Cutoff values of midnight salivary cortisol for the diagnosis of overt hypercortisolism are highly influenced by methods

Bekő, Gabriella; Varga, Imre; Gláz, Edit; Sereg, Márta; Feldman, Karolina; Tóth, Miklós; Rácz, Kàroly; Patócs, Attila

doi:10.1016/j.cca.2009.11.033

Cited by 46 publications

(56 citation statements)

References 25 publications

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“…The measurement of SC carried out after storage at room temperature was comparable with that performed pre-storage (PZ0.8). The cross-reactivity of the method with dexamethasone was !0.5% and therefore not significant (17,18,19,20).…”

Section: Sc Collection and Assaymentioning

confidence: 88%

“…The main limitation in the use of SC measured by RIA or other immunoassay method is cross-reactivity by other steroids, exogenous glucocorticoids, and endogenous cortisol precursor and metabolites (17,18,19,20). This is partly responsible for the variable cutoffs for MSC reported by various authors, so that each laboratory should identify their normal range in a large series of subjects.…”

Section: Discussionmentioning

confidence: 99%

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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: Sc Collection and Assaymentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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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“…Differences between presented results may be explained by different diagnostic criteria for SCS and different assay methods used. Salivary cortisol has been usually measured by RIA and ELISA [18,19,23,25,26] and much more rarely by electrochemiluminescent immunoassay (ECLIA) or liquid chromatography tandem mass spectrometry (LC-MS/ /MS) [23,27,28]. The study by Beko et al revealed better performance of LSC using ECLIA (sensitivity 100% and specificity 88%) compared to RIA (sensitivity 100% and specificity 71%) [23].…”

Section: Discussionmentioning

confidence: 99%

“…Salivary cortisol has been usually measured by RIA and ELISA [18,19,23,25,26] and much more rarely by electrochemiluminescent immunoassay (ECLIA) or liquid chromatography tandem mass spectrometry (LC-MS/ /MS) [23,27,28]. The study by Beko et al revealed better performance of LSC using ECLIA (sensitivity 100% and specificity 88%) compared to RIA (sensitivity 100% and specificity 71%) [23]. Another study demonstrated an important rate of abnormal LSC results in volunteers without evidence of Cushing's syndrome when measured using two different commercial assays and evaluated with laboratory provided normative ranges [24].…”

Section: Discussionmentioning

confidence: 99%

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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“…Respective reports have mainly focused on the lowest concentration range of late night samples, which is relevant to exclude Cushing's disease [4,5] and less on the entire range of physiological salivary cortisol concentrations as a relevant parameter for stress research [6,7]; methods of higher metrological level were applied inconsistently. Consequently, there is uncertainty as to the commutability of research results related to absolute salivary cortisol concentrations in stress research.…”

mentioning

confidence: 99%

Inter-method comparison of salivary cortisol measurement

Baecher

Azad

Vogeser³

2013

LaboratoriumsMedizin

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Background: Salivary cortisol is increasingly used in the diagnostic work-up of suspected Cushing's disease as well as in stress research. In this study, the agreement of different methods for salivary cortisol measurement was assessed. Methods: Saliva samples from five healthy volunteers were distributed to three routine clinical chemistry laboratories. As a reference, all samples were also analyzed using liquid chromatography-tandem mass spectrometry involving stable isotope labeled cortisol for internal standardization in our laboratory. Results: All immunometric routine methods substantially overestimated salivary cortisol concentrations by approximately 50%. The agreement between these immunoassays was moderate with between-method coefficients of variation of up to 36% for individual samples. Conclusions: Standardization of salivary cortisol measurement requires substantial improvement, in particular by implementation of proficiency testing schemes, a defined reference method, and reference materials. Interpretation of salivary cortisol data in psycho-neuroendocrinological research has to consider the inappropriate level of standardization realized for salivary cortisol measurement to date.

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Cutoff values of midnight salivary cortisol for the diagnosis of overt hypercortisolism are highly influenced by methods

Cited by 46 publications

References 25 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

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

Inter-method comparison of salivary cortisol measurement

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