Late-night Salivary Cortisol Has a Better Performance Than Urinary Free Cortisol in the Diagnosis of Cushing's Syndrome

Elias, Paula Condé Lamparelli; Martinez, Edson Zangiacomi; Barone, Bruno F. C.; Mermejo, Lívia Mara; Castro, Margaret de; Moreira, Ayrton Custódio

doi:10.1210/jc.2013-4262

Cited by 79 publications

(59 citation statements)

References 35 publications

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“…Unfortunately, concordance with LNSC has not been performed. However, previous studies have reported a significant correlation between UFC and LNSC [39][40][41], showing even a better performance of LNSC compared to UFC in the diagnosis of Cushing's syndrome.…”

Section: Discussionmentioning

confidence: 83%

The degree of urinary hypercortisolism is not correlated with the severity of cushing’s syndrome

et al. 2016

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Cushing syndrome (CS) is characterized by increased morbidity and mortality compared to the general population. However, there are patients who have more clinical aggressive forms than others. Aim of the study is to evaluate whether the degree of hypercortisolism, defined by the number of times urinary free cortisol (UFC) levels exceed the upper limit of the normal range (ULN), is related to the worsening of phenotypic features, as well as metabolic and cardiovascular parameters, in a cohort of CS patients. A cross-sectional study was conducted on 192 patients with active CS, consecutively presenting at the outpatients' clinic of the University Hospitals of Ancona, Naples, and Palermo. Patients were grouped into mild (UFC not exceeding twice the ULN), moderate (2-5 times the ULN), and severe (more than 5 times the ULN) hypercortisolism. Thirty-seven patients (19.3 %) had mild, 115 (59.8 %) moderate, and 40 (20.9 %) severe hypercortisolism. A significant trend of increase among the three groups was demonstrated for 8-, 16-, and 24-h serum cortisol levels (p \ 0.001) and serum cortisol after low dose of dexamethasone suppression test (p = 0.001). No significant trend of increase was found regarding phenotype and comorbidities. The degree of hypercortisolism by itself does not appear to be a sufficient parameter to express the severity of CS. Therefore, estimating the severity of CS according to biochemical parameters remains a challenge, while the clinical phenotype and the associated comorbidities might be more useful to assessing the severity of the CS.

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Section: Discussionmentioning

confidence: 83%

The degree of urinary hypercortisolism is not correlated with the severity of cushing’s syndrome

et al. 2016

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“…86,87 In addition, the levels of dehydroepiandrosterone are measured in the diagnosis of hirsutism, adrenal tumors, and adrenal genital syndrome, 88,89 progesterone in diagnosis of menstruation disorders or infertility, 90 estriol in diagnosis of fetal maturation, 91 or cortisol in diagnosis of Cushing's syndrome. [92][93][94] Saliva is also used for determining of levels of estradiol and testosterone in the diagnosis of hirsutism, menstrual disorders, adrenal and testicular tumors, steroidogenesis disorders, and for control of antiandrogenic therapy outcomes. 95 Taking into consideration that testosterone in saliva is free and unbound with proteins (sex-hormone-binding globulins [SHBGs]), the superiority of its determination is unquestionable compared to other biofluids.…”

Section: 65mentioning

confidence: 99%

Saliva diagnostics – Current views and directions

Kaczor‐Urbanowicz

Carreras‐Presas

Aro

et al. 2016

Exp Biol Med (Maywood)

315

244

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The purpose of this mini-review is to make an update about the present and future applications of saliva as a diagnostic biofluid in many fields of science such as dentistry, medicine and pharmacotherapy. Using saliva as a fluid for diagnostic purposes would be a huge breakthrough for both patients and healthcare providers since saliva collection is easy, non-invasive and inexpensive. We will go through the current main diagnostic applications of saliva, and provide a highlight on the emerging, newly developing technologies and tools for cancer screening, detection and monitoring. AbstractIn this review, we provide an update on the current and future applications of saliva for diagnostic purposes. There are many advantages of using saliva as a biofluid. Its collection is fast, easy, inexpensive, and non-invasive. In addition, saliva, as a ''mirror of the body,'' can reflect the physiological and pathological state of the body. Therefore, it serves as a diagnostic and monitoring tool in many fields of science such as medicine, dentistry, and pharmacotherapy. Introduced in 2008, the term ''Salivaomics'' aimed to highlight the rapid development of knowledge about various ''omics'' constituents of saliva, including: proteome, transcriptome, micro-RNA, metabolome, and microbiome. In the last few years, researchers have developed new technologies and validated a wide range of salivary biomarkers that will soon make the use of saliva a clinical reality. However, a great need still exists for convenient and accurate point-of-care devices that can serve as a non-invasive diagnostic tool. In addition, there is an urgent need to decipher the scientific rationale and mechanisms that convey systemic diseases to saliva. Another promising technology called liquid biopsy enables detection of circulating tumor cells (CTCs) and fragments of tumor DNA in saliva, thus enabling non-invasive early detection of various cancers. The newly developed technology-electric field-induced release and measurement (EFIRM) provides near perfect detection of actionable mutations in lung cancer patients. These recent advances widened the salivary diagnostic approach from the oral cavity to the whole physiological system, and thus point towards a promising future of salivary diagnostics for personalized individual medicine applications including clinical decisions and post-treatment outcome predictions.

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“…Twenty-four-hour UFC excretion is not affected by changes in cortisol-binding globulin, which was reported to be a potential disadvantage in the measurement of serum cortisol [6]. The Endocrine Society recommended 24-hour UFC as an initial investigation for CS [10]; however, more recent studies have shown that its value in adults with suspected CS is limited because of high variability, particularly in cases of subclinical or cyclical Cushing's disease (CD) [22,23]. …”

Section: Introductionmentioning

confidence: 99%

Investigation for Paediatric Cushing's Syndrome Using Twenty-Four-Hour Urinary Free Cortisol Determination

Shapiro

Elahi²,

Riddoch³

et al. 2016

Horm Res Paediatr

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Objective: Paediatric Cushing's syndrome (CS) remains a challenge to diagnose and exclude. We assessed the accuracy of 24-hour urinary free cortisol (UFC) determination in children referred for suspected CS. Design: We conducted a retrospective study of paediatric patients referred to our centre with suspected CS between 1982 and 2014. Patients: Of 66 subjects (mean age 12.9 years; range 4.4-16.9), there were 47 cases of CS (29 males), which included Cushing's disease (CD; 39 patients, 25 males), primary pigmented nodular adrenocortical disease (8 patients, 4 males) and 19 ‘controls' (6 males) in whom the diagnosis of CS was excluded. Measurements: The subjects had between one and five 24-hour UFC collections analysed by radioimmunoassay, chemiluminescent immunoassay or liquid chromatography-mass spectrometry. The data were normalised, corrected for body surface area (m²) and assessed using receiver operating characteristic analysis and an independent two-tailed t test. Results: The diagnostic accuracy of 24-hour UFC for CS was excellent (area under the curve 0.98, 95% CI 0.946-1.00, sensitivity 89%, specificity 100%). Conclusions: Twenty-four-hour UFC is a reliable and practical investigation with high diagnostic accuracy for paediatric CS. However, further investigations may be required if the UFC is normal but there is a high diagnostic suspicion of CS.

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Late-night Salivary Cortisol Has a Better Performance Than Urinary Free Cortisol in the Diagnosis of Cushing's Syndrome

Abstract: Our data show that despite similar variability between both methods, LNSF has a superior diagnostic performance than UFC and should be used as the primary biochemical diagnostic test for CS diagnosis.

Cited by 79 publications

References 35 publications

The degree of urinary hypercortisolism is not correlated with the severity of cushing’s syndrome

The degree of urinary hypercortisolism is not correlated with the severity of cushing’s syndrome

Saliva diagnostics – Current views and directions

Investigation for Paediatric Cushing's Syndrome Using Twenty-Four-Hour Urinary Free Cortisol Determination

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