CONTEXT: Midnight salivary cortisol (MSC) is now recognized as a reliable index for Cushing's syndrome diagnosis but has to be validated for the follow-up of treated patients. OBJECTIVE: Our objective was to evaluate MSC for assessing the outcome of transsphenoidal surgery (TSS) in patients with Cushing's disease (CD). DESIGN: We conducted a retrospective cohort study in a single center. PATIENTS AND METHODS: Sixty-eight patients treated by TSS between 1996 and 2006 and followed for at least 6 months with postoperative MSC were included. Mean follow-up (+/- sd) was 45 +/- 31 months. Morning plasma cortisol was determined 5 d after TSS, and MSC and urinary cortisol (UC) were determined 6-12 months after surgery. The remission group included hypocortisolic (morning plasma cortisol < 50 ng/ml and/or insufficient response to cosyntropin) and eucortisolic (midnight plasma cortisol < 75 ng/ml and normal UC) patients. Patients in the treatment failure group had high midnight plasma cortisol and UC concentrations. RESULTS: Fifty patients (74%) were in remission. Mean MSC was 0.7 +/- 0.4 ng/ml (range, 0.4-2.1 ng/ml) and 6.5 +/- 6.5 ng/ml (range, 2.1-27.2 ng/ml) for the remission and treatment failure groups, respectively (P = 0.001). A cutoff of 2 ng/ml for MSC gave a sensitivity of 100% and a specificity of 98% for treatment failure diagnosis, whereas UC less than 90 microg/d had a sensitivity of 71% and specificity of 98%. Postsurgical morning plasma cortisol less than or equal to 18 ng/ml had a sensitivity of 93% and specificity of 74%. CONCLUSIONS: MSC is a simple, robust marker of remission after TSS for CD.
CONTEXT: Midnight salivary cortisol (MSC) is now recognized as a reliable index for Cushing's syndrome diagnosis but has to be validated for the follow-up of treated patients. OBJECTIVE: Our objective was to evaluate MSC for assessing the outcome of transsphenoidal surgery (TSS) in patients with Cushing's disease (CD). DESIGN: We conducted a retrospective cohort study in a single center. PATIENTS AND METHODS: Sixty-eight patients treated by TSS between 1996 and 2006 and followed for at least 6 months with postoperative MSC were included. Mean follow-up (+/- sd) was 45 +/- 31 months. Morning plasma cortisol was determined 5 d after TSS, and MSC and urinary cortisol (UC) were determined 6-12 months after surgery. The remission group included hypocortisolic (morning plasma cortisol < 50 ng/ml and/or insufficient response to cosyntropin) and eucortisolic (midnight plasma cortisol < 75 ng/ml and normal UC) patients. Patients in the treatment failure group had high midnight plasma cortisol and UC concentrations. RESULTS: Fifty patients (74%) were in remission. Mean MSC was 0.7 +/- 0.4 ng/ml (range, 0.4-2.1 ng/ml) and 6.5 +/- 6.5 ng/ml (range, 2.1-27.2 ng/ml) for the remission and treatment failure groups, respectively (P = 0.001). A cutoff of 2 ng/ml for MSC gave a sensitivity of 100% and a specificity of 98% for treatment failure diagnosis, whereas UC less than 90 microg/d had a sensitivity of 71% and specificity of 98%. Postsurgical morning plasma cortisol less than or equal to 18 ng/ml had a sensitivity of 93% and specificity of 74%. CONCLUSIONS: MSC is a simple, robust marker of remission after TSS for CD.
Authors: C A Carrasco; M García; M Goycoolea; J Cerda; J Bertherat; O Padilla; D Meza; N Wohllk; T Quiroga Journal: Endocrine Date: 2012-01-24 Impact factor: 3.633
Authors: L Trementino; M Zilio; G Marcelli; G Michetti; M Barbot; F Ceccato; M Boscaro; C Scaroni; G Arnaldi Journal: Endocrine Date: 2014-12-11 Impact factor: 3.633
Authors: Elena Valassi; Beverly M K Biller; Brooke Swearingen; Francesca Pecori Giraldi; Marco Losa; Pietro Mortini; Douglas Hayden; Francesco Cavagnini; Anne Klibanski Journal: J Clin Endocrinol Metab Date: 2010-01-15 Impact factor: 5.958
Authors: Dalia L Batista; Edward H Oldfield; Margaret F Keil; Constantine A Stratakis Journal: J Clin Endocrinol Metab Date: 2009-05-26 Impact factor: 5.958