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

Abstract

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.

Age and the metabolic syndrome affect salivary cortisol rhythm: data from a community sample

“…18 In contrast to another study, 1 we did not find any gender differences in salivary cortisol values, probably because our volunteers included individuals from 20 to 88 years old, while Lederbogen et al studied only 50-69 year-old subjects. 1 As likewise reported by Manetti et al, 7 we found no differences in late-night salivary cortisol levels, in daytime cortisol rhythm, as indicated by the F 14 /F 0 ratio, or in cortisol production rate, as indicated by AUC F0àF14 , between the women of reproductive age with regular menses who collected saliva during their follicular phase and those who were on estrogen-progestin therapy. In view of the fact that salivary cortisol reflects the free fraction of the hormone, saliva testing could be a particularly useful tool in the clinical setting in which cortisol-binding globulin is elevated.…”

“…in medical conditions characterized by increased cortisol-binding globulin levels, such as during pregnancy or when estrogen-progestin contraceptives are being taken. 6,7 The aim of this study was to examine, in a community sample of adults, whether, and if so how, age, gender, metabolic syndrome and estrogen-progestin therapy affect salivary cortisol rhythm.…”

The degree of urinary hypercortisolism is not correlated with the severity of cushing’s syndrome

“…Similarly, in another study performed in 15 patients in remission for at least 5 years, the persistence of visceral obesity, hypertension, impairment of glucose tolerance or diabetes mellitus, and dyslipidemia were found. Thus, patients with CS in remission might have a higher incidence of the metabolic syndrome and vascular disease, due to the persistence of an insulin resistance state and cardiac damage [49,50], but also of psychiatric disorders, compared to the general population [51][52][53].…”

La diagnostica di laboratorio delle malattie del surrene. Raccomandazioni pratiche per la sindrome di Cushing

“…Il CLU può essere determinato con metodi cromatografici (HPLC, GC-MS, LC-MS/MS), immunometrici competitivi senza estrazione, immunometrici competitivi con estrazione in fase liquida o solida, manuali (RIA, EIA) o automatizzati (CLIA) (Tab. 3) [14][15][16][17][18][19][20][21]. I metodi cromatografici, in particolare quelli in fase liquida, sono i più accurati perché in grado di separare e quantificare il cortisolo in presenza di altri steroidi anche di origine sintetica [22][23][24][25][26][27].…”

“…Si conferma l'importanza di standardizzare la fase della raccolta della saliva utilizzando un dispositivo adeguato e istruzioni dettagliate per il paziente. Si ribadisce di non eseguire per lo screening della sindrome di Cushing i seguenti test: cortisolo sierico e ACTH plasmatico, prelevati casualmente nel corso della giornata, 17 …”