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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...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Bioscientifica Ltd
2022
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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. |
format | Online Article Text |
id | pubmed-9254321 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Bioscientifica Ltd |
record_format | MEDLINE/PubMed |
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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