Overnight dexamethasone suppression test: comparison of plasma and salivary cortisol measurement for the screening of Cushing's syndrome

Barrou, Zina; Guiban, D.; Maroufi, Amel; Fournier, C; Dugué, Marie-Annick; Luton, J. P.; Thomopoulos, P

doi:10.1530/eje.0.1340093

Cited by 37 publications

(38 citation statements)

References 13 publications

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“…A sensitivity varying between 97% and 100% and a specificity between 77% and 100% have been variously reported, with cut-off level varying between 1.7 nmol/L and 2 nmol/L. [6][7][8][9] In the current study, we found that the sensitivity of SalF Dex was only 76.2% at the optimal cut-off of 0.85 nmol/L. Although this discrepancy with other studies might be due to a number of factors, such as the means of defining normal ranges and the criteria for diagnosing Cushing's syndrome, one important factor that is evident from our data is the method used for assaying salivary cortisol: some used electrochemiluminescence assay, 9 others used radioimmunoassay [6][7][8] ; but we measured SalF Dex with LC-MS/MS.…”

Section: Discussionmentioning

confidence: 98%

“…5 Significant advances have been made with the use of salivary cortisol in the investigation of hypercortisolism. 3,[6][7][8][9] The availability of liquid chromatography-tandem mass spectrometry (LC-MS/MS) also enables the measurement of other glucocorticoid analytes. Among these and of particular interest is cortisone that is present in the saliva at a higher concentration-the salivary cortisone-to-cortisol ratio is up to 6-8:1…”

Section: Discussionmentioning

confidence: 99%

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Clinical utility of late-night and post-overnight dexamethasone suppression salivary cortisone for the investigation of Cushing’s syndrome

Lam

Yeung

et al. 2017

Hong Kong Med J

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Introduction: There is a pressing need to identify diagnostic testing for Cushing's syndrome that can be achieved with ease and at low cost. This study aimed to explore the usefulness of late-night and postovernight 1-mg dexamethasone suppression salivary cortisone, as measured by liquid chromatographytandem mass spectrometry, for investigation of hypercortisolism.Methods: Salivary cortisone data of subjects were investigated according to a pre-specified protocol. Subjects were classified as having 'hypercortisolism' or 'eucortisolism' on the basis of histological or biochemical criteria. Receiver operating characteristic curves were drawn to identify the cut-off values and study their performance characteristics. We measured 24-hour urinary free cortisol; late-night salivary cortisol and cortisone; and post-overnight 1-mg dexamethasone suppression serum cortisol, and salivary cortisol and cortisone. Saliva and urine samples were assayed by liquid chromatography-tandem mass spectrometry. Results:In this study, 21 subjects were classified as having hypercortisolism and 78 as having eucortisolism. A late-night salivary cortisone cut-off of 13.50 nmol/L had a sensitivity of 94.7% and a specificity of 87.2%. After taking 1-mg dexamethasone the night before, a salivary cortisol cut-off of 0.85 nmol/L had a sensitivity of 76.2% and a specificity of 96.2%; a salivary cortisone cut-off of 7.45 nmol/L had a

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Clinical utility of late-night and post-overnight dexamethasone suppression salivary cortisone for the investigation of Cushing’s syndrome

Lam

Yeung

et al. 2017

Hong Kong Med J

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“…Up to now, only a few groups investigated the validity of this method, providing cutoffs between 1.5 and 3.7 nmol/l (10,13,14,15,16). Although the Dexamethasone-suppressed salivary cortisol at 0800 h (nmol/l) Figure 1 (A) Individual peak serum cortisol levels during the insulin tolerance test and corresponding basal salivary cortisol levels at 0800 h. The two study groups are patients with adrenal insufficiency (open circles, nZ30) and patients with adrenal sufficiency (closed circles, nZ32).…”

Section: Discussionmentioning

confidence: 99%

Salivary cortisol as a diagnostic tool for Cushing's syndrome and adrenal insufficiency: improved screening by an automatic immunoassay

Deutschbein

Broecker-Preuß

Flitsch

et al. 2012

European Journal of Endocrinology

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Background: Salivary cortisol is increasingly used to assess patients with suspected hypo-and hypercortisolism. This study established disease-specific reference ranges for an automated electrochemiluminescence immunoassay (ECLIA). Methods: Unstimulated saliva from 62 patients with hypothalamic-pituitary disease was collected at 0800 h. A peak serum cortisol level below 500 nmol/l during the insulin tolerance test (ITT) was used to identify hypocortisolism. Receiver-operating characteristic (ROC) analysis allowed establishment of lower and upper cutoffs with at least 95% specificity for adrenal insufficiency and adrenal sufficiency. Saliva from 40 patients with confirmed hypercortisolism, 45 patients with various adrenal masses, and 115 healthy subjects was sampled at 2300 h and after low-dose dexamethasone suppression at 0800 h. ROC analysis was used to calculate thresholds with at least 95% sensitivity for hypercortisolism. Salivary cortisol was measured with an automated ECLIA. Results: When screening for secondary adrenal insufficiency, a lower cutoff of 3.2 nmol/l and an upper cutoff of 13.2 nmol/l for unstimulated salivary cortisol allowed a highly specific diagnosis (i.e. similar to the ITT result) in 26% of patients. For identification of hypercortisolism, cutoffs of 6.1 nmol/l (sensitivity 95%, specificity 91%, area under the curve (AUC) 0.97) and 2.0 nmol/l (sensitivity 97%, specificity 86%, AUC 0.97) were established for salivary cortisol at 2300 h and for dexamethasonesuppressed salivary cortisol at 0800 h. Conclusions: The newly established thresholds facilitated initial screening for secondary adrenal insufficiency and allowed excellent identification of hypercortisolism. Measurement by an automated immunoassay will allow broader use of salivary cortisol as a diagnostic tool.

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“…Plasma 17-hydroxyprogesterone (17OHP) and the 24-h urinary excretions of metanephrines were also assessed. Plasma cortisol was assessed by a competitive protein-binding assay (5,6). The other plasma steroids and urinary cortisol were assessed by speci®c radioimmunoassays in routine use at the time.…”

Section: Endocrinological Studiesmentioning

confidence: 99%

Outcome in patients with adrenal incidentaloma selected for surgery: an analysis of 88 cases investigated in a single clinical center

Luton¹,

Martinez²,

Coste

et al. 2000

European Journal of Endocrinology

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Objective: The study was designed to evaluate the clinical, endocrinological and radiological parameters used to investigate adrenal incidentalomas and select patients for surgery. Design and Methods: An analysis of 88 consecutive patients with adrenal incidentaloma selected for surgery and investigated in a single clinical center was performed. Results: Mean (6 S.D.) age of the patients was 53614 years. Fourteen (16%) of the adrenal incidentalomas were malignant tumors (2 adrenocortical carcinomas, 3 metastases, 4 adenocarcinomas, 4 sarcomas and 1 mesenchymoma), 10 (11%) were pheochromocytomas, 32 (36%) were non-secretory benign adrenal adenomas and the remaining were benign adrenal (n 8; 9%) or extraadrenal (n 24; 27%) masses. Endocrinological investigations revealed 1 Conn adenoma, 4 tumors responsible for Cushing's syndrome or silent hypercortisolism and 1 androgen secreting tumor. Abnormalities of endocrine evaluations were observed in the 2 malignant adrenocortical carcinomas. Elevated 24-h urinary metanephrine levels were observed in the 9 pheochromocytomas tested. Complications of surgery occurred in 14% of the cases. Regardless of the endocrine status, parameters associated with malignant tumors were: older age (mean age of patients harboring malignant tumors vs patients with benign incidentalomas: 62 6 17 years vs 52 6 13 years, P 0.005), weight loss (39% vs 7%, P 0.005), and mass diameter greater than 60 mm (69% vs 15%, P < 0.001). By multiple logistic regression analysis malignant tumors were associated with increased age, diameter greater than 60 mm and bilateral masses. Conclusion: This study points to a high rate of pheochromocytomas and malignant tumors in patients selected for surgery. This high rate differs from some previous reports and might be explained by the criteria used to select patients for surgery. Among these two groups of tumors, careful systematic endocrinological investigations allow the detection of altered secretion in the vast majority ± if not all ± malignant tumors of adrenal origin and pheochromocytomas. Only 5% of the incidentalomas below 30 mm selected for surgery in this study were malignant, in keeping with the use of this criteria as an important parameter to select patients with normal hormonal investigations for careful follow-up.

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Overnight dexamethasone suppression test: comparison of plasma and salivary cortisol measurement for the screening of Cushing's syndrome

Cited by 37 publications

References 13 publications

Clinical utility of late-night and post-overnight dexamethasone suppression salivary cortisone for the investigation of Cushing’s syndrome

Clinical utility of late-night and post-overnight dexamethasone suppression salivary cortisone for the investigation of Cushing’s syndrome

Salivary cortisol as a diagnostic tool for Cushing's syndrome and adrenal insufficiency: improved screening by an automatic immunoassay

Outcome in patients with adrenal incidentaloma selected for surgery: an analysis of 88 cases investigated in a single clinical center

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