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

Masserini, Benedetta; Morelli, Valentina; Bergamaschi, S.; Ermetici, Federica; Eller-Vainicher, Cristina; Barbieri, Anna Maria; Maffini, Maria Antonia; Scillitani, Alfredo; Ambrosi, Bruno; Beck‐Peccoz, Paolo; Chiodini, Iacopo

doi:10.1530/eje-08-0485

Cited by 101 publications

(76 citation statements)

References 34 publications

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“…To test the effectiveness of the different proposed cortisol cut-off after the 1-mg DST by using Bayesan analysis we had to define a priori the probability of autonomous cortisol secretion based on observed alterations in the tests used to assess the function of the HPA axis. We acknowledge that such a definition is arbitrary, but the presence of at least two alterations of the HPA axis has been widely used in previous work (14,22,23,24). Our data confirm that only a cut-point at 138 nmol/l achieves an incremental diagnostic effectiveness to detect functional adrenal autonomy.…”

Section: Discussionsupporting

confidence: 62%

Pros and cons of dexamethasone suppression test for screening of subclinical Cushing’s syndrome in patients with adrenal incidentalomas

Reimondo

Allasino

Bovio

et al. 2011

J Endocrinol Invest

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The results of dexamethasone suppression tests (DST) in the screening of subclinical hypercortisolism are not readily comparable. Aim of the present study was to review the effectiveness of the overnight 1-mg DST and 8-mg DST to look for functional autonomy of clinically inapparent adrenal adenomas.Sixty-eight consecutive patients with clinically inapparent adrenal adenomas were enrolled. All patients underwent 1-mg DST. The 8-mg DST was performed in the 11 patients who had post 1-mg DST cortisol >138 nmol/L and in 11 patients who had post 1-mg DST cortisol between 50 -138 nmol/L. The a priori probability to have autonomous cortisol secretion was defined by the presence of at least two alterations of the HPA axis among reduced ACTH concentrations, elevated UFC or elevated midnight serum cortisol. Cortisol levels > 138 nmol/L after the 1-mg DST increases the post-test probability of adrenal functional autonomy to 55%, whereas cortisol levels <50 nmol/L reduce the post-test probability to 8%. Cortisol levels recorded after the 8-mg DST were non-significantly lower than after the 1-mg DST and all the patients with cortisol >138 nmol/L after the 1 mg DST maintained cortisol above this cut-point.The 1-mg DST should be considered as the more effective test to detect autonomous cortisol secretion by a clinically inapparent adrenal adenoma when cortisol levels are >138 nmol/l, while cortisol levels < 50 nmol/L reduces remarkably the post-test probability of this event. The 8-mg DST seems to replicate by large the results of the 1-mg DST.4

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Section: Discussionsupporting

confidence: 62%

Pros and cons of dexamethasone suppression test for screening of subclinical Cushing’s syndrome in patients with adrenal incidentalomas

Reimondo

Allasino

Bovio

et al. 2011

J Endocrinol Invest

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“…In our study, LSC measurement in SCS cases reached sensitivity of 75% and specificity of 89% for 0.82 μg/dL. 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].…”

Section: Discussionsupporting

confidence: 44%

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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“…Although in our series a normal LNSC value in adrenal incidentaloma can rule out CS with certainty, we did not evaluate SH due to the selection criteria of our group, so we do not suggest using the LNSC test, rather than the 1 mg DST, as a suitable screening procedure for SH, as first reported by Masserini et al (28).…”

Section: Discussionmentioning

confidence: 74%

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

Cited by 101 publications

References 34 publications

Pros and cons of dexamethasone suppression test for screening of subclinical Cushing’s syndrome in patients with adrenal incidentalomas

Pros and cons of dexamethasone suppression test for screening of subclinical Cushing’s syndrome in patients with adrenal incidentalomas

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

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

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