Midnight Salivary Cortisol for the Initial Diagnosis of Cushing’s Syndrome of Various Causes

Yaneva, Maria; Mosnier-Pudar, Helen; Dugué, Marie-Annick; Grabar, Sophie; Fulla, Y.; Bertagna, Xavier

doi:10.1210/jc.2003-031790

Cited by 170 publications

(138 citation statements)

References 39 publications

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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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“…Recently, the determination of salivary cortisol at bedtime (2300 h) has been described as a sensitive and easy-to-perform marker for the diagnosis of CS, and some authors have proposed the determination of bedtime salivary cortisol in the place of serum cortisol at midnight (16)(17)(18)(19)(20)(21). The aim of this study is to evaluate the possible utility of determination of bedtime salivary cortisol in the diagnosis of SH in patients with AI.…”

Section: Introductionmentioning

confidence: 99%

The limited role of midnight salivary cortisol levels in the diagnosis of subclinical hypercortisolism in patients with adrenal incidentaloma

Masserini

Morelli

Bergamaschi

et al. 2009

European Journal of Endocrinology

101

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Objective: The criteria for defining subclinical hypercortisolism (SH) are debated and a real gold standard test or combination of tests is lacking. Recently, late-night salivary cortisol (MSC) has been described as a sensitive and easy-to-perform marker for diagnosing overt hypercortisolism. No data are available on the role of MSC in the diagnosis of SH. The aim of this study was to evaluate the sensitivity and specificity of MSC levels in the diagnosis of SH in patients with adrenal incidentalomas (AI). Methods: In 103 (females/males, 69/34) patients with AI, MSC levels were studied. One milligram overnight dexamethasone suppression test (DST), urinary-free cortisol (UFC), and ACTH plasma levels were also evaluated. Patients were defined as affected by SH if they showed two of the following criteria: DSTO83 nmol/l, ACTH !2.2 pmol/l, and UFC O193 nmol/24 h. Results: No difference in MSC levels in patients with SH (3.1G3.1 nmol/l) compared with patients without SH (2.2G2.8 nmol/l) was observed. In patients with SH, MSC levels were significantly correlated with DST (rZ0.4, P!0.05). Using the cut-off of 5.1 nmol/l, the sensitivity and specificity of MSC levels for diagnosis of SH is 22.7 and 87.7% respectively. Conclusion: In patients with AI, normal levels of MSC do not exclude SH, whereas high levels may suggest the presence of SH identified by conventional tests. Thus, MSC is not suitable as a screening test, although it may be used in conjunction with other tests as the confirming test in selected patients.

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“…Meanwhile, growing evidence suggests measurement of midnight or late-night salivary cortisol as a useful and convenient non-invasive method to be applied in the screening for Cushing's disease (5)(6)(7). In investigations carried out so far, laborious and typically radioactivity-based manual tests for salivary cortisol determination have been used (8)(9)(10)(11)(12)(13)(14). To date, only one automated cortisol immunoassay has specified saliva as a suitable sample material (Roche Cobas Cortisol) (15,16).…”

Section: Introductionmentioning

confidence: 99%

Measurement of late-night salivary cortisol with an automated immunoassay system

Vogeser¹,

Durner²,

Seliger³

et al. 2006

Clinical Chemistry and Laboratory Medicine (CCLM)

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Background: Measurement of late-night salivary cortisol concentrations is increasingly used as a screening test in suspected Cushing's syndrome. Cortisol concentrations are typically extremely low in latenight samples and discordant assay-specific reference ranges have been reported. Therefore, the aim of our study was to assess the analytical performance of the first automated cortisol immunoassay specified for salivary measurements and to establish late-night sampling reference-range data for this test. Methods: Salivary cortisol was measured using the Roche Cobas Cortisol assay (Roche Diagnostics). Five salivary pools in different concentration ranges were used to assess the inter-assay imprecision of this test in a two-centre evaluation protocol including two reagent lots. Linearity was tested by serial dilution. Salivary samples were obtained at 23:00 h from 100 apparently healthy volunteers using a commercially available salivary sampling device (Salivette, Sarstedt). A subset of 20 samples was used for method comparison with isotope dilution liquid chromatography-tandem mass spectrometry. Results: Inter-assay coefficients of variation (ns20) between 11.6% and 40.4% were found for mean cortisol concentrations between 12.9 and 2.6 nmol/L, with an estimated functional sensitivity of approximately 5.0 nmol/L. The test also gave linear results in the lowest concentration range between 1.0 and 8.3 nmol/L. Mean late-night salivary cortisol of 5.0 nmol/L was found for healthy individuals; the absolute range was 1.4-16.7 nmol/L, and the 95th percentile was 8.9 nmol/L. Substantially lower concentrations were found with isotope dilution LC-MS/MS compared to immunoassay results (mean concentrations 1.8 and 4.4 nmol/L, respectively). Conclusions: The automated assay investigated was found to offer acceptable analytical performance in the very low concentration range required for latenight salivary cortisol, despite a very short turnaround time. Using this assay, late-night salivary

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Midnight Salivary Cortisol for the Initial Diagnosis of Cushing’s Syndrome of Various Causes

Cited by 170 publications

References 39 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

The limited role of midnight salivary cortisol levels in the diagnosis of subclinical hypercortisolism in patients with adrenal incidentaloma

Measurement of late-night salivary cortisol with an automated immunoassay system

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