Document Detail


Late-night salivary cortisol for diagnosis of overt and subclinical Cushing's syndrome in hospitalized and ambulatory patients.
MedLine Citation:
PMID:  19001518     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: Neither precise evaluation of pertinent thresholds nor comparison of the diagnostic performance of late-night salivary cortisol (NSC) between inpatient and outpatient settings has been conducted. The usefulness of NSC for the screening of "subclinical" Cushing's syndrome is still unknown. OBJECTIVES: The aim of the study was to compare the influence of inpatient and outpatient settings on the diagnostic performance of NSC and assess its usefulness as a screening test for subclinical Cushing's syndrome. DESIGN: Consecutive patients were investigated prospectively with two salivary collections, first as inpatients and then as outpatients. PARTICIPANTS: Forty-two obese subjects participated in the study, as well as nine patients cured of Cushing's disease, 13 with overt Cushing's syndrome, 14 showing mild recurrence of Cushing's disease, and 48 with adrenal incidentalomas [23 subclinical cortisol-secreting adenomas (SCSA), 25 nonsecreting adenomas]. MAIN OUTCOME MEASURES: Reproducibility of NSC and diagnostic performance were measured using receiver operating characteristic analysis. RESULTS: NSC in controls was similar between inpatient and outpatient settings. The diagnostic performance of NSC across the different patient groups was similar irrespective of the setting. A threshold of 12 nmol/liter yielded 100% sensitivity and specificity in overt Cushing's syndrome. Optimal performance in subclinical Cushing's syndrome required lower thresholds. NSC showed acceptable performance in diagnosing recurrence of Cushing's disease (90% sensitivity, 91.8% specificity). On the contrary, NSC was similar between patients with SCSA and nonsecreting adenomas. CONCLUSIONS: Our data validate the outpatient bed sampling strategy for NSC with no need for specific outpatient threshold. NSC may be helpful to detect mild recurrence of Cushing's disease after surgery but is of little value in identifying SCSA amongst adrenal incidentalomas.
Authors:
Marie-Laure Nunes; Stéphanie Vattaut; Jean-Benoît Corcuff; Alexandre Rault; Hugues Loiseau; Blandine Gatta; Nathalie Valli; Luc Letenneur; Antoine Tabarin
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Publication Detail:
Type:  Journal Article; Validation Studies     Date:  2008-11-11
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  94     ISSN:  0021-972X     ISO Abbreviation:  J. Clin. Endocrinol. Metab.     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-02-05     Completed Date:  2009-03-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  United States    
Other Details:
Languages:  eng     Pagination:  456-62     Citation Subset:  AIM; IM    
Affiliation:
Department of Endocrinology, University Hospital of Bordeaux, Haut Lévêque, Pessac, France.
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MeSH Terms
Descriptor/Qualifier:
Adrenal Cortex Neoplasms / blood,  complications,  diagnosis,  pathology
Adrenocortical Adenoma / blood,  complications,  diagnosis,  pathology
Ambulatory Care / methods
Case-Control Studies
Circadian Rhythm / physiology*
Cushing Syndrome / blood,  classification,  diagnosis*,  etiology,  pathology
Female
Hospitalization
Humans
Hydrocortisone / analysis*,  blood
Incidental Findings
Inpatients*
Male
Outpatients*
Recurrence
Saliva / chemistry
Sensitivity and Specificity
Time Factors
Chemical
Reg. No./Substance:
50-23-7/Hydrocortisone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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