Report from the HarmoSter study: Inter-laboratory comparison of LC-MS/MS measurements of corticosterone, 11-deoxycortisol and cortisone

Flaminia Fanelli, Stephen Bruce, Marco Cantù, Anastasia Temchenko, Marco Mezzullo, Johanna M. Lindner, Mirko Peitzsch, Pierre-Alain Binz, Mariette T. Ackermans, Annemieke C. Heijboer, Jody van den Ouweland, Daniel Koeppl, Elena Nardi, Manfred Rauh, Michael Vogeser, Graeme Eisenhofer, Uberto Pagotto

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Objectives: Liquid chromatography-tandem mass spectrometry (LC-MS/MS) panels that include glucocorticoid-related steroids are increasingly used to characterize and diagnose adrenal cortical diseases. Limited information is currently available about reproducibility of these measurements among laboratories. The aim of the study was to compare LC-MS/MS measurements of corticosterone, 11-deoxycortisol and cortisone at eight European centers and assess the performance after unification of calibration. Methods: Seventy-eight patient samples and commercial calibrators were measured twice by laboratory-specific procedures. Results were obtained according to in-house and external calibration. We evaluated intra-laboratory and inter-laboratory imprecision, regression and agreement against performance specifications derived from 11-deoxycortisol biological variation. Results: Intra-laboratory CVs ranged between 3.3 and 7.7%, 3.3 and 11.8% and 2.7 and 12.8% for corticosterone, 11-deoxycortisol and cortisone, with 1, 4 and 3 laboratories often exceeding the maximum allowable imprecision (MAI), respectively. Median inter-laboratory CVs were 10.0, 10.7 and 6.2%, with 38.5, 50.7 and 2.6% cases exceeding the MAI for corticosterone, 11-deoxycortisol and cortisone, respectively. Median laboratory bias vs. all laboratory-medians ranged from -5.6 to 12.3% for corticosterone, -14.6 to 12.4% for 11-deoxycortisol and -4.0 to 6.5% for cortisone, with few cases exceeding the total allowable error. Modest deviations were found in regression equations among most laboratories. External calibration did not improve 11-deoxycortisol and worsened corticosterone and cortisone inter-laboratory comparability. Conclusions: Method imprecision was variable. Inter-laboratory performance was reasonably good. However, cases with imprecision and total error above the acceptable limits were apparent for corticosterone and 11-deoxycortisol. Variability did not depend on calibration but apparently on imprecision, accuracy and specificity of individual methods. Tools for improving selectivity and accuracy are required to improve harmonization.

Original languageEnglish
Pages (from-to)67-77
Number of pages11
JournalClinical chemistry and laboratory medicine
Issue number1
Early online date2022
Publication statusPublished - 1 Jan 2023


  • 11-deoxycortisol
  • calibration
  • corticosterone
  • cortisone
  • harmonization
  • inter-laboratory performance
  • liquid chromatography - tandem mass spectrometry
  • method comparison
  • steroid hormones

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