Overnight urinary free cortisol determination: A screening test for the diagnosis of Cushing's syndrome

Corcuff, Jean-Benoı̂t; Tabarin, Antoine; Rashedi, M; Duclos, Martine; Roger, Patrick; Ducassou, D.

doi:10.1046/j.1365-2265.1998.00401.x

Cited by 40 publications

(21 citation statements)

References 12 publications

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“…Cortisol measured in 24 h-urine samples is a better approximation as only free cortisol is excreted by urine [5]. However, urine measurements may be inaccurate due to inadequate collection [6].…”

Section: Introductionmentioning

confidence: 99%

Advantage of salivary cortisol measurements in the diagnosis of glucocorticoid related disorders

Restituto¹,

Galofré²,

Gil³

et al. 2008

Clinical Biochemistry

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Section: Introductionmentioning

confidence: 99%

Advantage of salivary cortisol measurements in the diagnosis of glucocorticoid related disorders

Restituto¹,

Galofré²,

Gil³

et al. 2008

Clinical Biochemistry

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“…These include the 24-hour urinary free cortisol level, timed overnight cortisol/Creatinine ratio [15], the 1mg oral overnight dexamethasone suppression test and the single midnight serum cortisol level [13], all of which have sensitivities and specifici- ties ranging between 95-100% and 94-98%, respectively. Newer first-line tests include the combined oral low dose Dexamethasone suppression test with IV Corticotropin Releasing Hormone (CRH) and IV Desmopressin stimulation test which help to differentiate between Pseudo-CS and CS [12,16,17].…”

Section: Discussionmentioning

confidence: 99%

Dexamethasone Infusion Testing in the Diagnosis of Cushing's Syndrome

Tran

Petrovsky

2005

Endocr J

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Abstract. Cushing's syndrome and its various aetiologies is a markedly difficult diagnosis to make given its subtle signs, sometime cyclical nature, and the lack of a single definitive diagnostic test. Although a great variety of diagnostic tests have been developed to assist in the diagnosis, even with the best clinical acumen, biochemistry and medical imaging the diagnosis can remain elusive. The long low and high dose oral dexamethasone suppression test is cumbersome, costly and often requiring an extended inpatient stay. The utility of the dexamethasone suppression test would be greatly enhanced if it could be performed as a short outpatient procedure. In this study we sought to confirm and refine the clinical utility of the high dose 4 mg intravenous dexamethasone suppression test as an alternative diagnostic test for Cushing's syndrome. There were a total of 31 subjects: 8 patients with proven pituitary Cushing's disease, 3 with primary adrenal tumors, 10 with pseudo-Cushing's syndrome and 10 healthy controls. All subjects with pseudo-Cushing's syndrome suppress serum cortisol at +5 and at +24 hours. In subjects with pituitary Cushing's disease, 7 out of 8 (88%) had serum cortisol suppressed at +5 hours but rebounded at +24 hours to at least 70% of the original serum level. Primary adrenal tumors showed a pattern of non-suppression throughout. The 4 mg intravenous dexamethasone suppression test is excellent in ruling out pseudo-Cushing's syndrome. This test is much simpler and more convenient than the oral dexamethasone suppression test in confirming clinical suspicion of pituitary Cushing's disease.

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“…In an attempt to simplify the testing procedure, one study examined the value of an overnight 12-hour urine-free cortisol in 30 patients with CS and 150 obese controls. 51 Urine was collected from 8 PM to 8 AM. A 12-hour UFC/urinary creatinine ratio of greater than 16 nmol/mol diagnosed CS with a sensitivity of 100% and specificity of 97%, and was more accurate than a 24-hour collection.…”

Section: Urine-free Cortisol Testingmentioning

confidence: 99%

Update on the Diagnosis of Cushing Syndrome

Liu¹,

Crapo²

2005

The Endocrinologist

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The diagnosis of endogenous Cushing syndrome (CS) remains challenging and generally unfolds in two steps: first, the definitive determination of the presence of CS and second, the determination of the underlying cause. New definitive diagnostic tests, including late-night salivary cortisol, combination low-dose dexamethasone suppression testing (DST) and salivary cortisol testing, and combination CRH-DST testing appear promising. Traditional diagnostic tests, including urine-free cortisol and low-dose DST, remain important in the definitive evaluation for CS. Lowering of the serum cortisol cutoff value for low-dose DST will improve sensitivity but likely adversely impact specificity. Recent studies suggest that subtle hypercortisolism may be found in patients with adrenal incidentalomas, diabetes, hypertension, or obesity without specific physical manifestations of CS, suggesting a subclinical form of the syndrome. It remains to be determined which population, if any, should be screened for CS. In determining the etiology of CS, a plasma ACTH level will help differentiate between ACTH-independent and ACTH-dependent CS. Central venous sampling should be considered in patients with equivocal standard test results to help differentiate between CS and ectopic ACTH syndrome. In centers with limited expertise in central venous sampling, internal jugular vein sampling with CRH stimulation may be the preferred invasive test given its relative simplicity.

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Overnight urinary free cortisol determination: A screening test for the diagnosis of Cushing's syndrome

Cited by 40 publications

References 12 publications

Advantage of salivary cortisol measurements in the diagnosis of glucocorticoid related disorders

Advantage of salivary cortisol measurements in the diagnosis of glucocorticoid related disorders

Dexamethasone Infusion Testing in the Diagnosis of Cushing's Syndrome

Update on the Diagnosis of Cushing Syndrome

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