The role of non-invasive dynamic tests in the diagnosis of Cushing’s syndrome

Vilar, Lúcio; Freitas, Maria Cristina Foss de; Naves, Luciana Ansaneli; Canadas, Viviane; Albuquerque, José de Lima; Botelho, Carlos; Egito, Célia S.; Arruda, Maria Juliana; Silva, L. M.; Arahata, Carla M.; Agra, Rodrigo; Lima, Lúcia Helena C.; Azevedo, Monalisa F.; Casulari, Luíz Augusto

doi:10.1007/bf03345640

Cited by 28 publications

(29 citation statements)

References 26 publications

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“…As reported in some studies (2,5,6,7,10,11,12,14), we found that LNSC levels were higher in CS; a threshold value above 5.24 ng/ml provided a good accuracy to detect endogenous hypercortisolism, and in particular to discover CD, the most common form. LNSC was able to differentiate CS patients from the control population, which included not only healthy subjects but also patients with suspected CS, and our proposed threshold value is consistent with other data reported in the literature and obtained with RIAs (5, 11, 23).…”

Section: Discussionsupporting

confidence: 77%

“…UFC collection and the 1 mg DST are simple, but neither is able to make a certain diagnosis of CS (15,20,21). The LNSC test, as proposed recently (5,6,7,10,11,12,14), is a reliable, noninvasive, stress-free, and low-cost procedure to diagnose CS. Moreover, elevation of LNSC levels might be the first abnormality to be checked in the follow-up after surgery (22).…”

Section: Discussionmentioning

confidence: 99%

“…The lack of a circadian rhythm is a peculiar marker of CS (4), so the LNSC test seems to be the best choice to screen for CS because of its noninvasive, stress-free, easy collection in outpatients (1). There is a marked variation between studies in the performance of the LNSC test, reflecting differences in laboratory assays, sample collection, severity of CS, and control groups (2,5,6,7,8,9,10,11,12,13,14). It is also important to have reference data not only for healthy volunteers but also for a control group of obese, hypertensive, diabetic, and depressed subjects or other clinical features of CS that are common in the general population (3,15).…”

Section: Introductionmentioning

confidence: 99%

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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: 77%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…Patients with metabolic syndrome were excluded from the study when they had: 1) low levels of free and total testosterone associated with high concentrations of FSH and LH, characterizing andropause or primary gonadal insufficiency; 2) altered prolactin and/or TSH levels; and/or 3) Cushing's syndrome (that was excluded when plasma cortisol levels were lower than 1.8 µg/dL at 8.00 p.m. after the intake of 1.0 mg of dexamethasone at 11.00 p.m. on the previous day) (12).…”

Section: Methodsmentioning

confidence: 99%

Relationship between insulin and hypogonadism in men with metabolic syndrome

Caldas

Porto

Motta

et al. 2009

Arq Bras Endocrinol Metab

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Objective: To evaluate the incidence of hypogonadism in men with metabolic syndrome and its correlation with serum insulin levels. Methods: Observational, transversal study with 80 men with metabolic syndrome. The individuals were divided into two groups: Group 1: 56 patients (70%) with total testosterone ≥ 300 ng/dL (normal gonadal function); Group 2: 24 patients (30%) with total testosterone < 300 ng/dL (hypogonadic). Results: The subjects from Group 2 compared to Group 1 presented higher body mass index (BMI), waist and hip circumferences, insulin, homeostasis model assessment insulin resistance index (Homa-IR) and beta cell (Homa-β), and triglycerides, but lower SHBG and free testosterone values. Inverse correlations between insulin levels and total testosterone and SHBG, as well as between Homa-IR and total testosterone were observed. Conclusion: In this series of men with metabolic syndrome, hypogonadism was associated with insulin resistance and may be a marker of metabolic abnormalities. Arq Bras Endocrinol Metab. 2009;53(8):1005-11

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“…Once an accurate urine collection is achieved, the sensitivity of UFC measurement is 45-71% when specificity is set at 100% (5). The 1 mg overnight dexamethasone suppression test (DST) and the 2 mg dexamethasone 2-day suppression test (low-dose DST (LDDST)) are simple and inexpensive; failure of normal suppression of SeC is a well-known biochemical screening test when CS is suspected, showing a sensitivity and specificity O95 and 80% respectively (3,6,7).…”

Section: Introductionmentioning

confidence: 99%

Usefulness of salivary cortisol in the diagnosis of hypercortisolism: comparison with serum and urinary cortisol

Manetti¹,

Rossi²,

Grasso³

et al. 2013

European Journal of Endocrinology

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Objective: Several tests have been proposed to diagnose patients with Cushing's syndrome (CS). The aims of the study were: i) to evaluate the performance of salivary cortisol (SC) in hypercortisolism and ii) to compare SC with serum cortisol (SeC) and urinary cortisol. Design and patients: This was a diagnostic study. Twenty-seven patients with untreated Cushing's disease (CD untr), 21 women consuming oral contraceptive pill (OCP), 18 pregnant women, and 89 healthy subjects (controls) were enrolled. Methods: SC and SeC at baseline and after the low-dose dexamethasone suppression test (LDDST) and urinary free cortisol (UFC) were measured. Results: Midnight SC had a sensitivity of 100% in the CD untr group and a specificity of 97.7% in the controls. Specificity remained high (95.2%) in women taking OCP, while in pregnant women, it decreased to 83.3%. SC after the LDDST showed a sensitivity of 96.3% in the CD untr group; specificity was 97.7% in the controls and 90.5% in OCP women. Midnight SeC had a sensitivity of 100% in the CD untr group. SeC after the LDDST had a sensitivity of 100% in the CD untr group while specificity was 97.7% in the controls and 61.9% in women taking OCP. For UFC, sensitivity was 92.6% in the CD untr group while specificity was 97.7% in the controls and 100% in the OCP group. Conclusions: SC is a reliable parameter for the diagnosis of severe hypercortisolism, with high sensitivity and specificity. In women during pregnancy or taking OCP, the measurement of SC, identifying the free fraction, could be helpful to exclude CS.

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The role of non-invasive dynamic tests in the diagnosis of Cushing’s syndrome

Abstract: Our findings demonstrate that LDDST had 100% sensitivity for the diagnosis of CS and that HDDST and stimulation tests with CRH or desmopressin may be very useful for confirmation of CS etiology when analyzed together or when more stringent cut-offs are used.

Cited by 28 publications

References 26 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

Relationship between insulin and hypogonadism in men with metabolic syndrome

Usefulness of salivary cortisol in the diagnosis of hypercortisolism: comparison with serum and urinary cortisol

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