Reproducibility of Late-Night Salivary Cortisol Using an Automated Immunoassay System and Performance of One or Two Samples in the Diagnosis of Cushing Syndrome

2011 ◽  
pp. P3-570-P3-570
Author(s):  
Carmen MA Carrasco ◽  
Marisol Garcia ◽  
Manuela Goycoolea ◽  
Jaime Cerda ◽  
Jerome Bertherat ◽  
...  
Keyword(s):  
Salivary Cortisol ◽  
Cushing Syndrome ◽  
Late Night ◽  
Late Night Salivary Cortisol ◽  
Two Samples ◽  
And Performance ◽  
Automated Immunoassay

Influence of age, gender and body mass index on late-night salivary cortisol in healthy adults

2017 ◽  
Vol 55 (12) ◽  
Author(s):  
Sabrina Coelli ◽  
Camila Bergonsi Farias ◽  
Ariana Aguiar Soares ◽  
Gabriele Martins Crescente ◽  
Vânia Naomi Hirakata ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Salivary Cortisol ◽  
Cushing Syndrome ◽  
Reference Value ◽  
Healthy Adults ◽  
Healthy Population ◽  
Cross Sectional ◽  
Late Night ◽  
Late Night Salivary Cortisol

AbstractBackground:Late-night salivary cortisol (LNSC) is one of the most reliable tests to screen for endogenous Cushing syndrome. This test is simple, inexpensive and noninvasive and has high sensitivity and specificity. The aim of our study was to analyze the putative influence of age, gender and body mass index (BMI) on LNSC levels in a healthy population.Methods:Cross-sectional study conducted in healthy adults. Midnight saliva samples were collected at home. Participants refrained from teeth brushing, eating or drinking for 2 h prior to collection. Salivary cortisol measured by electrochemiluminescence immunoassay (ECLIA). The study was approved by the Ethics Committee of the hospital (number 140073).Results:We evaluated 122 nonsmoking healthy volunteers. Mean age was 35±14 years (range, 18–74 years); 63% were women. Mean BMI was 24±3 kg/mConclusions:The maximum reference value (P97.5) of LNSC was set at 8.3 nmol/L (0.3 μg/dL) using ECLIA. Advanced age was associated with higher LNSC levels, with no evident influence of gender or BMI.

scholarly journals Use of late-night salivary cortisol to monitor response to medical treatment in Cushing’s disease

2020 ◽  
Vol 182 (2) ◽  
pp. 207-217 ◽  
Author(s):  
John Newell-Price ◽  
Rosario Pivonello ◽  
Antoine Tabarin ◽  
Maria Fleseriu ◽  
Przemysław Witek ◽  
...  
Keyword(s):  
Cushing’S Disease ◽  
Salivary Cortisol ◽  
Clinical Signs ◽  
Urinary Free Cortisol ◽  
Phase Iii ◽  
Cushing's Disease ◽  
Late Night ◽  
Late Night Salivary Cortisol ◽  
Free Cortisol ◽  
Two Samples

Objective Monitoring of patients with Cushing’s disease on cortisol-lowering drugs is usually performed with urinary free cortisol (UFC). Late-night salivary cortisol (LNSC) has an established role in screening for hypercortisolism and can help to detect the loss of cortisol circadian rhythm. Less evidence exists regarding the usefulness of LNSC in monitoring pharmacological response in Cushing’s disease. Design Exploratory analysis evaluating LNSC during a Phase III study of long-acting pasireotide in Cushing’s disease (clinicaltrials.gov: NCT01374906). Methods Mean LNSC (mLNSC) was calculated from two samples, collected on the same days as the first two of three 24-h urine samples (used to calculate mean UFC [mUFC]). Clinical signs of hypercortisolism were evaluated over time. Results At baseline, 137 patients had evaluable mLNSC measurements; 91.2% had mLNSC exceeding the upper limit of normal (ULN; 3.2 nmol/L). Of patients with evaluable assessments at month 12 (n = 92), 17.4% had both mLNSC ≤ULN and mUFC ≤ULN; 22.8% had mLNSC ≤ULN, and 45.7% had mUFC ≤ULN. There was high variability in LNSC (intra-patient coefficient of variation (CV): 49.4%) and UFC (intra-patient CV: 39.2%). mLNSC levels decreased over 12 months of treatment and paralleled changes in mUFC. Moderate correlation was seen between mLNSC and mUFC (Spearman’s correlation: ρ = 0.50 [all time points pooled]). Greater improvements in systolic/diastolic blood pressure and weight were seen in patients with both mLNSC ≤ULN and mUFC ≤ULN. Conclusion mUFC and mLNSC are complementary measurements for monitoring treatment response in Cushing’s disease, with better clinical outcomes seen for patients in whom both mUFC and mLNSC are controlled.

Late-Night Salivary Cortisol for the Diagnosis of Cushing Syndrome: A Meta-Analysis

2009 ◽  
Vol 15 (4) ◽  
pp. 335-342 ◽  
Author(s):  
Ty Carroll ◽  
Hershel Raff ◽  
James Findling
Keyword(s):  
Salivary Cortisol ◽  
Cushing Syndrome ◽  
Meta Analysis ◽  
Late Night ◽  
Late Night Salivary Cortisol

scholarly journals Measurement of late-night salivary cortisol with an automated immunoassay system

2006 ◽  
Vol 44 (12) ◽  
Author(s):  
Michael Vogeser ◽  
Jürgen Durner ◽  
Ewald Seliger ◽  
Christoph Auernhammer
Keyword(s):  
Salivary Cortisol ◽  
Late Night ◽  
Late Night Salivary Cortisol ◽  
Automated Immunoassay

AbstractClin Chem Lab Med 2006;44:1441–5.

scholarly journals Bedtime Salivary Cortisol and Cortisone by LC-MS/MS in Healthy Adult Subjects: Evaluation of Sampling Time

2019 ◽  
Vol 3 (8) ◽  
pp. 1631-1640 ◽  
Author(s):  
Hershel Raff ◽  
Jonathan M Phillips
Keyword(s):  
Salivary Cortisol ◽  
Healthy Adult ◽  
Cushing Syndrome ◽  
Cortisol Awakening Response ◽  
Late Night ◽  
Upper Limit ◽  
Chromatography Tandem Mass Spectrometry ◽  
Late Night Salivary Cortisol ◽  
The Us ◽  
Liquid Chromatography Tandem Mass

AbstractThe measurement of late-night salivary cortisol is a mainstay in the diagnosis of Cushing syndrome. Furthermore, the measurement of salivary cortisol is useful in assessing the cortisol awakening response. Because the salivary glands express 11-β-hydroxysteroid dehydrogenase, the measurement of salivary cortisone may improve the performance of salivary corticosteroid measurements. We measured salivary cortisol by enzyme immunoassay (EIA) and salivary cortisol and cortisone by liquid chromatography-tandem mass spectrometry (LC-MS/MS) in only 50 µL of saliva sampled from 54 healthy subjects (aged 20 to 64 years). We allowed patients to sample at their normal bedtime (2025 to 2400 hours) to answer a common question as to whether sampling at the normal bedtime is equivalent to the standard required sampling at 2300 to 2400 hours. We found that the salivary cortisol and cortisone results by LC-MS/MS correlated well with salivary cortisol measured with the US Food and Drug Administration-cleared EIA. Furthermore, the upper limit of normal of salivary cortisol by EIA for bedtime samples was lower than the previously published upper limit of normal with sampling required at 2300 to 2400 hours. There were no significant effects of age or sex on any of the salivary steroid measurements. We conclude that (i) salivary cortisol and cortisone can be reliably measured by LC-MS/MS in small volumes of saliva and (ii) that patients can be evaluated using saliva sampled at their normal bedtime, rather than being required to stay awake until 2300 to 2400 hours.

scholarly journals Prospective Evaluation of Late-Night Salivary Cortisol and Cortisone by EIA and LC-MS/MS in Suspected Cushing Syndrome

2020 ◽  
Vol 4 (10) ◽  
Author(s):  
Joshua Kannankeril ◽  
Ty Carroll ◽  
James W Findling ◽  
Bradley Javorsky ◽  
Ian L Gunsolus ◽  
...  
Keyword(s):  
Salivary Cortisol ◽  
Cushing Syndrome ◽  
High Sensitivity ◽  
Lower Sensitivity ◽  
First Line ◽  
Cushing Disease ◽  
Late Night ◽  
Late Night Salivary Cortisol ◽  
Liquid Chromatography Tandem Mass ◽  
Very High

Abstract Context Late-night salivary cortisol (LNSC) measured by enzyme immunoassay (EIA-F) is a first-line screening test for Cushing syndrome (CS) with a reported sensitivity and specificity of >90%. However, liquid chromatography-tandem mass spectrometry, validated to measure salivary cortisol (LCMS-F) and cortisone (LCMS-E), has been proposed to be superior diagnostically. Objective, Setting, and Main Outcome Measures Prospectively evaluate the diagnostic performance of EIA-F, LCMS-F, and LCMS-E in 1453 consecutive late-night saliva samples from 705 patients with suspected CS. Design Patients grouped by the presence or absence of at least one elevated salivary steroid result and then subdivided by diagnosis. Results We identified 283 patients with at least one elevated salivary result; 45 had an established diagnosis of neoplastic hypercortisolism (CS) for which EIA-F had a very high sensitivity (97.5%). LCMS-F and LCMS-E had lower sensitivity but higher specificity than EIA-F. EIA-F had poor sensitivity (31.3%) for adrenocorticotropic hormone (ACTH)-independent CS (5 patients with at least 1 and 11 without any elevated salivary result). In patients with Cushing disease (CD), most nonelevated LCMS-F results were in patients with persistent/recurrent CD; their EIA-F levels were lower than in patients with newly diagnosed CD. Conclusions Since the majority of patients with ≥1 elevated late-night salivary cortisol or cortisone result did not have CS, a single elevated level has poor specificity and positive predictive value. LNSC measured by EIA is a sensitive test for ACTH-dependent Cushing syndrome but not for ACTH-independent CS. We suggest that neither LCMS-F nor LCMS-E improves the sensitivity of late-night EIA-F for CS.

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