Midnight Salivary Cortisol Determination for Assessing the Outcome of Transsphenoidal Surgery in Cushing’s Disease

Carrasco, Claudia; Coste, Joël; Guignat, Laurence; Groussin, Lionel; Dugué, Marie Annick; Gaillard, Stéphane; Bertagna, Xavier; Bertherat, Jérôme

doi:10.1210/jc.2008-1171

Cited by 72 publications

(69 citation statements)

References 32 publications

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“…There are data about the efficacy in relapse prediction of stimulatory tests (22,25,26) and fewer about salivary cortisol (27). We demonstrated higher LNSC levels in active CD patients than in those with CD in remission and also in those with non-CS than in those with CD in remission, confirming the data published by Carrasco et al (27) and suggesting salivary cortisol as a simple and reliable tool to follow up patients with CD in remission. In clinical practice, some features of hypercorticism (e.g.…”

Section: Discussionsupporting

confidence: 87%

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

Ceccato

Barbot

Zilio

et al. 2013

European Journal of Endocrinology

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Objective: Salivary cortisol has recently been suggested for studies on the hypothalamic-pituitaryadrenal (HPA) axis. The lack of circadian rhythm is a marker of Cushing's syndrome (CS), and some authors have reported that low salivary cortisol levels may be a marker of adrenal insufficiency. The aim of our study was to define the role of salivary cortisol in specific diagnostic settings of HPA axis disease. Subjects and methods: We analyzed morning salivary cortisol (MSC) and late-night salivary cortisol (LNSC) levels in 406 subjects: 52 patients with Cushing's disease (CD), 13 with ectopic CS, 17 with adrenal CS, 27 with CD in remission (a mean follow-up of 66G39 months), 45 with adrenal incidentaloma, 73 assessed as having CS and then ruled out for endogenous hypercortisolism, 75 with adrenal insufficiency, and 104 healthy subjects. Results: A LNSC value above 5.24 ng/ml differentiated CS patients from controls with high sensitivity (96.3%) and specificity (97.1%); we found higher LNSC levels in ectopic CS patients than in CD patients. We found no difference in MSC and LNSC levels between patients with CD in remission and healthy subjects. Both MSC and LNSC levels were higher in patients with adrenal incidentaloma than in healthy controls. A MSC value below 2.65 ng/ml distinguished patients with adrenal insufficiency from controls with high sensitivity (97.1%) and specificity (93.3%). Conclusions: Salivary cortisol is a useful tool to assess endogenous cortisol excess or adrenal insufficiency and to evaluate stable CD in remission.

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Section: Discussionsupporting

confidence: 87%

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

Ceccato

Barbot

Zilio

et al. 2013

European Journal of Endocrinology

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“…Undetectable early morning serum cortisol (!18 ng/ml, 50 nmol/l) is as a good index of long-term remission (10,16,17,20,(29)(30)(31)(32)42). Yet, it is not a full protector (10-12, 16, 20, 21, 29, 33, 42, 45).…”

Section: Discussionmentioning

confidence: 99%

“…Hypocortisolism was defined by morning serum cortisol !50 ng/ml and/or subnormal response to corticotropin analog or to the overnight metyrapone test. Eucortisolism was defined by the absence of hypocortisolism along with the combination of normal UC (!90 mg/24 h) and a maintained nycthemeral cortisol cycle (midnight serum cortisol !75 ng/ml, midnight salivary cortisol !2 ng/ml) (42). Early remission should be maintained for at least 3 months post-TSS, otherwise it would be considered as immediate surgical failure.…”

Section: Immediate Tss Outcomementioning

confidence: 99%

“…Saliva was collected through Plain Salivette kit (Sarstedt, Newton, NC, USA) by placing a cotton wool plug in the mouth for 1-3 min (42,43). LVP was injected at a dose of 10 U i.m., and desmopressin was injected at a dose of 10 mg i.v.…”

Section: Testing Proceduresmentioning

confidence: 99%

“…Salivary cortisol was assayed with CORT-CT2 RIA (Cis Bio International), as described previously (42).…”

Section: Hormone Assaysmentioning

confidence: 99%

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Sequential hormonal changes in 21 patients with recurrent Cushing's disease after successful pituitary surgery

Khalil

Baudry

Guignat

et al. 2011

European Journal of Endocrinology

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Objective: To describe the sequence of hormonal changes during recurrence of Cushing's disease (CD) after successful transsphenoidal surgery (TSS). Design: Retrospective study in a single center. Patients and methods: We studied 101 of the 127 patients treated by TSS for CD between 1996 and 2009, who had hypocortisolism or eucortisolism for at least 3 months post-TSS. We arbitrarily defined 'overt recurrence', as presence of two classical parameters of excess cortisol (increased midnight -either serum or salivary -and 24 h urinary cortisol (UC)), leading to further specific therapeutic action, and 'mild recurrence', as presence of a single classical parameter, leading to simple surveillance. Results: Of the 101 patients, 21 (20.8%) presented with recurrence, 'mild' or 'overt', during long-term follow-up (median 50.4 months, range 7-99). Recurrence occurred less frequently (16.8 vs 50%, PZ0.02), and later (mean 44.7 months, median 43, range 7-94 vs mean 21.5 months, median 17, range 3-61, PZ0.05), in patients with early post-TSS hypocortisolism compared with those with eucortisolism. Increase in midnight cortisol occurred in a mean time of 38.2 months, while UC elevation was observed at 50.6 months. Vasopressin analogs and CRH tests were eventually positive in 85 and 93% of all patients respectively; a positive response to one of the two dynamic tests preceded the increase in midnight cortisol or UC in 71 and 64% of the patients respectively. Conclusion: A positive response to vasopressin analogs and/or CRH tests occurs early in recurrence, followed by an increase in midnight cortisol, while UC elevation is at a later stage.

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Surgical Treatment of Cushing’s Disease

Tierney

Swearingen

2011

Cushing's Disease

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Midnight Salivary Cortisol Determination for Assessing the Outcome of Transsphenoidal Surgery in Cushing’s Disease

Abstract: MSC is a simple, robust marker of remission after TSS for CD.

Cited by 72 publications

References 32 publications

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

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

Sequential hormonal changes in 21 patients with recurrent Cushing's disease after successful pituitary surgery

Surgical Treatment of Cushing’s Disease

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