Document Detail

Usefulness of salivary cortisol in the diagnosis of hypercortisolism: comparison with serum and urinary cortisol.
MedLine Citation:
PMID:  23211575     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Several tests have been proposed to diagnose patients with Cushing's syndrome (CS). The aims of the study were: i) to evaluate the performance of salivary cortisol (SC) in hypercortisolism and ii) to compare SC with serum cortisol (SeC) and urinary cortisol.
DESIGN AND PATIENTS: This was a diagnostic study. Twenty-seven patients with untreated Cushing's disease (CD untr), 21 women consuming oral contraceptive pill (OCP), 18 pregnant women, and 89 healthy subjects (controls) were enrolled.
METHODS: SC and SeC at baseline and after the low-dose dexamethasone suppression test (LDDST) and urinary free cortisol (UFC) were measured.
RESULTS: Midnight SC had a sensitivity of 100% in the CD untr group and a specificity of 97.7% in the controls. Specificity remained high (95.2%) in women taking OCP, while in pregnant women, it decreased to 83.3%. SC after the LDDST showed a sensitivity of 96.3% in the CD untr group; specificity was 97.7% in the controls and 90.5% in OCP women. Midnight SeC had a sensitivity of 100% in the CD untr group. SeC after the LDDST had a sensitivity of 100% in the CD untr group while specificity was 97.7% in the controls and 61.9% in women taking OCP. For UFC, sensitivity was 92.6% in the CD untr group while specificity was 97.7% in the controls and 100% in the OCP group.
CONCLUSIONS: SC is a reliable parameter for the diagnosis of severe hypercortisolism, with high sensitivity and specificity. In women during pregnancy or taking OCP, the measurement of SC, identifying the free fraction, could be helpful to exclude CS.
Luca Manetti; Giuseppe Rossi; Lucia Grasso; Valentina Raffaelli; Ilaria Scattina; Simone Del Sarto; Mirco Cosottini; Aldo Iannelli; Maurizio Gasperi; Fausto Bogazzi; Enio Martino
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't     Date:  2013-02-15
Journal Detail:
Title:  European journal of endocrinology / European Federation of Endocrine Societies     Volume:  168     ISSN:  1479-683X     ISO Abbreviation:  Eur. J. Endocrinol.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-18     Completed Date:  2013-04-08     Revised Date:  2013-05-08    
Medline Journal Info:
Nlm Unique ID:  9423848     Medline TA:  Eur J Endocrinol     Country:  England    
Other Details:
Languages:  eng     Pagination:  315-21     Citation Subset:  IM    
Department of Endocrinology and Metabolism, University of Pisa, Ospedale Cisanello, via Paradisa 2, 56124 Pisa, Italy.
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MeSH Terms
Aged, 80 and over
Circadian Rhythm
Contraceptives, Oral / pharmacology
Cushing Syndrome / diagnosis*,  metabolism,  physiopathology,  urine
Dexamethasone / diagnostic use
Glucocorticoids / diagnostic use
Hydrocortisone / blood,  metabolism*,  secretion,  urine
Middle Aged
Pregnancy Complications / diagnosis,  metabolism,  physiopathology,  urine
Saliva / metabolism*
Sensitivity and Specificity
Severity of Illness Index
Young Adult
Reg. No./Substance:
0/Contraceptives, Oral; 0/Glucocorticoids; 50-02-2/Dexamethasone; 50-23-7/Hydrocortisone

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