Late-Night Salivary Cortisol: Cut-Off Definition and Diagnostic Accuracy for Cushing’s Syndrome in a Portuguese Population
Introduction: Diagnosis of Cushing’s syndrome remains a challenge in clinical endocrinology. Even though late-night salivary cortisol is used as screening tool, individualized cut-off levels for each population must be defined. Material and Methods: Three groups of subjects were studied: normal subj...
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| Format: | Article |
| Language: | English |
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Ordem dos Médicos
2019-05-01
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| Series: | Acta Médica Portuguesa |
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| Online Access: | https://actamedicaportuguesa.com/revista/index.php/amp/article/view/11265 |
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| author | Adriana De Sousa Lages João Gonçalo Frade Diana Oliveira Isabel Paiva Patrícia Oliveira Alexandre Rebelo-Marques Francisco Carrilho |
| author_facet | Adriana De Sousa Lages João Gonçalo Frade Diana Oliveira Isabel Paiva Patrícia Oliveira Alexandre Rebelo-Marques Francisco Carrilho |
| author_sort | Adriana De Sousa Lages |
| collection | DOAJ |
| description | Introduction: Diagnosis of Cushing’s syndrome remains a challenge in clinical endocrinology. Even though late-night salivary cortisol is used as screening tool, individualized cut-off levels for each population must be defined.
Material and Methods: Three groups of subjects were studied: normal subjects, suspected and proven Cushing’s syndrome. Salivary cortisol was measured using an automated electrochemiluminescence assay. The functional sensitivity of the assay is 0.018 μg/dL. The diagnostic cut-off level was defined by Receiver Operating Characteristic curve and Youden’s J index.
Results: We studied 127 subjects: 57 healthy volunteers, 39 patients with suspected and 31 with proven Cushing’s syndrome. 2.5th - 97.5th percentile of the late-night salivary cortisol concentrations in normal subjects was 0.054 to 0.1827 μg/dL. Receiver Operating Characteristic curve analysis showed an area under the curve of 0.9881 (p < 0.0001). A cut-off point of 0.1 μg/dL provided a sensitivity of 96.77% (95% CI 83.3 - 99.92%) and specificity of 91.23% (95% CI 80.7 - 97.09%). There was a significant correlation between latenight salivary cortisol and late-night serum cortisol (R = 0.6977; p < 0.0001) and urinary free cortisol (R = 0.5404; p = 0.0025) in proven Cushing’s syndrome group.
Discussion: The mean ± SD late-night salivary cortisol concentration in patients with proven Cushing’s syndrome (0.6798 ± 0.52 μg/ dL) was significantly higher (p < 0.0001). In our population, the late-night salivary cortisol cut-off was 0.1 μg/dL with high sensitivity and specificity.
Conclusion: Late-night salivary cortisol has excellent diagnostic accuracy, making it a highly reliable, noninvasive, screening tool for outpatient assessment. Given its convenience and diagnostic accuracy, late-night salivary cortisol may be added to other traditional screening tests on hypercortisolism. |
| first_indexed | 2024-12-10T14:28:44Z |
| format | Article |
| id | doaj.art-db05cc3c03224081b7b90e695e8ca70a |
| institution | Directory Open Access Journal |
| issn | 1646-0758 1646-0758 |
| language | English |
| last_indexed | 2024-12-10T14:28:44Z |
| publishDate | 2019-05-01 |
| publisher | Ordem dos Médicos |
| record_format | Article |
| series | Acta Médica Portuguesa |
| spelling | doaj.art-db05cc3c03224081b7b90e695e8ca70a2022-12-22T01:44:59ZengOrdem dos MédicosActa Médica Portuguesa1646-07581646-07582019-05-0132538138710.20344/amp.112654889Late-Night Salivary Cortisol: Cut-Off Definition and Diagnostic Accuracy for Cushing’s Syndrome in a Portuguese PopulationAdriana De Sousa Lages0João Gonçalo Frade1Diana Oliveira2Isabel Paiva3Patrícia Oliveira4Alexandre Rebelo-Marques5Francisco Carrilho6Endocrinology, Diabetes and Metabolism Department. Coimbra Hospital and University Center. Coimbra.Clinical Pathology Department. Coimbra Hospital and University Center. Coimbra. School of Health Sciences. Polytechnic Institute of Leiria. LeiriaEndocrinology, Diabetes and Metabolism Department. Coimbra Hospital and University Center. Coimbra.Endocrinology, Diabetes and Metabolism Department. Coimbra Hospital and University Center. Coimbra.Endocrinology, Diabetes and Metabolism Department. Coimbra Hospital and University Center. Coimbra.Family Health Unit from Condeixa. Agrupamento de Centros de Saúde do Baixo Mondego, Administração Regional de Saúde do Centro. Condeixa-A-Nova. Faculty of Medicine. University of Coimbra. Coimbra.Endocrinology, Diabetes and Metabolism Department. Coimbra Hospital and University Center. Coimbra.Introduction: Diagnosis of Cushing’s syndrome remains a challenge in clinical endocrinology. Even though late-night salivary cortisol is used as screening tool, individualized cut-off levels for each population must be defined. Material and Methods: Three groups of subjects were studied: normal subjects, suspected and proven Cushing’s syndrome. Salivary cortisol was measured using an automated electrochemiluminescence assay. The functional sensitivity of the assay is 0.018 μg/dL. The diagnostic cut-off level was defined by Receiver Operating Characteristic curve and Youden’s J index. Results: We studied 127 subjects: 57 healthy volunteers, 39 patients with suspected and 31 with proven Cushing’s syndrome. 2.5th - 97.5th percentile of the late-night salivary cortisol concentrations in normal subjects was 0.054 to 0.1827 μg/dL. Receiver Operating Characteristic curve analysis showed an area under the curve of 0.9881 (p < 0.0001). A cut-off point of 0.1 μg/dL provided a sensitivity of 96.77% (95% CI 83.3 - 99.92%) and specificity of 91.23% (95% CI 80.7 - 97.09%). There was a significant correlation between latenight salivary cortisol and late-night serum cortisol (R = 0.6977; p < 0.0001) and urinary free cortisol (R = 0.5404; p = 0.0025) in proven Cushing’s syndrome group. Discussion: The mean ± SD late-night salivary cortisol concentration in patients with proven Cushing’s syndrome (0.6798 ± 0.52 μg/ dL) was significantly higher (p < 0.0001). In our population, the late-night salivary cortisol cut-off was 0.1 μg/dL with high sensitivity and specificity. Conclusion: Late-night salivary cortisol has excellent diagnostic accuracy, making it a highly reliable, noninvasive, screening tool for outpatient assessment. Given its convenience and diagnostic accuracy, late-night salivary cortisol may be added to other traditional screening tests on hypercortisolism.https://actamedicaportuguesa.com/revista/index.php/amp/article/view/11265Circadian RhythmCushing Syndrome/diagnosisDiagnostic Techniques, EndocrineHydrocortisoneSaliva |
| spellingShingle | Adriana De Sousa Lages João Gonçalo Frade Diana Oliveira Isabel Paiva Patrícia Oliveira Alexandre Rebelo-Marques Francisco Carrilho Late-Night Salivary Cortisol: Cut-Off Definition and Diagnostic Accuracy for Cushing’s Syndrome in a Portuguese Population Acta Médica Portuguesa Circadian Rhythm Cushing Syndrome/diagnosis Diagnostic Techniques, Endocrine Hydrocortisone Saliva |
| title | Late-Night Salivary Cortisol: Cut-Off Definition and Diagnostic Accuracy for Cushing’s Syndrome in a Portuguese Population |
| title_full | Late-Night Salivary Cortisol: Cut-Off Definition and Diagnostic Accuracy for Cushing’s Syndrome in a Portuguese Population |
| title_fullStr | Late-Night Salivary Cortisol: Cut-Off Definition and Diagnostic Accuracy for Cushing’s Syndrome in a Portuguese Population |
| title_full_unstemmed | Late-Night Salivary Cortisol: Cut-Off Definition and Diagnostic Accuracy for Cushing’s Syndrome in a Portuguese Population |
| title_short | Late-Night Salivary Cortisol: Cut-Off Definition and Diagnostic Accuracy for Cushing’s Syndrome in a Portuguese Population |
| title_sort | late night salivary cortisol cut off definition and diagnostic accuracy for cushing s syndrome in a portuguese population |
| topic | Circadian Rhythm Cushing Syndrome/diagnosis Diagnostic Techniques, Endocrine Hydrocortisone Saliva |
| url | https://actamedicaportuguesa.com/revista/index.php/amp/article/view/11265 |
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