Cushing’s syndrome: diagnosis and surveillance using salivary cortisol

Abstract

This short review summarizes the use of late-night salivary cortisol measurement in the diagnosis of Cushing's syndrome, in the evaluation of patients with adrenal incidentalomas, and in monitoring of post-operative patients, with a focus on the different assay methodologies currently in common use. The focus is on recent studies identified by literature searches using Ovid Medline and Google Scholar as well as analysis of several recent review articles on the topic. Measurement of late night salivary cortisol (LNSC) has an excellent sensitivity and specificity for the diagnosis of Cushing's syndrome regardless of the assay methodology used. Immunoassays have the advantage of simplicity, low cost, and small sample volume requirement, while liquid chromatography-tandem mass spectrometry has the advantage of a high specificity for cortisol and the ability to measure cortisone. The overnight dexamethasone suppression test appears to be superior to LNSC measurement in the evaluation of patients with adrenal incidentalomas. LNSC measurement is an excellent approach to monitor post-operative Cushing's disease patients for surgical failure or recurrence. Salivary cortisol is most useful as the initial test when Cushing's syndrome is suspected and for periodic patient monitoring after pituitary surgery for Cushing's disease.

The role of salivary cortisol measured by liquid chromatography–tandem mass spectrometry in the diagnosis of subclinical hypercortisolism

“…Moreover, in this group of patients, we did not evaluate the salivary cortisol by immunoassay to compare the diagnostic accuracy of the two methods in the same patients. This comparison might have been useful as some studies on overt CS reported a similar performance of LNSalC measured by LC-MS/MS than by immunoassay, which, however, has the advantage of simplicity (37). In addition, in our methods, a cotton swab was used.…”

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

“…Salivary cortisol is increasingly being used to assess hyper-or hypocortisolism (1,2). The measurement of late-night salivary cortisol (LNSC) levels in combination with the 1 mg dexamethasone suppression test (DST) and that of urinary free cortisol (UFC) levels have been proposed as the first-line laboratory tests in the diagnosis of Cushing's syndrome (CS) (3).…”

“…The measurement of late-night salivary cortisol (LNSC) levels in combination with the 1 mg dexamethasone suppression test (DST) and that of urinary free cortisol (UFC) levels have been proposed as the first-line laboratory tests in the diagnosis of Cushing's syndrome (CS) (3). The lack of a circadian rhythm is a peculiar marker of CS (4), so the LNSC test seems to be the best choice to screen for CS because of its noninvasive, stress-free, easy collection in outpatients (1). There is a marked variation between studies in the performance of the LNSC test, reflecting differences in laboratory assays, sample collection, severity of CS, and control groups (2,5,6,7,8,9,10,11,12,13,14).…”

Cushing’s disease: the clinical features, diagnostics, differential diagnostics, and methods of treatment

“…Слюна содержит свободный, стабильный при комнатной температуре до 7 дней кортизол, уровень которого не зависит от содержа-ния кортизолсвязывающего глобулина (можно ис-пользовать у женщин, получающих гормональные контрацептивы и гормональную заместительную терапию) и количества слюны, что дает преимуще-ство перед определением свободного кортизола в суточной моче, когда потеря части мочи влияет на результат [26][27][28][29]. K. Kivlighan и соавт.…”