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Erschienen in: Journal of Endocrinological Investigation 3/2019

01.03.2019 | Original Article

The diagnostic accuracy of increased late night salivary cortisol for Cushing’s syndrome: a real-life prospective study

verfasst von: F. Ceccato, G. Marcelli, M. Martino, C. Concettoni, M. Brugia, L. Trementino, G. Michetti, G. Arnaldi

Erschienen in: Journal of Endocrinological Investigation | Ausgabe 3/2019

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Abstract

Introduction and aim

A prompt diagnosis of Cushing’s Syndrome (CS) in high-risk populations is mandatory: 1-mg dexamethasone suppression test (1-mg DST), late night salivary cortisol (LNSC), and urinary-free cortisol (UFC) are recommended, despite thresholds calculated in retrospective studies. Our aim was to study the diagnostic accuracy of LNSC measured with chemiluminescence assay in a prospective study, confirming discrepancies with mass spectrometry (MS).

Materials and methods

We enrolled 117 controls and 164 suspected CS (CS = 47, non-CS = 117). In case of increased LNSC, high clinical suspicion of CS or adrenal incidentaloma, patients were hospitalized to exclude/confirm CS.

Results

LNSC levels were higher in patients with suspected CS, CS, and non-CS than controls. Considering 16 nmol/L as threshold for CS, overall LNSC revealed SE 97% and SP 84% in the whole group of subjects considered, achieving positive/negative likelihood ratio of 5.56/0.045, respectively. 35 out of 81 subjects with increased LNSC were non-CS (15 diabetic and 20 obese): considering only those patients with increased likelihood to have a CS (the non-CS patients) SP decreased to 70%, and further reduced to 60% if we discharged subjects with adrenal incidentaloma. MS analyses reduced partially the number of false-positive LNSC.

Conclusions

LNSC measured in automated chemiluminescence is reliable in clinical practice: it present a high diagnostic accuracy to exclude hypercortisolism in patients with normal cortisol levels. MS could be used to reduce the number of false-positive results; nevertheless, some non-CS subjects with functional hypercortisolism could have a mild impairment of cortisol rhythm.
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Metadaten
Titel
The diagnostic accuracy of increased late night salivary cortisol for Cushing’s syndrome: a real-life prospective study
verfasst von
F. Ceccato
G. Marcelli
M. Martino
C. Concettoni
M. Brugia
L. Trementino
G. Michetti
G. Arnaldi
Publikationsdatum
01.03.2019
Verlag
Springer International Publishing
Erschienen in
Journal of Endocrinological Investigation / Ausgabe 3/2019
Elektronische ISSN: 1720-8386
DOI
https://doi.org/10.1007/s40618-018-0921-1

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