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Late-night salivary cortisol and cortisone should be the initial screening test for Cushing’s syndrome

Endogenous Cushing’s syndrome (CS) poses considerable diagnostic challenges. Although late-night salivary cortisol (LNSC) is recommended as a first-line screening investigation, it remains the least widely used test in many countries. The combined measurement of LNSC and late-night salivary cortison...

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Autores principales: Mohamed, Ramjan Sanas, Abuelgasim, Biyaser, Barker, Sally, Prabhudev, Hemanth, Martin, Niamh M, Meeran, Karim, Williams, Emma L, Darch, Sarah, Matthew, Whitlock, Tan, Tricia, Wernig, Florian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bioscientifica Ltd 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9254321/
https://www.ncbi.nlm.nih.gov/pubmed/35671282
http://dx.doi.org/10.1530/EC-22-0050
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author Mohamed, Ramjan Sanas
Abuelgasim, Biyaser
Barker, Sally
Prabhudev, Hemanth
Martin, Niamh M
Meeran, Karim
Williams, Emma L
Darch, Sarah
Matthew, Whitlock
Tan, Tricia
Wernig, Florian
author_facet Mohamed, Ramjan Sanas
Abuelgasim, Biyaser
Barker, Sally
Prabhudev, Hemanth
Martin, Niamh M
Meeran, Karim
Williams, Emma L
Darch, Sarah
Matthew, Whitlock
Tan, Tricia
Wernig, Florian
author_sort Mohamed, Ramjan Sanas
collection PubMed
description Endogenous Cushing’s syndrome (CS) poses considerable diagnostic challenges. Although late-night salivary cortisol (LNSC) is recommended as a first-line screening investigation, it remains the least widely used test in many countries. The combined measurement of LNSC and late-night salivary cortisone (LNS cortisone) has shown to further improve diagnostic accuracy. We present a retrospective study in a tertiary referral centre comparing LNSC, LNS cortisone, overnight dexamethasone suppression test, low-dose dexamethasone suppression test and 24-h urinary free cortisol results of patients investigated for CS. Patients were categorised into those who had CS (21 patients) and those who did not (33 patients). LNSC had a sensitivity of 95% and a specificity of 91%. LNS cortisone had a specificity of 100% and a sensitivity of 86%. With an optimal cut-off for LNS cortisone of >14.5 nmol/L the sensitivity was 95.2%, and the specificity was 100% with an area under the curve of 0.997, for diagnosing CS. Saliva collection is non-invasive and can be carried out at home. We therefore advocate simultaneous measurement of LNSC and LNS cortisone as the first-line screening test to evaluate patients with suspected CS.
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spelling pubmed-92543212022-07-05 Late-night salivary cortisol and cortisone should be the initial screening test for Cushing’s syndrome Mohamed, Ramjan Sanas Abuelgasim, Biyaser Barker, Sally Prabhudev, Hemanth Martin, Niamh M Meeran, Karim Williams, Emma L Darch, Sarah Matthew, Whitlock Tan, Tricia Wernig, Florian Endocr Connect Research Endogenous Cushing’s syndrome (CS) poses considerable diagnostic challenges. Although late-night salivary cortisol (LNSC) is recommended as a first-line screening investigation, it remains the least widely used test in many countries. The combined measurement of LNSC and late-night salivary cortisone (LNS cortisone) has shown to further improve diagnostic accuracy. We present a retrospective study in a tertiary referral centre comparing LNSC, LNS cortisone, overnight dexamethasone suppression test, low-dose dexamethasone suppression test and 24-h urinary free cortisol results of patients investigated for CS. Patients were categorised into those who had CS (21 patients) and those who did not (33 patients). LNSC had a sensitivity of 95% and a specificity of 91%. LNS cortisone had a specificity of 100% and a sensitivity of 86%. With an optimal cut-off for LNS cortisone of >14.5 nmol/L the sensitivity was 95.2%, and the specificity was 100% with an area under the curve of 0.997, for diagnosing CS. Saliva collection is non-invasive and can be carried out at home. We therefore advocate simultaneous measurement of LNSC and LNS cortisone as the first-line screening test to evaluate patients with suspected CS. Bioscientifica Ltd 2022-06-07 /pmc/articles/PMC9254321/ /pubmed/35671282 http://dx.doi.org/10.1530/EC-22-0050 Text en © The authors https://creativecommons.org/licenses/by-nc-nd/4.0/This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
spellingShingle Research
Mohamed, Ramjan Sanas
Abuelgasim, Biyaser
Barker, Sally
Prabhudev, Hemanth
Martin, Niamh M
Meeran, Karim
Williams, Emma L
Darch, Sarah
Matthew, Whitlock
Tan, Tricia
Wernig, Florian
Late-night salivary cortisol and cortisone should be the initial screening test for Cushing’s syndrome
title Late-night salivary cortisol and cortisone should be the initial screening test for Cushing’s syndrome
title_full Late-night salivary cortisol and cortisone should be the initial screening test for Cushing’s syndrome
title_fullStr Late-night salivary cortisol and cortisone should be the initial screening test for Cushing’s syndrome
title_full_unstemmed Late-night salivary cortisol and cortisone should be the initial screening test for Cushing’s syndrome
title_short Late-night salivary cortisol and cortisone should be the initial screening test for Cushing’s syndrome
title_sort late-night salivary cortisol and cortisone should be the initial screening test for cushing’s syndrome
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9254321/
https://www.ncbi.nlm.nih.gov/pubmed/35671282
http://dx.doi.org/10.1530/EC-22-0050
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