Urinary free cortisol over 24 hours reflects total daily cortisol production and is a cornerstone screening test for Cushing syndrome. HPLC provides good specificity for cortisol with minimal interference from related steroids, though some labs now use LC-MS/MS for even higher specificity.
This test is used to evaluate suspected hypercortisolism, monitor known Cushing disease, and assess response to treatment. Two or more elevated collections support the diagnosis. Patient education about complete and accurate collection is critical. Sample type is a 24-hour urine collection.
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