Salivary cortisol and the diagnosis of Cushing’s syndrome: a coming of age

Raff, Hershel

doi:10.1007/s12020-012-9661-8

Cited by 16 publications

(4 citation statements)

References 14 publications

(17 reference statements)

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“…A potential concern when saliva sampling is performed at home is contamination with topical or inhaled steroids or collection of insufficient volumes of saliva. Other possible interfering factors are gingival bleeding or the stress of midnight awakening (38). Some authors therefore suggest the collection of two samples of saliva (during consecutive nights) when performed at home (39).…”

Section: Discussionmentioning

confidence: 99%

Differentiating between Cushing's disease and pseudo-Cushing's syndrome: comparison of four tests

Alwani

Jongbloed

Jong

et al. 2014

European Journal of Endocrinology

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Objective: To evaluate the diagnostic performance of four different tests in order to differentiate between Cushing's disease (CD) and pseudo-Cushing's syndrome (PCS). Methods: In this prospective study, a total of 73 patients with clinical features of hypercortisolism and insufficient suppression of serum cortisol after 1 mg overnight dexamethasone and/or an elevated excretion of cortisol in 24-h urine samples were included. The circadian rhythm of serum cortisol levels as well as midnight serum cortisol (MserC) levels were assessed in all 73 patients. Late-night salivary cortisol (LNSC) concentrations were obtained in 44 patients. The dexamethasone-CRH (Dex-CRH) test was performed in 54 patients. Results: Fifty-three patients were diagnosed with CD and subsequently treated. Twenty patients were classified as having PSC. Serum cortisol circadian rhythm: the diurnal rhythmicity of cortisol secretion was retained in PCS. A cortisol midnight:morning ratio of O0.67 is highly suggestive of CD (positive predictive value (PPV) 100% and negative predictive value (NPV) 73%). MserC concentration O243 nmol/l has a PPV of 98% in predicting true CD (NPV 95%). LNSC level O9.3 nmol/l predicted CD in 94% of patients (NPV 100%). Dex-CRH test: after 2 days of dexamethasone suppression, a CRH-stimulated cortisol level O87 nmol/l (TZ15 min) resulted in a PPV of 100% and an NPV of 90%. Conclusion: The Dex-CRH test as well as a single measurement of cortisol in serum or saliva at late (mid-) night demonstrated high diagnostic accuracy in differentiating PCS from true CD.

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Section: Discussionmentioning

confidence: 99%

Differentiating between Cushing's disease and pseudo-Cushing's syndrome: comparison of four tests

Alwani

Jongbloed

Jong

et al. 2014

European Journal of Endocrinology

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“…The measurement of salivary cortisol has been extensively validated as a highly reliable and reproducible surrogate for biologically active serum free cortisol [17, 18, 19]. Therefore, the current study measured salivary cortisol at the circadian nadir and peak in infants between 3 months and 1 year of age with hypoxia secondary to cyanotic heart disease compared to a group with acyanotic heart disease.…”

Section: Introductionmentioning

confidence: 99%

Circadian rhythm of salivary cortisol in infants with congenital heart disease

et al. 2012

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Children with congenital heart disease (CHD) have associated extracardiac co-morbidities at the time of surgery and during ongoing growth and development. Perioperative events include disrupted glucose homeostasis, capillary leak, and fluid retention. The hypothalamic-pituitary-adrenal (HPA) axis has an important role in homeostasis in that the secretion of cortisol contributes to the response to stress, glucose regulation, blood volume control and immune regulation. We investigated the diurnal rhythm of the HPA axis in infants with CHD by measuring salivary cortisol in the morning (0600–0900 hr – circadian peak) and evening (2100–2400 hr – circadian nadir). Twenty-nine infants aged 12 weeks to 1 year were included: 16 with acyanotic disease (SpO2≥90%) and 13 with cyanotic disease (SpO2<90%). Morning salivary cortisol was similar between the two groups [acyanotic 7.0 nmol/L (1.8–23.1); cyanotic 9.7 nmol/L (0.9–15.6); p=0.68]. Evening salivary cortisol was similar between the two groups [acyanotic 0.9 nmol/L (0.2–8.5); cyanotic 1.4 nmol/L (0.5–14.9); p=0.32]. Both cyanotic and acyanotic groups demonstrated an intact diurnal rhythm. In conclusion, chronic hypoxia secondary to cyanotic CHD does not affect the circadian rhythm of the HPA axis. By twelve weeks of age, infants with hypoxia secondary to cyanotic CHD have a normal cortisol diurnal rhythm.

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“…Measurement of total testosterone, sex hormone binding globulin and DHEA-sulfate are useful, as well as other endocrine tests, such as FSH, LH, estradiol, prolactin and thyroid functions in oligo-or amenorrhea. Since weight management is beneficial in both cases, lifestyle changes should be encouraged before considering medical treatment, after excluding NCAH and other pathologic causes of androgenic symptoms [42].…”

Section: Laboratory Evaluation Of Premature Adrenarchementioning

confidence: 99%

Adrenal Dysfunction

2015

Endocrinol Metab Syndr

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Adrenal cortical disease, especially adrenal insufficiency, is more common than adrenal medullary disease and often goes unrecognized for extended periods. Physicians should consider the diagnosis of adrenal insufficiency in any patient with non-specific unexplained signs or symptoms including hypoglycemia, growth failure, weight loss, vomiting, or lethargy. The clinical features may be mistaken for, and should be differentiated from, infection, malnutrition, and gastrointestinal disease, inborn errors of metabolism, anorexia, chronic fatigue syndrome, and depression.

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Salivary cortisol and the diagnosis of Cushing’s syndrome: a coming of age

Cited by 16 publications

References 14 publications

Differentiating between Cushing's disease and pseudo-Cushing's syndrome: comparison of four tests

Differentiating between Cushing's disease and pseudo-Cushing's syndrome: comparison of four tests

Circadian rhythm of salivary cortisol in infants with congenital heart disease

Adrenal Dysfunction

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