A dose–response study of salivary cortisol after dexamethasone suppression test in Cushing's disease and its potential use in the differential diagnosis of Cushing's syndrome

Castro, Margaret de; Elias, Lucila Leico Kagohara; Elias, Paula Condé Lamparelli; Moreira, Ayrton Custódio

doi:10.1046/j.1365-2265.2003.01908.x

Cited by 35 publications

(27 citation statements)

References 23 publications

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“…In our series, a cutoff of 2.77 ng/ml for MSC obtained a sensitivity of 100% to identify patients with CD untr and a specificity of 97.7% in the controls, the results being similar to those described in the literature (5,7,20,21,22,23,24,25,26,27,28,29,30,31). More limited data are available regarding the determination of SC after the DST and not always as reliable as MSC (22,28,31,32,33). In our series of CD untr patients, SC LDDST obtained an excellent performance: using the threshold of 1.22 ng/ml, we obtained a sensitivity of 96% with a specificity of 97.7% in the controls.…”

Section: Discussionsupporting

confidence: 76%

Usefulness of salivary cortisol in the diagnosis of hypercortisolism: comparison with serum and urinary cortisol

Manetti¹,

Rossi²,

Grasso³

et al. 2013

European Journal of Endocrinology

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Objective: Several tests have been proposed to diagnose patients with Cushing's syndrome (CS). The aims of the study were: i) to evaluate the performance of salivary cortisol (SC) in hypercortisolism and ii) to compare SC with serum cortisol (SeC) and urinary cortisol. Design and patients: This was a diagnostic study. Twenty-seven patients with untreated Cushing's disease (CD untr), 21 women consuming oral contraceptive pill (OCP), 18 pregnant women, and 89 healthy subjects (controls) were enrolled. Methods: SC and SeC at baseline and after the low-dose dexamethasone suppression test (LDDST) and urinary free cortisol (UFC) were measured. Results: Midnight SC had a sensitivity of 100% in the CD untr group and a specificity of 97.7% in the controls. Specificity remained high (95.2%) in women taking OCP, while in pregnant women, it decreased to 83.3%. SC after the LDDST showed a sensitivity of 96.3% in the CD untr group; specificity was 97.7% in the controls and 90.5% in OCP women. Midnight SeC had a sensitivity of 100% in the CD untr group. SeC after the LDDST had a sensitivity of 100% in the CD untr group while specificity was 97.7% in the controls and 61.9% in women taking OCP. For UFC, sensitivity was 92.6% in the CD untr group while specificity was 97.7% in the controls and 100% in the OCP group. Conclusions: SC is a reliable parameter for the diagnosis of severe hypercortisolism, with high sensitivity and specificity. In women during pregnancy or taking OCP, the measurement of SC, identifying the free fraction, could be helpful to exclude CS.

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Section: Discussionsupporting

confidence: 76%

Usefulness of salivary cortisol in the diagnosis of hypercortisolism: comparison with serum and urinary cortisol

Manetti¹,

Rossi²,

Grasso³

et al. 2013

European Journal of Endocrinology

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“…The usefulness of the combination of midnight and after LDDST SC has been confirmed by other studies. 8,16,21 On the basis of our data, cut-off values of 1.7 nmol/L for SC after LDDST, above which lack of suppression can be assessed, evaluated by the ROC curve considering CS and non-CS patients, showed high sensitivity (100%) and specificity (72.7%). As suggested by the endocrine society clinical practice guidelines, 3 SC represents a useful first-line screening test in CS diagnosis, but it is important that each laboratory deduces its cut-off value in relation to the assay used and evaluates the clinical accuracy of its own method.…”

Section: Discussionmentioning

confidence: 99%

“…16 On the basis of these correlations, SC can be considered a useful first-line test for CS screening, showing several practical advantages compared with PC. Indeed, saliva collection is a stress-free procedure that does not cause ............................................................................................................................................. venipuncture-induced cortisol elevation and could also be obtained from patients in whom blood samples are hard to obtain.…”

Section: Discussionmentioning

confidence: 99%

Clinical accuracy of midnight salivary cortisol measured by automated electrochemiluminescence immunoassay method in Cushing's syndrome

Carrozza¹,

Corsello

Paragliola

et al. 2010

Ann Clin Biochem

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Background: The diagnosis of Cushing's syndrome (CS) represents a challenge for endocrinologists. Several screening tests are used, but none of them seems to be the gold standard for the diagnosis. The aim of this study was to confirm the diagnostic value of salivary cortisol (SC) as a first-level screening test and to evaluate the clinical performance of a electrochemiluminescence immunoassay (ECLIA) method. Methods: In 33 patients with a strong clinical suspicion of CS, we evaluated urinary free cortisol, circadian rhythm plasma cortisol (PC) and morning PC after low-dose dexamethasone suppression test (LDDST). At the same sampling times, we evaluated SC analysed by the same automated method. Correlation studies were evaluated by Spearman index (significance P , 0.05). Results: On the basis of biochemical results CS was confirmed in 21/33. SC was significantly correlated to PC at 12:00 and 23:00. Thus, we chose 8.3 nmol/L as midnight SC cut-off value with 100% sensitivity and 97.4% specificity. The cut-off chosen after LDDST was 1.7 nmol/L (100% sensitivity and 72% specificity). Conclusion: SC assay showed a good clinical accuracy and the ECLIA method can be used in clinical routine to obtain fast results easily.

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“…Under standardized conditions, a remarkable reproducibility was observed for night-time cortisol during overnight dexamethasone suppression (62 ). Consequently, these short-term interval (15 min or less) sample-collection protocols can provide useful information for the individual differential diagnosis of Cushing disease (63 ).…”

Section: Salivary Cortisol As a Proven Parameter In The Diagnosis Of mentioning

confidence: 99%

Current Status of Salivary Hormone Analysis

2008

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BACKGROUND: Saliva, which offers a noninvasive and stress-free alternative to plasma and serum, is a widely accepted sample source for analysis of steroids and also of certain amines and peptides. In recent years, numerous publications have described the use of salivary hormone analysis in many fields of clinical and basic research.CONTENT: This review provides an overview of the current applications of salivary hormone analysis. A description of the different modes of hormone entry into saliva is followed by a detailed description of analytical methods and approaches for reliable collection of saliva, including several interesting applications in diverse fields including psychiatry, stress research, clinical endocrinology, sports medicine, and veterinary medicine.

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A dose–response study of salivary cortisol after dexamethasone suppression test in Cushing's disease and its potential use in the differential diagnosis of Cushing's syndrome

Cited by 35 publications

References 23 publications

Usefulness of salivary cortisol in the diagnosis of hypercortisolism: comparison with serum and urinary cortisol

Usefulness of salivary cortisol in the diagnosis of hypercortisolism: comparison with serum and urinary cortisol

Clinical accuracy of midnight salivary cortisol measured by automated electrochemiluminescence immunoassay method in Cushing's syndrome

Current Status of Salivary Hormone Analysis

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