Salivary Cortisol Measurement: A Practical Approach to Assess Pituitary-Adrenal Function

Laudat, M H; Cerdas, Sonia; Fournier, Charles; Guiban, D.; Guilhaume, B; Luton, J. P.

doi:10.1210/jcem-66-2-343

Cited by 353 publications

(219 citation statements)

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“…The concentration of cortisol in saliva is equilibrium with free serum cortisol and is independent of the rate of saliva production [8][9][10][11]. Thus, salivary cortisol levels could represent the free cortisol levels in serum.…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

“…Since lack of circadian rhythm of serum secretion is a hallmark of CS [8,12], midnight serum cortisol levels greater than 1.8 µg/dl have been reported to be indicative of CS [6]. Measurement of late-night to midnight serum cortisol, however, requires hospitalization, trained medical staff, and painful venipunctures.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2008

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“…The abdominal sagittal diameter (D, cm) was determined as the distance between the examination table and the highest point of the abdomen in the recumbent position, and is a close approximation of visceral fat mass. 23 Salivary cortisol 24 was determined by radioimmunoassay (RIA, Orion Diagnostica, Turku, Finland). A sampling device called Salivette 1 (Sarstedt Inc., Rommelsdorf, Germany) was used to measure salivary cortisol levels.…”

Section: Examinationsmentioning

confidence: 99%

The interactions between hypothalamic-pituitary-adrenal axis activity, testosterone, insulin-like growth factor I and abdominal obesity with metabolism and blood pressure in men

Rosmond

Björntorp

1998

Int J Obes

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OBJECTIVE: To examine potential interactions between abdominal obesity, endocrine, metabolic and hemodynamic perturbations. SUBJECTS: A subgroup of 284 men from a population sample of 1040 at the age of 51 y. MEASUREMENTS: Anthropometric measurements included body mass index (BMI, kgam 2 ), waistahip circumference ratio (WHR) and abdominal sagittal diameter (D). Endocrine measurements were a modi®ed, low dose (0.5 mg) dexamethasone suppression test (Dex), testosterone (T) and insulin-like growth factor I (IGF-I). Overnight fasting values of blood glucose, serum insulin, triglycerides, total, low and high density lipoprotein cholesterol, as well as resting heart rate and blood pressure were also determined. RESULTS: Arbitrary subdivisions of the men were performed to obtain subgroups of low T and IGF-I values (lowest decile, borderlines 13.13 nmolal and 128.80 m mgal, respectively) and normal or blunted Dex. Signi®cant relationships with BMI, WHR or D, and abnormal metabolic and hemodynamic factors, usually with the exception of total and low density lipoprotein cholesterol, were then found in subgroups with different endocrine pro®les. These included men with a blunted Dex test with low T or IGF-I values, as well as men with a normal Dex test and low or normal T or IGF-I values. In addition, a group with isolated low Dex suppression, as well as another group without endocrine abnormalities, showed such relationships. These ®ndings suggest that, in men, obesity factors are associated with metabolic and hemodynamic complications with or without the presence of perturbations of hypothalamic-pituitaryadrenal axis (HPA) regulation or low T or growth hormone secretion. In order to generate hypotheses concerning the nature of the impact of the endocrine perturbations in abdominal obesity and its metabolic complications, path analyses were performed, testing different models. These models included the endocrine measurements (Dex test, T and IGF-I), the WHR and D (representing abdominal distribution of fat), BMI (representing obesity), as well as insulin and triglyceride values (representing metabolic perturbations). The results showed a satisfactory ®t (goodness-of-®t index: 0.945 ± 1.0) for the path diagrams: Dex ? TaIGF-I ? WHR or D ? insulin ? triglycerides with additional direct input of blunted Dex on insulin values (see Figure 1). With BMI as determinant, essentially the same results were found with the addition of a direct pathway between Dex and BMI as well as between IGF-I-T and insulin (Figure 2). There was no evidence for pathways where WHR or BMI determined endocrine variables. CONCLUSIONS: The results suggest that abdominal obesity with or without endocrine abnormalities exerts a major impact on abnormalities in metabolic and hemodynamic variables. Abdominal obesity seems to be dependent on endocrine abnormalities, which in turn show direct or indirect relationships to the metabolic and circulatory variables, including a direct pathway between HPA-axis perturbations and accumulation of total body fat as ind...

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“…Salivary samples are obtained by noninvasive stress-free procedures, easier to collect, has stability at room temperature, and may be collected many times a day (36). The importance of salivary cortisol in the evaluation of the pituitary-adrenal function, specifically in CS, has been demonstrated more than two decades ago using a competitive assay (37,38). Because of the continuing need for improved noninvasive means of distinguishing pseudo-Cushing from CS, salivary cortisol is a highly suitable screening procedure for outpatient assessment.…”

Section: Late-night Salivary Cortisolmentioning

confidence: 99%

Screening and diagnosis of Cushing's syndrome

Castro

Moreira

2007

Arq Bras Endocrinol Metab

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Cushing's syndrome (CS) results from sustained pathologic hypercortisolism. The clinical features are variable and the most specific features for CS include abnormal fat distribution, particularly in the supraclavicular and temporal fossae, proximal muscle weakness, wide purple striae, and decreased linear growth with continued weight gain in a child. Clinical presentation of CS can be florid and in this case the diagnosis is usually straightforward. However, the diagnosis can be difficult particularly in states of mild or cyclical or periodical hypercortisolism. Several tests based on the understanding of the physiologic characteristics of the hypothalamic-pituitary-adrenal axis have been used extensively to confirm the diagnosis of Cushing's syndrome, but none has proven fully capable of distinguishing all cases of CS from normal and/or pseudo-Cushing individuals. Three first-line diagnostic tests are currently used to screen for CS: measurement of free cortisol in 24-hour urine (UFC), cortisol suppressibility by low doses of dexamethasone (DST), and assessment of cortisol circadian rhythm using late-night serum and/or salivary cortisol. This paper discusses the effectiveness regarding best cut-off values, the sensitivity and the specificity of these tests to screen for CS. Late-night salivary cortisol appears to be the most useful screening test. UFC and DST should be performed to provide further confirmation of the diagnosis. RESUMO Rastreamento e Diagnóstico da Síndrome de Cushing.A síndrome de Cushing (SC) resulta de um hipercortisolismo patológico mantido. As manifestações clínicas são variáveis e os achados mais específicos para a SC incluem distribuição anormal de gordura, particularmente nas fossas supraclaviculares e temporais, fraqueza muscular proximal, estrias purpúreas largas e interrupção do crescimento linear com ganho contínuo de peso na criança. A apresentação clínica da SC pode ser florida e, neste caso, o diagnósti-co é usualmente direto. Entretanto, o diagnóstico pode ser dificultado particularmente em estados de hipercortisolismo leve ou cíclico/periódico. Vários testes baseados na compreensão das características fisiológicas do eixo hipotálamo-hipófise-adrenal têm sido usados extensivamente para confirmar o diagnóstico da SC, mas nenhum deles mostrou-se totalmente capaz de distinguir todos os casos de SC dos indivíduos normais e/ou portadores de pseudo-Cushing. Três testes diagnósticos de primeira linha são atualmente empregados para rastrear SC: a medida do cortisol livre em urina de 24-horas (CLU), a supressão do cortisol por doses baixas de dexametasona (TSD) e a avaliação do ritmo circadiano do cortisol usando a dosagem do cortisol sérico ou salivar às 23-24 hs. Este artigo discute a efetividade com relação aos melhores valores de corte e a sensibilidade e especificidade destes testes no rastreamento da SC. O cortisol salivar às 23-24 hs parece ser o teste mais útil de rastreamento. O CLU e o TSD devem ser realizados na tentativa de fornecer confirmação adicional ao diagnósti...

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Salivary Cortisol Measurement: A Practical Approach to Assess Pituitary-Adrenal Function

Cited by 353 publications

References 11 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 interactions between hypothalamic-pituitary-adrenal axis activity, testosterone, insulin-like growth factor I and abdominal obesity with metabolism and blood pressure in men

Screening and diagnosis of Cushing's syndrome

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