K Mészáros1,2,3, G Karvaly1,3, Z Márta4, B Magda4, J Tőke5, N Szücs5, M Tóth5, K Rácz5,6, A Patócs7,8,9. 1. Department of Laboratory Medicine, MTA-SE Lendulet Research Group, Hungarian Academy of Sciences, Semmelweis University, 46. Szentkiralyi str, Budapest, 1088, Hungary. 2. "Lendület" Hereditary Endocrine Tumours Research Group, HAS-SE, Budapest, Hungary. 3. Bionics Innovation Center, Budapest, Hungary. 4. MS Metabolomics Research Group, HAS, Budapest, Hungary. 5. 2nd Department of Medicine, Semmelweis University, Budapest, Hungary. 6. Molecular Medicine Research Group, HAS-SE, Budapest, Hungary. 7. Department of Laboratory Medicine, MTA-SE Lendulet Research Group, Hungarian Academy of Sciences, Semmelweis University, 46. Szentkiralyi str, Budapest, 1088, Hungary. patocs.attila@med.semmelweis-univ.hu. 8. "Lendület" Hereditary Endocrine Tumours Research Group, HAS-SE, Budapest, Hungary. patocs.attila@med.semmelweis-univ.hu. 9. Bionics Innovation Center, Budapest, Hungary. patocs.attila@med.semmelweis-univ.hu.
Abstract
BACKGROUND: Late-night salivary cortisol level is one of the first-line tests recommended by the Endocrine Society for the diagnosis of endogenous hypercortisolism. Most routine laboratories measure cortisol levels using immunoassay tests which fail to determine low cortisol levels accurately due to the numerous interfering substances. A liquid chromatography-tandem mass spectrometry (LC-MS/MS) method with simple and rapid sample preparation was developed for the simultaneous measurement of cortisol and cortisone and its performance in the diagnosis of endogenous hypercortisolism was evaluated. METHODS: 324 late-night saliva samples were analyzed from which 272 samples were derived from patients with a suspected diagnosis of endogenous hypercortisolism. Salivary cortisol levels were assayed using an electrochemiluminescent immunoassay (ECLIA, Cortisol II, Roche), and simultaneous measurement of cortisol and cortisone was performed using an LC-MS/MS method. RESULTS: A strong correlation between cortisol results measured using ECLIA and LC-MS/MS (r 2 = 0.892) was demonstrated. Receiver operating characteristics (ROC) analysis showed good diagnostic performance of cortisol and cortisone levels assayed using LC-MS/MS method and for cortisol measured using ECLIA. CONCLUSIONS: Late-night salivary cortisol and cortisone are useful parameters for the diagnosis of hypercortisolism. Using samples obtained from patients where the diagnosis of hypercortisolism is extremely challenging cut-off values for midnight salivary cortisol and cortisone measured by LC-MS/MS method were established.
BACKGROUND: Late-night salivary cortisol level is one of the first-line tests recommended by the Endocrine Society for the diagnosis of endogenous hypercortisolism. Most routine laboratories measure cortisol levels using immunoassay tests which fail to determine low cortisol levels accurately due to the numerous interfering substances. A liquid chromatography-tandem mass spectrometry (LC-MS/MS) method with simple and rapid sample preparation was developed for the simultaneous measurement of cortisol and cortisone and its performance in the diagnosis of endogenous hypercortisolism was evaluated. METHODS: 324 late-night saliva samples were analyzed from which 272 samples were derived from patients with a suspected diagnosis of endogenous hypercortisolism. Salivary cortisol levels were assayed using an electrochemiluminescent immunoassay (ECLIA, Cortisol II, Roche), and simultaneous measurement of cortisol and cortisone was performed using an LC-MS/MS method. RESULTS: A strong correlation between cortisol results measured using ECLIA and LC-MS/MS (r 2 = 0.892) was demonstrated. Receiver operating characteristics (ROC) analysis showed good diagnostic performance of cortisol and cortisone levels assayed using LC-MS/MS method and for cortisol measured using ECLIA. CONCLUSIONS: Late-night salivary cortisol and cortisone are useful parameters for the diagnosis of hypercortisolism. Using samples obtained from patients where the diagnosis of hypercortisolism is extremely challenging cut-off values for midnight salivary cortisol and cortisone measured by LC-MS/MS method were established.
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