Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2008) 16 P424

ECE2008 Poster Presentations Neuroendocrinology (107 abstracts)

Midnight salivary cortisol (MSC) to assess the outcome of transsphenoidal surgery (TSS) in Cushing's disease (CD)

Carmen Carrasco 1 , Joël Coste 2 , Laurence Guignat 1 , Marie-Annick Dugué 3 , Stéphane Gaillard 4 , Xavier Bertagna 1 & Jerôme Bertherat 1


1Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Department of Endocrinology, Reference Center for Rare Adrenal Diseases, Paris, France; 2Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Department of Biostatistic, Paris, France; 3Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Department of Hormonal Biochemistry, Paris, France; 4Hôpital Foch, Department of neurosurgery, Suresnes, France.


Introduction: MSC is a simple and reliable mean to diagnose hypercortisolism, yet its value to asses the outcome of treatment has rarely been addressed.

Objective: Compare MSC and other classical parameters, to assess the outcome of TSS in CD.

Patients and methods: Sixty-eight patients from a single Center operated for CD between 1996 and 2006. Outcome was assessed between 6–12 months post TSS. Remission was defined as: morning plasma cortisol <50 ng/ml and/or insufficient response to ACTH; or normal urinary free cortisol (UFC<90 μg/d) together with midnight plasma cortisol <75 ng/ml and normal suppression to dexamethasone. Morning plasma cortisol at day five post TSS (TSS +5) was also retrospectively analysed.

Results: The 73.5% of the patients achieved remission. MSC was significantly lower remission group (group 1, n=50) than of failure (group 2, n=18): 0.7±0.4 ng/ml (mean ±S.D., range: 0.4–2.2 ng/ml) versus 6.5±6.6 ng/ml (range: 2.1–27.2 ng/ml), P<0.001. Similarly, UFC was significantly lower in group 1 than in group 2: 14±19 μg/d (range: 2–105 mg/d) versus 307±304 μg/d (range: 20–1070 μg/d), P<0.001. Retrospectively, morning plasma cortisol at TSS+5 was lower in group 1 than in group 2: 26.8±46.4 ng/ml (range: 10–270 ng/ml) versus 136.6±85.6 ng/ml (range:14–298 ng/ml), P<0.001. MSC was correlated to UFC (r 0.618, P<0.001), as well as to morning plasma cortisol at TSS+5 (r 0.410, P<0.001). For the diagnosis of remission the performances (specificity-sensitivity) of the different measurements were as follows: MSC (cut off of 2 ng/ml) 100%–98%; morning plasma cortisol post TSS +5 (cut off 18 ng/ml) 92.9%–26%; UFC (cut off of 90 μg/day) 70.6%–21%.

Conclusion: MSC is a valid marker of remission after TSS for CD, with better sensitivity and specificity than UFC or early morning plasma cortisol immediately after TSS.

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