Specificity of late-night salivary cortisol measured by automated electrochemiluminescence immunoassay for Cushing’s disease in an obese population

Aberle, Jens; Wiesch, Clarissa Schulze zur; Flitsch, Jörg; Veigel, J; Schön, Gerhard; Jung, Roman; Reining, F; Lautenbach, Anne; Rotermund, Roman; Riedel, Nina

doi:10.1007/s40618-018-0870-8

Cited by 16 publications

(15 citation statements)

References 21 publications

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“…Different groups have reported cut-off levels ranging from 2.8-12.3 nmol/l (0.10-0.45 μg/dl) with different sensitivities and specificities for the diagnosis of HC (▶ table 1) [8-12, 15-17,19-26]. Almost all cited studies used at least partially or solely healthy subjects as control group [8,12,16,17,[19][20][21][22][23]27]. This will very like-ly limit the use of the calculated cut-offs in daily clinical work because healthy subjects will not be undergoing HC testing.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, published studies often included healthy controls or control groups that did not meet criteria for suspicion of HC to define thresholds (▶table 1). Described thresholds differ from 2.2-13.5 nmol/l (0.08-0.49 μg/dl) for the diagnosis of HC [9][10][11], with reported sensitivities and specificities of up to 100 % [9,10,[12][13][14][15][16][17]. Therefore, the goal of this prospective single centre study was to evaluate a cut-off value for LNSaC for the diagnosis of HC using a chemiluminescence immunoassay and to investigate the impact of different comorbidities and aetiologies on this cut-off in a tertiary endocrine referral centre with the so far largest meaningful control group.…”

Section: Introductionmentioning

confidence: 99%

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Distinct Late-Night Salivary Cortisol Cut-Off Values for the Diagnosis of Hypercortisolism

et al. 2021

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Due to high morbidity and mortality of untreated hypercortisolism, a prompt diagnosis is essential. Measurement of late-night salivary cortisol provides a simple and non-invasive method. However, thresholds and reference ranges differ among studies. The goal of this study was to define a threshold of late-night salivary cortisol for the diagnosis of hypercortisolism based on the used assay. Moreover, the influence of different aetiologies of hypercortisolism and individual comorbidities were investigated. Prospective analyses of 217 patients, including 36 patients with proven hypercortisolism were carried out. A sum of 149 patients with suspicion of hypercortisolism but negative endocrine testing and 32 patients with hypercortisolism in remission served as control group. Late-night salivary cortisol was measured using an automated chemiluminescence immunoassay. Cut-off values were calculated by ROC analysis. The calculated cut-off value for the diagnosis of hypercortisolism was 10.1 nmol/l (sensitivity 94%; specificity 84%). Only slightly lower thresholds were obtained in patients with suspected hypercortisolism due to weight gain/obesity (9.1 nmol/l), hypertension or adrenal tumours (both 9.8 nmol/l) or pituitary adenomas (9.5 nmol/l). The late-night salivary cortisol threshold to distinguish between Cushing’s disease and Cushing’s disease in remission was 9.2 nmol/l. The cut-off value for the diagnosis of ectopic ACTH-production was 109.0 nmol/l (sensitivity 50%, specificity 92%). Late-night salivary cortisol is a convenient and reliable parameter for the diagnosis of hypercortisolism. Except for ectopic ACTH-production, thresholds considering different indications for evaluation of hypercortisolism were only slightly different. Therefore, they might only be useful if late-night salivary cortisol results near the established cut-off value are present.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Distinct Late-Night Salivary Cortisol Cut-Off Values for the Diagnosis of Hypercortisolism

et al. 2021

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“…Salivary cortisol is a reliable indicator of plasma free cortisol levels unrelated to the saliva production rate and CBG variability [71]. It has a high sensitivity but its specificity may be low, particularly in the elderly as well as in patients with comorbidities such as obesity, hypertension, and diabetes [57,60,72,73,74]. In healthy adults, advanced age has been reported to be associated with higher late-night salivary cortisol levels, with no evident influence of sex or BMI [75].…”

Section: Diagnosis and Differential Diagnosesmentioning

confidence: 99%

“…In healthy adults, advanced age has been reported to be associated with higher late-night salivary cortisol levels, with no evident influence of sex or BMI [75]. The proposed reference ranges and cut-off value of salivary cortisol differ immensely because of differences in the assays used [44,72]. It has also been reported that neither normal UFC levels nor normal late-night salivary cortisol levels exclude mild CS [76].…”

Section: Diagnosis and Differential Diagnosesmentioning

confidence: 99%

Cushing’s Disease

Nishioka

Yamada²

2019

JCM

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In patients with Cushing’s disease (CD), prompt diagnosis and treatment are essential for favorable long-term outcomes, although this remains a challenging task. The differential diagnosis of CD is still difficult in some patients, even with an organized stepwise diagnostic approach. Moreover, despite the use of high-resolution magnetic resonance imaging (MRI) combined with advanced fine sequences, some tumors remain invisible. Surgery, using various surgical approaches for safe maximum tumor removal, still remains the first-line treatment for most patients with CD. Persistent or recurrent CD after unsuccessful surgery requires further treatment, including repeat surgery, medical therapy, radiotherapy, or sometimes, bilateral adrenalectomy. These treatments have their own advantages and disadvantages. However, the most important thing is that this complex disease should be managed by a multidisciplinary team with collaborating experts. In addition, a personalized and individual-based approach is paramount to achieve high success rates while minimizing the occurrence of adverse events and improving the patients’ quality of life. Finally, the recent new insights into the pathophysiology of CD at the molecular level are highly anticipated to lead to the introduction of more accurate diagnostic tests and efficacious therapies for this devastating disease in the near future.

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“…Data regarding sensitivity and sensibility of biochemical tests in obese populations are rather conflicting. Recently, sensitivity of the late-night salivary cortisol (LNSC) measured by automated electrochemiluminescence immunoassay (ECLIA) was found to be low in detecting CD in an obese population (BMI ≥ 35 kg/m 2 ) [49]. An automatic face classification of hypercortisolism by computer software has been even suggested as a novel screening approach in women [50].…”

Section: Advances In Diagnostic Testing and Need For New Testsmentioning

confidence: 99%

“The Adrenal Gland: Central Relay in Health and Disease - Current Challenges and Perspectives 2018” – Cushing’s Disease

Stalla

Ciato

Dimopoulou

2018

Exp Clin Endocrinol Diabetes

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CD is associated to a significant clinical burden, since numerous comorbidities persist after long-term biochemical control. These chronically ill patients show an increased mortality despite disease remission. Clinicians should treat comorbidities aggressively and seek for appropriate consultations. Structured consultation hours and expert excellence networks are needed in order to allow optimal, individualized care for affected patients, reverse increased morbidity and mortality and identify tumor recurrence early.

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Specificity of late-night salivary cortisol measured by automated electrochemiluminescence immunoassay for Cushing’s disease in an obese population

Abstract: In our obese cohort, we found that LNSC assayed by ECLIA had a low specificity in the diagnosis of CD.

Cited by 16 publications

References 21 publications

Distinct Late-Night Salivary Cortisol Cut-Off Values for the Diagnosis of Hypercortisolism

Distinct Late-Night Salivary Cortisol Cut-Off Values for the Diagnosis of Hypercortisolism

Cushing’s Disease

“The Adrenal Gland: Central Relay in Health and Disease - Current Challenges and Perspectives 2018” – Cushing’s Disease

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