F Ceccato1, G Marcelli2, M Martino2, C Concettoni2, M Brugia2, L Trementino2, G Michetti2, G Arnaldi2. 1. Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Via Ospedale Civile, 105, 35128, Padua, PD, Italy. ceccato.filippo@gmail.com. 2. Division of Endocrinology, Department of Clinical and Molecular Sciences (DISCLIMO), Umberto I Hospital, Polytechnic University of Marche, Via Tronto 10B, 60020, Torrette, AN, Italy.
Abstract
INTRODUCTION AND AIM: A prompt diagnosis of Cushing's Syndrome (CS) in high-risk populations is mandatory: 1-mg dexamethasone suppression test (1-mg DST), late night salivary cortisol (LNSC), and urinary-free cortisol (UFC) are recommended, despite thresholds calculated in retrospective studies. Our aim was to study the diagnostic accuracy of LNSC measured with chemiluminescence assay in a prospective study, confirming discrepancies with mass spectrometry (MS). MATERIALS AND METHODS: We enrolled 117 controls and 164 suspected CS (CS = 47, non-CS = 117). In case of increased LNSC, high clinical suspicion of CS or adrenal incidentaloma, patients were hospitalized to exclude/confirm CS. RESULTS: LNSC levels were higher in patients with suspected CS, CS, and non-CS than controls. Considering 16 nmol/L as threshold for CS, overall LNSC revealed SE 97% and SP 84% in the whole group of subjects considered, achieving positive/negative likelihood ratio of 5.56/0.045, respectively. 35 out of 81 subjects with increased LNSC were non-CS (15 diabetic and 20 obese): considering only those patients with increased likelihood to have a CS (the non-CS patients) SP decreased to 70%, and further reduced to 60% if we discharged subjects with adrenal incidentaloma. MS analyses reduced partially the number of false-positive LNSC. CONCLUSIONS: LNSC measured in automated chemiluminescence is reliable in clinical practice: it present a high diagnostic accuracy to exclude hypercortisolism in patients with normal cortisol levels. MS could be used to reduce the number of false-positive results; nevertheless, some non-CS subjects with functional hypercortisolism could have a mild impairment of cortisol rhythm.
INTRODUCTION AND AIM: A prompt diagnosis of Cushing's Syndrome (CS) in high-risk populations is mandatory: 1-mg dexamethasone suppression test (1-mg DST), late night salivary cortisol (LNSC), and urinary-free cortisol (UFC) are recommended, despite thresholds calculated in retrospective studies. Our aim was to study the diagnostic accuracy of LNSC measured with chemiluminescence assay in a prospective study, confirming discrepancies with mass spectrometry (MS). MATERIALS AND METHODS: We enrolled 117 controls and 164 suspected CS (CS = 47, non-CS = 117). In case of increased LNSC, high clinical suspicion of CS or adrenal incidentaloma, patients were hospitalized to exclude/confirm CS. RESULTS: LNSC levels were higher in patients with suspected CS, CS, and non-CS than controls. Considering 16 nmol/L as threshold for CS, overall LNSC revealed SE 97% and SP 84% in the whole group of subjects considered, achieving positive/negative likelihood ratio of 5.56/0.045, respectively. 35 out of 81 subjects with increased LNSC were non-CS (15 diabetic and 20 obese): considering only those patients with increased likelihood to have a CS (the non-CS patients) SP decreased to 70%, and further reduced to 60% if we discharged subjects with adrenal incidentaloma. MS analyses reduced partially the number of false-positive LNSC. CONCLUSIONS: LNSC measured in automated chemiluminescence is reliable in clinical practice: it present a high diagnostic accuracy to exclude hypercortisolism in patients with normal cortisol levels. MS could be used to reduce the number of false-positive results; nevertheless, some non-CS subjects with functional hypercortisolism could have a mild impairment of cortisol rhythm.
Entities:
Keywords:
Cushing’s syndrome; Diagnosis; Late night salivary cortisol; Liquid chromatography–tandem mass spectrometry
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: R Kurdi Zerikly; L Amiri; C Faiman; M Gupta; R J Singh; B Nutter; L Kennedy; B Hatipoglu; R J Weil; A H Hamrahian Journal: J Clin Endocrinol Metab Date: 2010-07-14 Impact factor: 5.958
Authors: Timo Deutschbein; Martina Broecker-Preuss; Jörg Flitsch; Andrea Jaeger; Ricarda Althoff; Martin K Walz; Klaus Mann; Stephan Petersenn Journal: Eur J Endocrinol Date: 2012-01-03 Impact factor: 6.664
Authors: Miguel Debono; Mike Bradburn; Matthew Bull; Barney Harrison; Richard J Ross; John Newell-Price Journal: J Clin Endocrinol Metab Date: 2014-12 Impact factor: 5.958
Authors: L Bianchi; B Campi; M R Sessa; G De Marco; E Ferrarini; R Zucchi; C Marcocci; P Vitti; L Manetti; A Saba; P Agretti Journal: J Endocrinol Invest Date: 2019-04-22 Impact factor: 4.256
Authors: Joshua Kannankeril; Ty Carroll; James W Findling; Bradley Javorsky; Ian L Gunsolus; Jonathan Phillips; Hershel Raff Journal: J Endocr Soc Date: 2020-07-24