtration rate was estimated using creatinine clearance. Psychological distress (General Health Questionnaire), smoking, alcohol use and exercise were measured by means of questionnaires.

Results: 24-h UFC stability on a day-to-day basis was 0.69 (T1, N = 1192) and 0.72 (T2, N = 963) (both p <0.001). Long-term stability as indicated by correlation between 2-day averages of T1 and T2 was 0.60 (N = 972, p <0.001). Multivariable linear regression analysis revealed that 24-h UFC was predicted by urine volume (standardized beta 0.282 (T1, N = 1556) and 0.276 (T2, N = 1244); both p <0.001) and glomerular filtration rate (standardized beta 0.137 (T1) and 0.179 (T2); both p <0.001), while also sex explained a small part (standardized beta for female sex -0.057 (T1) and -0.080 (T2); both p <0.05).

Conclusion: 24-h UFC is moderately stable both in the short and the long term. The effects of urine volume and glomerular filtration rate on 24-h UFC are much stronger than those of sex. (C) 2014 Elsevier Ltd. All rights reserved.

Originele taal-2English
Pagina's (van-tot)10-16
Aantal pagina's7
StatusPublished - sep-2014

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