Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2010) 22 P32

ECE2010 Poster Presentations Adrenal (66 abstracts)

Utility of midnight salivary cortisol measurement in the diagnosis of overt and subclinical Cushing's syndrome

Márta Sereg 1 , Judit Toke 1 , Attila Patócs 2 , Péter Igaz 1 , Nikolett Szucs 1 , Ibolya Varga 2 , Ágnes Szappanos 1 , Edit Gláz 1 , Károly Rácz 1 & Miklós Tóth 1

1Second Department of Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary; 2Molecular Medicine Research Group, Hungarian Academy of Sciences and Semmelweis University, Budapest, Hungary.

Background: Midnight salivary cortisol (SalC2400) measurement has been recently suggested as one of the first-line screening tests for hypercortisolism.

Aims: In our present study, we evaluated the clinical utility of the salivary cortisol (SalC) measurement in the diagnosis of both overt and subclinical Cushing’s syndrome.

Patients and methods: Patients with overt Cushing’s syndrome (n=23, group A) and those with subclinical Cushing’s syndrome due to incidentally discovered adrenal adenomas (n=18, group B) were sampled for serum cortisol (SerC) and SalC at 2400 and 0800 h. Urinary cortisol excretion (UFC) was measured and overnight low dose dexamethasone test (LDDST, 1 mg) was performed. The control group consisted of patients with the final diagnosis of inactive adrenocortical adenomas (n=40, group C) and of patients investigated for various reasons (severe obesity, hypertension, etc.) finally proved to be non-hypercortisolemic (n=70, group D). Receiver operating characteristics (ROC) analysis was performed to determine optimal cut-offs for diagnosis of both overt and subclinical hypercortisolism. Diagnostic power of each test was expressed as area under the curve (AUC) obtained by ROC analysis.

Results: Cortisol concentrations in each test except SerC0800 were higher in group A than in group B. The AUCs for discrimination of patients with overt or subclinical Cushing’s syndrome (n=41, groups A+B) from controls (n=110, groups C+D) in decreasing order were: LDDST 0.930, SeC2400 0.924, SalC2400 0.907, UFC 0.828, SalC0800 0.645 and SerC0800 0.642. SalC and UFC concentrations significantly correlated with body mass index in group D but not in the other groups.

Conclusion: The diagnostic utility of SalC2400 for the diagnosis Cushing’s syndrome was similar to LDDST and SerC2400. The differences in SalC2400 between overt and subclinical Cushing’s syndrome as well as the significant correlations between SalC/UFC and body mass index indicate that the diagnostic utility of SalC2400 is highly dependent on the composition of patient and control groups.

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