Long-distance and long-term follow-up of a patient with intermittent Cushing's disease by salivary cortisol measurements

Abstract

Salivary cortisol is an excellent indicator of the plasma free cortisol concentration in normal and pathological situations. We took advantage of its ease of sampling, allowing multiple collections at home, to follow the course of a patient with Cushing's disease living in North Africa. This 48-year-old woman presented with a clinically moderate hypercortisolism caused by a large basophilic pituitary adenoma. Bilateral extension to the cavernous sinuses precluded surgical therapy. She went into spontaneous remission based on clinical signs as well as biochemical findings. During the following 2 years she demonstrated intermittent relapses that were treated by radiotherapy (50 Gy), followed by ketoconazole and then o-paraprime-dichloro-diphenyl-dichloroethane (Op'DDD). After a prolonged clinical remission, Cushing's syndrome again became active. Bromocriptine was started without effect and a new treatment with Op'DDD was began. Evaluation and follow-up were performed during hospitalizations and mainly through the measurements of salivary cortisol in more than 100 samples sent from North Africa by air mail to our department in Paris. Thus we were able to demonstrate intermittent overproduction of cortisol before any treatment, with periods of normal and even low values, and to follow the efficacy of therapy and to detect the relapses. We conclude that measurement of salivary cortisol is a valuable tool in difficult clinical situations such as intermittent hypercortisolism and remoteness between the patient and hospital.

Differentiating between Cushing's disease and pseudo-Cushing's syndrome: comparison of four tests

“…However, an advantage of LNSC measurement is the fact that it is a simple and non-invasive method in the evaluation of patients with suspected hypercortisolism, and it is therefore increasingly used as first-line screening test. Salivary samples can be obtained in ambulatory patients and can be stored at room temperature for several days (35,36,37). A potential concern when saliva sampling is performed at home is contamination with topical or inhaled steroids or collection of insufficient volumes of saliva.…”

Midnight salivary cortisol, measured by highly sensitive electrochemiluminescence immunoassay, for the diagnosis of Cushing’s syndrome

“…It can be easily performed in ambulatory conditions. Samples can be stored at room temperature [19] and sent by regular mail [20,21]. Despite its advantages, salivary cortisol measurement has its limitations: in cases of dehydratation, Sjögren's syndrome, gingivitis, etc.…”

Late-night Salivary Cortisol as A Screening Test for the Diagnosis of Cushing's Syndrome in Japan

“…This test is very easy for patients to perform and can be done at home on multiple occasions. It should be noted that salivary cortisol samples thus collected are very stable even at room temperature for at least 1 week and can be transported to the laboratory by mail or express carrier without any loss of cortisol activity [14,15]. Furthermore, the actual measurement of cortisol in the saliva can be easily performed with only a minor modification of widely available RIA [16].…”