Late-Night Salivary Cortisol for Diagnosis of Overt and Subclinical Cushing’s Syndrome in Hospitalized and Ambulatory Patients

Nunes, Marie-Laure; Vattaut, Stéphanie; Corcuff, Jean-Benoı̂t; Rault, A.; Loiseau, Hugues; Gatta, Blandine; Valli, Nathalie; Letenneur, Luc; Tabarin, Antoine

doi:10.1210/jc.2008-1542

Cited by 127 publications

(101 citation statements)

References 41 publications

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“…As reported in some studies (2,5,6,7,10,11,12,14), we found that LNSC levels were higher in CS; a threshold value above 5.24 ng/ml provided a good accuracy to detect endogenous hypercortisolism, and in particular to discover CD, the most common form. LNSC was able to differentiate CS patients from the control population, which included not only healthy subjects but also patients with suspected CS, and our proposed threshold value is consistent with other data reported in the literature and obtained with RIAs (5, 11, 23).…”

Section: Discussionsupporting

confidence: 77%

“…UFC collection and the 1 mg DST are simple, but neither is able to make a certain diagnosis of CS (15,20,21). The LNSC test, as proposed recently (5,6,7,10,11,12,14), is a reliable, noninvasive, stress-free, and low-cost procedure to diagnose CS. Moreover, elevation of LNSC levels might be the first abnormality to be checked in the follow-up after surgery (22).…”

Section: Discussionmentioning

confidence: 99%

“…The lack of a circadian rhythm is a peculiar marker of CS (4), so the LNSC test seems to be the best choice to screen for CS because of its noninvasive, stress-free, easy collection in outpatients (1). There is a marked variation between studies in the performance of the LNSC test, reflecting differences in laboratory assays, sample collection, severity of CS, and control groups (2,5,6,7,8,9,10,11,12,13,14). It is also important to have reference data not only for healthy volunteers but also for a control group of obese, hypertensive, diabetic, and depressed subjects or other clinical features of CS that are common in the general population (3,15).…”

Section: Introductionmentioning

confidence: 99%

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Performance of salivary cortisol in the diagnosis of Cushing's syndrome, adrenal incidentaloma, and adrenal insufficiency

Ceccato

Barbot

Zilio

et al. 2013

European Journal of Endocrinology

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Objective: Salivary cortisol has recently been suggested for studies on the hypothalamic-pituitaryadrenal (HPA) axis. The lack of circadian rhythm is a marker of Cushing's syndrome (CS), and some authors have reported that low salivary cortisol levels may be a marker of adrenal insufficiency. The aim of our study was to define the role of salivary cortisol in specific diagnostic settings of HPA axis disease. Subjects and methods: We analyzed morning salivary cortisol (MSC) and late-night salivary cortisol (LNSC) levels in 406 subjects: 52 patients with Cushing's disease (CD), 13 with ectopic CS, 17 with adrenal CS, 27 with CD in remission (a mean follow-up of 66G39 months), 45 with adrenal incidentaloma, 73 assessed as having CS and then ruled out for endogenous hypercortisolism, 75 with adrenal insufficiency, and 104 healthy subjects. Results: A LNSC value above 5.24 ng/ml differentiated CS patients from controls with high sensitivity (96.3%) and specificity (97.1%); we found higher LNSC levels in ectopic CS patients than in CD patients. We found no difference in MSC and LNSC levels between patients with CD in remission and healthy subjects. Both MSC and LNSC levels were higher in patients with adrenal incidentaloma than in healthy controls. A MSC value below 2.65 ng/ml distinguished patients with adrenal insufficiency from controls with high sensitivity (97.1%) and specificity (93.3%). Conclusions: Salivary cortisol is a useful tool to assess endogenous cortisol excess or adrenal insufficiency and to evaluate stable CD in remission.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Performance of salivary cortisol in the diagnosis of Cushing's syndrome, adrenal incidentaloma, and adrenal insufficiency

Ceccato

Barbot

Zilio

et al. 2013

European Journal of Endocrinology

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“…A low sensitivity (22.7%), but high specificity (87.7%) for cut-off 0.18 μg/ dL characterised LSC in the study by Masserini et al [20]. In the analysis of Nunes et al, sensitivity and specificity were comparable (77% and 69% respectively) for 0.17 μg/dL [21]. By contrast, Yuko Tateishi et al indicated 0.11 μg/dL value of LSC with 100% sensitivity but only 50% specificity [22].…”

Section: Discussionmentioning

confidence: 85%

Diagnostics of hypercortisolism — comparison between the clinical usefulness of salivary and serum cortisol measurements

Żukowski

Myśliwiec²,

Górska³

2013

Endokrynologia Polska

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Introduction: The aim of this study was the comparison of 24h urine free cortisol (UFC), serum cortisol at 11pm (SCM) and late-night salivary cortisol (LSC) in patients suspected for hypercortisolism, and an assessment of the usefulness of these measurements in diagnosing overt Cushing's (OCS) syndrome, pseudo Cushing's state (PCS) and subclinical Cushing's syndrome (SCS). Material and methods:The study group consisted of 82 patients, of whom four patients had SCS, three OCS and eight PCS. For measurements of LSC, the ELISA method was used, and for UFC and SCM determination, chemiluminescent microparticle immunoassay was used.

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“…As an alternative, late-night salivary cortisol can be used, but it has shown less sensitivity when compared to the low-dose dexamethasone suppression test in this subgroup of patients (57,(110)(111)(112)(113). Finally, with regard to first-line methods, 24-h UFC is the method with the highest number of false negative results, as it is diagnostic only when the disease is overt.…”

Section: Adrenal Incidentalomamentioning

confidence: 99%

Recommendations of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism for the diagnosis of Cushing’s disease in Brazil

Machado

Fragoso

Moreira

et al. 2016

Arch. Endocrinol. Metab.

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Although it is a rare condition, the accurate diagnosis and treatment of Cushing's disease is important due to its higher morbidity and mortality compared to the general population, which is attributed to cardiovascular diseases, diabetes mellitus and infections. Screening for hypercortisolism is recommended for patients who present multiple and progressive clinical signs and symptoms, especially those who are considered to be more specific to Cushing's syndrome, abnormal findings relative to age (e.g., spinal osteoporosis and high blood pressure in young patients), weight gain associated with reduced growth rate in the pediatric population and for those with adrenal incidentalomas. Routine screening is not recommended for other groups of patients, such as those with obesity or diabetes mellitus. Magnetic resonance imaging (MRI) of the pituitary, the corticotropin-releasing hormone (CRH) test and the high-dose dexamethasone suppression test are the main tests for the differential diagnosis of ACTH-dependent Cushing's syndrome. Bilateral and simultaneous petrosal sinus sampling is the gold standard method and is performed when the triad of initial tests is inconclusive, doubtful or conflicting. The aim of this article is to provide information on the early detection and establishment of a proper diagnosis of Cushing's disease, recommending follow-up of these patients at experienced referral centers. Arch Endocrinol Metab. 2016;60(3):267-86

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Late-Night Salivary Cortisol for Diagnosis of Overt and Subclinical Cushing’s Syndrome in Hospitalized and Ambulatory Patients

Abstract: Our data validate the outpatient bed sampling strategy for NSC with no need for specific outpatient threshold. NSC may be helpful to detect mild recurrence of Cushing's disease after surgery but is of little value in identifying SCSA amongst adrenal incidentalomas.

Cited by 127 publications

References 41 publications

Performance of salivary cortisol in the diagnosis of Cushing's syndrome, adrenal incidentaloma, and adrenal insufficiency

Performance of salivary cortisol in the diagnosis of Cushing's syndrome, adrenal incidentaloma, and adrenal insufficiency

Diagnostics of hypercortisolism — comparison between the clinical usefulness of salivary and serum cortisol measurements

Recommendations of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism for the diagnosis of Cushing’s disease in Brazil

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