Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2016) 41 EP25 | DOI: 10.1530/endoabs.41.EP25

ECE2016 Eposter Presentations Adrenal cortex (to include Cushing's) (85 abstracts)

Low positive predictive value of midnight salivary cortisol measurement to detect hypercortisolism in type 2 diabetes

Charlotte Steffensen 1, , Henrik Holm Thomsen 1, , Olaf M Dekkers 3, , Jens S Christiansen 1, , Jørgen Rungby 5, & Jens Otto L Jørgensen 1,

1Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark; 2Department of Medicine, Viborg Regional Hospital, Viborg, Denmark; 3Department of Medicine, Section Endocrinology, Leiden University Medical Center, Leiden, The Netherlands; 4Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 5Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands; 6Centre for Diabetes Research, Gentofte University Hospital, Hellerup, Denmark.

Background: Hypercortisolism is prevalent in type 2 diabetes (T2D), but analytical and functional uncertainties prevail. Measurement of salivary cortisol is considered an expedient screening method for hypercortisolism, but its usefulness in the context of T2D is uncertain.

Aim: To compare late night salivary cortisol (LNSC) with the 1 mg overnight dexamethasone suppression test (DST), which was considered ‘reference standard’, in T2D.

Patients and methods: 382 unselected and recently diagnosed T2D patients underwent assessment of LNSC and DST, and the test outcome was related to age, gender, BMI and Hemoglobin A1C levels. We used the following cut-off values: LNSC ≤3.6 nmol/l and DST ≤50 nmol/l.

Results: The mean±S.E.M. levels of LNSC and DST were 7.3±0.25 nmol/l and 28.7±1.4 nmol/l, respectively. Hypercortisolim was present in 85.6% based on LNSC values and 22% based on DST. LNSC, as compared to DST, had the following test characteristics: sensitivity: 84.5% (95%CI: 75.0–91.5%), specificity: 14.1% (95%CI: 10.4–18.6%), positive predictive value: 21.7% (95%CI: 17.4–26.6%), negative predictive value: 76.4% (95%CI: 63.0–86.8%) and overall accuracy 29.6% (95%CI: 25.0–34.4%). LNSC and DST values were not associated with Hemoglobin A1C, BMI and age in this diabetes cohort.

Conclusion: The LNSC is characterized by very low specificity and poor positive predictive value as compared to the DST, resulting in an overall low accuracy. Further methodological and clinical studies are needed to substantiate the relevance of cortisol status in T2D.

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