Diagnostic performance of salivary cortisol and serum osteocalcin measurements in patients with overt and subclinical Cushing's syndrome

Diagnostic performance of osteocalcin measurements in patients with endogenous Cushing’s syndrome

“…These findings might be explained by the functional hypercortisolism reported in patients with obesity, which makes differential diagnosis from CS more challenging compared with healthy control subjects or subjects suffering inactive benign adrenal adenomas. The difference in the studied populations also explains the variation in suggested threshold values; the values were 8.3 ng ml À 1 in our study compared with 12.9 ng ml À 1 determined in the study of Sereg et al 17 The lower threshold value yielded slightly worse sensitivity but better specificity compared with that previously reported. Numerous studies evaluating bone complications in patients with CS reported low Osteocalcin is a diagnostic test for CS ZE Belaya et al bone formation markers compared with healthy control subjects.…”

“…This study cohort comprised patients whose BTMs might be assessed by various specialists before treating osteoporosis. In a previous study, Sereg et al 17 proved that serum OC is effective in differentiating overt CS among healthy subjects and inactive adrenal adenomas with an AUC of 0.922 (95% CI 0.860-0.984), which was statistically significantly better compared with morning cortisol in serum or in saliva and did not differ from LNSC or late-night serum cortisol or DST and 24hUFC. Contrary to the result of Sereg et al, 17 the diagnostic performance of OC measurement was lower compared with LNSC or DST in our study.…”

“…In a previous study, Sereg et al 17 proved that serum OC is effective in differentiating overt CS among healthy subjects and inactive adrenal adenomas with an AUC of 0.922 (95% CI 0.860-0.984), which was statistically significantly better compared with morning cortisol in serum or in saliva and did not differ from LNSC or late-night serum cortisol or DST and 24hUFC. Contrary to the result of Sereg et al, 17 the diagnostic performance of OC measurement was lower compared with LNSC or DST in our study. These findings might be explained by the functional hypercortisolism reported in patients with obesity, which makes differential diagnosis from CS more challenging compared with healthy control subjects or subjects suffering inactive benign adrenal adenomas.…”

“…Diagnostic performance of serum OC levels to differentiate patients older than 45 with osteoporosis and CS from postmenopausal osteoporosis The serum OC levels were investigated in 23 subjects older than 45 years with osteoporosis and established active CS (adrenal CS in 3 cases, ACTH-ectopic CS in 3 and Cushing's disease in 17), and in 67 women with newly diagnosed postmenopausal osteoporosis (PMO).…”

“…[14][15][16] The resulting suppression of bone formation is so profound that OC levels were tested and shown to be effective in differentiating endogenous Cushing's syndrome (CS) from healthy control subjects with an area under the curve (AUC) of 0.922, which is similar to the late-night salivary cortisol (LNSC) of 0.994 obtained from a receiver operating characteristic (ROC) analysis in the same cohort of people. 17 However, the most challenging cases involve differentiating patients with endogenous CS from obese subjects due to similar clinical features and complications such as the presence of functional hypercortisolism with relatively higher cortisol levels in obese subjects compared with healthy controls. [18][19][20] Furthermore, elderly patients with CS usually do not show typical changes in their appearance, and many of these patients remain undiagnosed, receiving treatment for hypertension, diabetes and osteoporosis.…”