Document Detail

The role of salivary cortisol measured by liquid chromatography-tandem mass spectrometry in the diagnosis of subclinical hypercortisolism.
MedLine Citation:
PMID:  23211572     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The use of late-night salivary cortisol (LNSalC) for diagnosing subclinical hypercortisolism (SH) is debated. No data are available regarding the role of LNSalC as measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) in SH diagnosis. The aim of this study was to evaluate the diagnostic accuracy of LNSalC measured by LC-MS/MS in SH.
DESIGN: Cross-sectional prospective study of outpatients.
METHODS: In 70 consecutive patients with adrenal incidentalomas (AI), without signs and symptoms of hypercortisolism, we diagnosed SH in the presence of at least two of the following: cortisol after 1 mg overnight dexamethasone suppression test (1  mg DST) >83  nmol/l, 24-h urinary free cortisol (UFC) >193  nmol/24  h, and morning ACTH <2.2  pmol/l. The LNSalC levels by LC-MS/MS at 2300  h (normal values <2.8  nmol/l) and the presence of hypertension, type 2 diabetes mellitus (T2DM), and osteoporosis (OP) were assessed.
RESULTS: The increased LNSalC levels (>2.8  nmol/l) had an 83.3% specificity (SP) and a 31.3% sensitivity (SN) for predicting the biochemical diagnosis of SH. The increased LNSalC had an 85.2% SP and a 55.6% SN for predicting the presence of hypertension, T2DM, and OP, while the combination of LNSalC >1.4  nmol/l (cutoff with 100% SN) plus 1 mg DST >50  nmol/l had an 88.9% SN and an 85.2% SP (similar to SH criterion at enrollment).
CONCLUSIONS: In AI patients, LNSalC measured by LC-MS/MS appears to be useful in combination with 1 mg DST for diagnosing SH, while it is not useful as a single criterion.
S Palmieri; V Morelli; E Polledri; S Fustinoni; R Mercadante; L Olgiati; C Eller Vainicher; E Cairoli; V V Zhukouskaya; P Beck-Peccoz; I Chiodini
Publication Detail:
Type:  Evaluation Studies; Journal Article     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:  289-96     Citation Subset:  IM    
Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy.
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MeSH Terms
Adrenal Cortex / drug effects,  secretion
Adrenal Gland Neoplasms / physiopathology
Adrenocorticotropic Hormone / blood
Chromatography, High Pressure Liquid
Circadian Rhythm
Cross-Sectional Studies
Cushing Syndrome / diagnosis*,  etiology,  metabolism,  physiopathology
Dexamethasone / diagnostic use
Glucocorticoids / diagnostic use
Hydrocortisone / metabolism*,  secretion,  urine
Middle Aged
Prospective Studies
Saliva / metabolism*
Sensitivity and Specificity
Severity of Illness Index
Spectrometry, Mass, Electrospray Ionization
Tandem Mass Spectrometry
Reg. No./Substance:
0/Glucocorticoids; 50-02-2/Dexamethasone; 50-23-7/Hydrocortisone; 9002-60-2/Adrenocorticotropic Hormone

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