scholarly journals Urine free cortisol measurement: Clinical perspective

Pathology ◽  
2016 ◽  
Vol 48 ◽  
pp. S17-S18
Author(s):  
Ann McCormack
Keyword(s):  
Clinical Perspective ◽  
Urine Free Cortisol ◽  
Free Cortisol

scholarly journals SUN-LB34 A Case of BMAH With Aberrant Vasopressin Adrenal Receptors

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Faheem Seedat ◽  
Nazeer Ahmed Mohamed ◽  
Nereshni Lutchman
Keyword(s):  
Cushing’S Syndrome ◽  
Salivary Cortisol ◽  
Incidental Finding ◽  
Serum Cortisol ◽  
Cushing's Syndrome ◽  
Screening Tests ◽  
Pathological Examination ◽  
Unilateral Adrenalectomy ◽  
Urine Free Cortisol ◽  
Free Cortisol

Abstract We report on a 42 - year old woman was referred following an incidental finding of bilateral macronodular (nodules > 1cm) adrenal glands after a computed tomography scan for investigation of an unrelated urological problem. Clear features of Cushing’s syndrome were elicited on initial clincal evaluation and screening tests confirmed the diagnosis biochemically: midnight salivary cortisol 15.4nmol/L (0.2 - 3nmol/L), 24 hour urine free cortisol > 662.4nmol/L (8.3 - 118.7nmol/L per 24 hours) and an 8am serum cortisol measured 951nmol/L following 1mg dexamethasone suppression test (< 50nm/L). A serum adrenocorticotropic hormone (ACTH) measured 0.3pmol/L (1.6 - 13.9pmol/L) suggesting, in light of the CT findings, an adrenal source of the elevated cortisol. Screening for aberrant adrenal receptors to catecholamines, Gastric inhibitory peptide, ACTH, vasopressin and Gonadotropin releasing hormone was performed. A positive biochemical response to ACTH and vasopressin was noted as measured serum cortisol increased to 1600pmol/L (upper limit of the assay). Following a unilateral adrenalectomy, were pathological examination of the respected adrenal gland confirmed adrenal hyperplasia, the patient had both clinical and biochemical resolution of hypercortisolemia. 2 weeks following surgery her midnight salivary cortisol measured 2.1nmol/L (0.2 - 3nmol/L) and 24 hour urine free cortisol 218nmol/L (8.3 - 118.7nmol/L per 24 hours). Her 8am ACTH also increased to 2.9pmol/L (1.6 - 13.9pmol/L). Biochemical screening of her sister showed no evidence of Cushing’s syndrome. Bilateral macronodualr hyperplasia (BMAH) represents a rare cause of Cushing’s syndrome may be diagnosed incidentally and is often associated with an insidious onset. We use this case to highlight the complexities of provocative testing for aberrant adrenal receptors which occur with BMAH and the utilization of unilateral adrenalectomy to achieve clinical and biochemical remission of Cushing’s syndrome thus, removing the need for post - operative steroid replacement following bilateral adrenalectomy.

scholarly journals Neutrophil-Lymphocyte Ratio as an Initial Screening Biomarker for Differential Diagnosis of Cushing’s Syndrome from Nonfunctional Adenoma in Patients with an Adrenal Mass

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Wei Wang ◽  
Jianing Wang ◽  
Cheng Shen ◽  
Sainan Zhu ◽  
Ying Gao ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Adrenal Mass ◽  
Serum Cortisol ◽  
Cushing's Syndrome ◽  
Initial Screening ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Late Night ◽  
Urine Free Cortisol ◽  
Free Cortisol

Objective. Assessing excess adrenal hormones is important in patients with adrenal mass. Current screening tests for excess cortisol hormones are complex, so it cannot be done sometimes due to the limited medical resources. The aim of the study was to evaluate whether the neutrophil-lymphocyte ratio (NLR) can be used as an initial screening biomarker for Cushing’s syndrome (CS) in patients with an adrenal mass. Methods. This retrospective study included a total of 185 patients with CS and 185 patients with nonfunctional adrenal adenoma (matched 1 : 1 by sex, body mass index, and discharge date). The NLR was compared between the two groups. The association between NLR and serum and urinary cortisol concentrations was analyzed, and an NLR cut-off value for CS screening was calculated. Results. NLR (3.38 (2.33, 5.45) vs. 2.13 (1.74, 3.00), P < 0.001 ) was significantly higher in the CS group than in the nonfunctional adenoma group. In CS patients, the NLR was positively associated with serum cortisol concentrations at 8 am, with 24-hour urine free cortisol and with serum cortisol after a 1 mg dexamethasone suppression test ( P < 0.001 each). An NLR cut-off of 2.2 had a sensitivity of 80.0% and a specificity of 54.05%. The weighted Youden index for the NLR was similar to that of the 24-hour urine free cortisol and late-night serum cortisol tests, which are recommended initial tests for CS diagnosis. Conclusion. The NLR may be useful for initial screening for CS among patients with an adrenal mass as an easy and convenient marker.

scholarly journals A commentary on Diagnosing Cushing’s disease in the context of renal failure

2019 ◽  
Vol 181 (4) ◽  
pp. C9-C11
Author(s):  
Hershel Raff ◽  
Eric P Cohen ◽  
James W Findling
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Failure ◽  
Cushing’S Syndrome ◽  
Salivary Cortisol ◽  
Cushing's Syndrome ◽  
Late Night ◽  
Urine Free Cortisol ◽  
Late Night Salivary Cortisol ◽  
Free Cortisol ◽  
Pituitary Adrenal Axis

The diagnosis of endogenous hypercortisolism (Cushing's syndrome) is extremely challenging. Chronic kidney disease (CKD) increases the activity of the hypothalamic-pituitary-adrenal axis making the diagnosis of Cushing's syndrome even more challenging. This is particularly so since urine free cortisol (UFC) testing is not useful in CKD. The case report by Stroud et al. in this issue of the European Journal of Endocrinology highlights this problem by finding normal UFC in a patient with pituitary ACTH-dependent Cushing's syndrome. Elevated late-night salivary cortisol (LNSC) testing was diagnostic and pituitary adenomectomy was curative. LNSC measurement is the diagnostic test of choice in patients with suspected Cushing's syndrome, particularly in the presence of CKD..

Urine-free cortisol assessment using immunoassay and gas chromatography coupled to mass spectrometry (GC-MS) – Result review

2019 ◽  
Vol 493 ◽  
pp. S340-S341
Author(s):  
A. Rubio Alaejos ◽  
S. Avellá Klaassen ◽  
S. Espinosa Fernández ◽  
B. Badal Cogul ◽  
M.Á. Elorza ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Gas Chromatography ◽  
Urine Free Cortisol ◽  
Free Cortisol

Urine Free-Cortisol Determination

JAMA ◽  
1982 ◽  
Vol 247 (14) ◽  
pp. 2002 ◽  
Author(s):  
Warner M. Burch
Keyword(s):  
Urine Free Cortisol ◽  
Free Cortisol

scholarly journals Authors’ Response: Urine Free Cortisol Assay

2003 ◽  
Vol 88 (8) ◽  
pp. 4003-4004
Author(s):  
Laurence M. Demers ◽  
Richard S. Legro
Keyword(s):  
Urine Free Cortisol ◽  
Free Cortisol

scholarly journals Limitations of nocturnal salivary cortisol and urine free cortisol in the diagnosis of mild Cushing's syndrome

2007 ◽  
Vol 157 (6) ◽  
pp. 725-731 ◽  
Author(s):  
Srividya Kidambi ◽  
Hershel Raff ◽  
James W Findling
Keyword(s):  
Cushing’S Syndrome ◽  
Salivary Cortisol ◽  
Adrenal Adenoma ◽  
High Sensitivity ◽  
Cushing's Syndrome ◽  
Urine Free Cortisol ◽  
Free Cortisol ◽  
Computer Tomography Scan ◽  
Magnetic Resonance Imaging Mri ◽  
Acth Secreting

ObjectiveCushing's syndrome (CS) is difficult to diagnose due to its nonspecific presentation. Diagnostic tests like 24-h urine free cortisol (UFC) and the overnight 1 mg dexamethasone suppression test (DST) lack sufficient sensitivity and specificity. Measurement of nocturnal salivary cortisol (NSC) is an accurate and reproducible test with a high sensitivity for CS. However, its performance in mild CS has not been reported. We present 11 cases of CS with normal or mildly elevated UFC in whom NSC was helpful in making a diagnosis.Design and methodsAll patients had at least one collection of 24-h UFC and NSC and eight had an overnight 1 mg DST. The number of NSC measurements per patient was determined by the clinical index of suspicion and the results of initial testing. Imaging studies included magnetic resonance imaging (MRI) of pituitary or computer tomography scan of abdomen.ResultsOnly four out of eleven patients had elevations in UFC and none were >2 times the upper limit of normal. Seven out of eight had an abnormal DST. All patients had some elevated NSCs (14–100%). Out of eleven patients, six had an abnormality in the pituitary gland found by MRI and two out of eleven had adrenal masses. The remaining three had normal pituitary MRI but had inferior petrosal sinus (IPS) sampling indicating Cushing's disease. All patients had appropriate surgery, and histopathology of all except one was suggestive of either a cortisol-producing adrenal adenoma or an ACTH-secreting pituitary adenoma.ConclusionNeither a normal UFC nor a normal NSC excludes mild CS. Multiple samples (urine/saliva) and DST are needed to make the diagnosis of mild CS.

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