Late-Night Salivary Cortisol as a Screening Test for Cushing's Syndrome

Raff, Hershel

doi:10.1210/jc.83.8.2681

Cited by 180 publications

(221 citation statements)

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“…Our data, the first of a series of studies on the diagnostic value of late-night salivary cortisol in CS patients conducted in Japan, confirm the results of other groups from overseas (Table 2), demonstrating a sensitivity of more than 90% at a specificity of 100% [17][18][19][20][21]. However, various cut-off points of the late-night and midnight salivary cortisol levels have been reported from independent studies, ranging from 0.13 µg/dl to 0.55 µg/dl [17][18][19][20][21] [21]. The different cut-off values may be accounted for by the different sample collections, assays, patient populations studied, and statistical methods employed.…”

Section: Discussionsupporting

confidence: 87%

Late-night Salivary Cortisol as A Screening Test for the Diagnosis of Cushing's Syndrome in Japan

et al. 2008

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Abstract. Measurement of late-night and/or midnight salivary cortisol currently used in US and European countries is a simple and convenient screening test for the initial diagnosis of Cushing's syndrome (CS). Unfortunately, this test has not been widely used in Japan. The purpose of this study was to evaluate the usefulness of the measurement of late-night salivary cortisol as a screening test for the diagnosis of CS in Japan. We studied 27 patients with various causes of CS, consisting of ACTH-dependent Cushing's disease [5] and ectopic ACTH syndrome [4] and ACTH-independent adrenal CS [11] and subclinical CS [7]. Eleven patients with type 2 diabetes and obesity and 16 normal subjects served as control group. Saliva samples were collected at late-night (23:00) in a commercially available device and assayed for cortisol by radioimmunoassay. There were highly significant correlations (P<0.0001) between late-night serum and salivary cortisol levels in normal subjects (r = 0.861) and in patients with CS (r = 0.788). Late-night salivary cortisol levels in CS patients (0.975 ± 1.56 µg/dl) were significantly higher than those in normal subjects (0.124 ± 0.031 µg/dl) and in obese diabetic patients (0.146 ± 0.043 µg/dl), respectively. Twenty-five out of 27 CS patients had late-night salivary cortisol concentrations greater than 0.21 µg/dl, whereas those in control group were less than 0.2 µg/dl. Receiver operating characteristic curve (ROC) analysis showed that the cut-off point of 0.21 µg/dl provides a sensitivity of 93% and a specificity of 100%. Therefore, it is concluded that the measurement of late-night salivary cortisol is an easy and reliable noninvasive screening test for the initial diagnosis of CS, especially useful for large high-risk populations, such as diabetes and obesity.

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Section: Discussionsupporting

confidence: 87%

Late-night Salivary Cortisol as A Screening Test for the Diagnosis of Cushing's Syndrome in Japan

et al. 2008

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“…40 There is less within-individual variation of late-night versus early morning cortisol. In patients with Cushing's syndrome, the circadian decline in cortisol is attenuated, and late-night cortisol measurements are more discriminating as a screening test than measurements obtained early in the day.…”

Section: Kidambi Et Al Adrenal Steroids and The Metabolic Syndromementioning

confidence: 99%

“…41,43,44 When salivary and urinary cortisol are not greatly elevated, there is essentially no correlation between the two, and salivary cortisol is a better index of hypothalamic-pituitary-adrenal activity than urine-free cortisol. 40,41 Furthermore, many studies have shown an excellent correlation of total and free-plasma cortisol with salivary cortisol in a variety of physiological situations. [45][46][47] It is possible, however, that the small increase in salivary cortisol in hypertensive subjects was attributable, at least in part, to a decreased conversion of cortisol to cortisone by salivary 11-␤-hydroxysteroid dehydrogenase 2.…”

Section: Kidambi Et Al Adrenal Steroids and The Metabolic Syndromementioning

confidence: 99%

Association of Adrenal Steroids With Hypertension and the Metabolic Syndrome in Blacks

et al. 2007

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Abstract-Blacks have a high prevalence of hypertension and adrenal cortical adenomas/hyperplasia. We evaluated the hypothesis that adrenal steroids are associated with hypertension and the metabolic syndrome in blacks. Ambulatory blood pressures, anthropometric measurements, and measurements of plasma renin activity (PRA), aldosterone, fasting lipids, glucose, and insulin were obtained in 397 subjects (46% hypertensive and 50% female) after discontinuing antihypertensive and lipid-lowering medications. Hypertension was defined as average ambulatory blood pressure Ͼ130/85 mm Hg. Late-night and early morning salivary cortisol, 24-hour urine-free cortisol, and cortisone excretion were measured in a consecutive subsample of 97 subjects (40% hypertensive and 52% female). Compared with normotensive subjects, hypertensive subjects had greater waist circumference and unfavorable lipid profiles, were more insulin resistant, and had lower PRA and higher plasma aldosterone and both late-night and early morning salivary cortisol concentrations. Twenty-four-hour urine-free cortisol and cortisone did not differ. Overall, ambulatory blood pressure was positively correlated with plasma aldosterone (rϭ0.22; PϽ0.0001) and late-night salivary cortisol (rϭ0.23; Pϭ0.03) and inversely correlated with PRA (rϭϪ0.21; PϽ0.001). Plasma aldosterone correlated significantly with waist circumference, total cholesterol, triglycerides, insulin, and the insulin-resistance index. Based on Adult Treatment Panel III criteria, 17% of all of the subjects were classified as having the metabolic syndrome. Plasma aldosterone levels, but not PRA, were elevated in subjects with the metabolic syndrome (Pϭ0.0002). The association of aldosterone with blood pressure, waist circumference, and insulin resistance suggests that aldosterone may contribute to obesity-related hypertension in blacks. In addition, we speculate that relatively high aldosterone and low PRA in these hypertensive individuals may reflect a mild variant of primary aldosteronism. Key Words: aldosterone Ⅲ cortisol Ⅲ hypertension Ⅲ metabolic syndrome Ⅲ insulin resistance Ⅲ plasma renin activity T he prevalence of hypertension in African-Americans is among the highest in the world. In the United States, compared with whites, hypertension is 50% more frequent in blacks. 1,2 Blacks develop hypertension at a young age and have higher rates of hypertension-related deaths and cardiovascular complications including stroke, heart disease, and end-stage renal disease. 2 In both black and white populations, hypertension is frequently associated with centripetal obesity, insulin resistance, and dyslipidemia. [3][4][5] This constellation of risk factors has been termed the metabolic syndrome and is associated with increased cardiovascular disease morbidity and mortality. 6,7 Based on an earlier study of the records of 35 000 consecutive autopsies, an increased prevalence of adrenal cortical adenomas and hyperplasia has been observed in association with essential hypertension, particularly in younger and ...

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“…2B). Similarly, some Cushing syndrome patients have elevated nadir and normal peak cortisol concentrations (46). In a previous study that reported normal corticosteronemia in the MC3-R −/− mouse, samples were collected in the afternoon, well after the circadian nadir of corticosterone concentrations (13).…”

Section: Discussionmentioning

confidence: 99%

Melanocortin-3 receptor regulates the normal fasting response

Renquist

Murphy

Larson

et al. 2012

Proc. Natl. Acad. Sci. U.S.A.

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The melanocortin-3 receptor-deficient (MC3-R −/− ) mouse exhibits mild obesity without hyperphagia or hypometabolism. MC3-R deletion is reported to increase adiposity, reduce lean mass and white adipose tissue inflammation, and increase sensitivity to salt-induced hypertension. We show here that the MC3-R −/− mouse exhibits defective fasting-induced white adipose tissue lipolysis, fasting-induced liver triglyceride accumulation, fasting-induced refeeding, and fasting-induced regulation of the adipostatic and hypothalamic-adrenal-pituitary axes. Close examination of the hypothalamic-pituitary-adrenal axis showed that MC3-R −/− mice exhibit elevated nadir corticosterone as well as a blunted fasting-induced activation of the axis. The previously described phenotypes of this animal and the reduced bone density reported here parallel those of Cushing syndrome. Thus, MC3-R is required for communicating nutritional status to both central and peripheral tissues involved in nutrient partitioning, and this defect explains much of the metabolic phenotype in the model. energy homeostasis | nonesterified fatty acid | corticotrophin-releasing hormone | hormone-sensitive lipase R esearch on the central melanocortin system has focused on the role of the melanocortin-4 receptor (MC4-R) in energy homeostasis, particularly as a result of the hyperphagic obesity syndrome found in both mice and humans with mutations in this receptor (1-3). A large body of work has demonstrated that circuitry regulated by the MC4-R is essential for much of leptin action and coordinates energy intake with energy expenditure to maintain long-term energy homeostasis (4). In contrast, the melanocortin-3 receptor (MC3-R), expressed in ∼35 different nuclei in the CNS with a pattern distinct from that of the MC4-R

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Late-Night Salivary Cortisol as a Screening Test for Cushing's Syndrome

Cited by 180 publications

References 0 publications

Late-night Salivary Cortisol as A Screening Test for the Diagnosis of Cushing's Syndrome in Japan

Late-night Salivary Cortisol as A Screening Test for the Diagnosis of Cushing's Syndrome in Japan

Association of Adrenal Steroids With Hypertension and the Metabolic Syndrome in Blacks

Melanocortin-3 receptor regulates the normal fasting response

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