Late-Night Salivary Cortisol: Cut-Off Definition and Diagnostic Accuracy for Cushing’s Syndrome in a Portuguese Population
Autor(a) principal: | |
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Data de Publicação: | 2019 |
Outros Autores: | , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11265 |
Resumo: | 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. |
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Late-Night Salivary Cortisol: Cut-Off Definition and Diagnostic Accuracy for Cushing’s Syndrome in a Portuguese PopulationCortisol Salivar Noturno: Definição de Ponto de Corte e Valor Diagnóstico na Síndrome de Cushing numa População PortuguesaCircadian RhythmCushing Syndrome/diagnosisDiagnostic TechniquesEndocrineHydrocortisoneSalivaHydrocortisonaRitmo CircadianoSalivaSíndrome de Cushing/diagnósticoTécnicas de Diagnóstico EndócrinoIntroduction: 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.Introdução: O diagnóstico de síndrome de Cushing continua a ser um desafio complexo. Apesar do cortisol salivar noturno ser utilizado como teste de rastreio, a definição de um valor diagnóstico deverá ser individualizada.Material e Métodos: Foram estudados 3 grupos: voluntários saudáveis, com suspeita clínica e com diagnóstico estabelecido de Síndrome de Cushing. O doseamento de cortisol salivar foi realizado por eletroquimioluminescência automatizado. A definição do ponto-de-corte foi obtida pela curva Receiver Operating Characteristic e índice J de Youden.Resultados: Entre os 127 indivíduos, 57 pertenciam ao grupo de voluntários saudáveis, 39 com suspeita clínica e 31 com diagnóstico estabelecido. O percentil 2,5 – 97,5 de cortisol salivar noturno no grupo de voluntários saudáveis foi 0,054 – 0,1827 μg/dL. A análise da curva Receiver Operating Characteristic revelou uma área abaixo da curva de 0,9881 (p < 0,0001) e o ponto-de-corte de 0,1 μg/dL com sensibilidade de 96,77% e especificidade de 91,23%. Verificou-se uma correlação significativa entre cortisol salivar noturno e o cortisol sérico noturno (R = 0,6977; p < 0,0001), bem como, com cortisol livre urinário (R = 0,5404; p = 0,0025) no grupo com diagnóstico estabelecido.Discussão: A concentração média ± DP cortisol salivar noturno no grupo com diagnóstico estabelecido (0,6798 ± 0,52 μg/dL) foi significativamente superior aos restantes grupos. Na nossa população, o valor de ponto-de-corte foi de 0,1 μg/dL com elevada sensibilidade e especificidade.Conclusão: Os resultados demonstram uma excelente acurácia do cortisol salivar noturno. Dada a sua conveniência e elevada exatidão, o doseamento de cortisol salivar noturno poderá ser adicionado aos testes de rastreio tradicionais para estudo de hipercortisolismo.Ordem dos Médicos2019-05-31info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfimage/pngimage/pngimage/pngimage/pngapplication/pdfapplication/pdfapplication/pdfapplication/vnd.openxmlformats-officedocument.wordprocessingml.documentapplication/pdfhttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11265oai:ojs.www.actamedicaportuguesa.com:article/11265Acta Médica Portuguesa; Vol. 32 No. 5 (2019): May; 381-387Acta Médica Portuguesa; Vol. 32 N.º 5 (2019): Maio; 381-3871646-07580870-399Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11265https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11265/5698https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11265/10686https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11265/10687https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11265/10688https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11265/10689https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11265/10823https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11265/10824https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11265/11018https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11265/11019https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11265/11066Direitos de Autor (c) 2019 Acta Médica Portuguesainfo:eu-repo/semantics/openAccessLages, Adriana De SousaFrade, João GonçaloOliveira, DianaPaiva, IsabelOliveira, PatríciaRebelo-Marques, AlexandreCarrilho, Francisco2022-12-20T11:06:13Zoai:ojs.www.actamedicaportuguesa.com:article/11265Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:20:01.287074Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Late-Night Salivary Cortisol: Cut-Off Definition and Diagnostic Accuracy for Cushing’s Syndrome in a Portuguese Population Cortisol Salivar Noturno: Definição de Ponto de Corte e Valor Diagnóstico na Síndrome de Cushing numa População Portuguesa |
title |
Late-Night Salivary Cortisol: Cut-Off Definition and Diagnostic Accuracy for Cushing’s Syndrome in a Portuguese Population |
spellingShingle |
Late-Night Salivary Cortisol: Cut-Off Definition and Diagnostic Accuracy for Cushing’s Syndrome in a Portuguese Population Lages, Adriana De Sousa Circadian Rhythm Cushing Syndrome/diagnosis Diagnostic Techniques Endocrine Hydrocortisone Saliva Hydrocortisona Ritmo Circadiano Saliva Síndrome de Cushing/diagnóstico Técnicas de Diagnóstico Endócrino |
title_short |
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_sort |
Late-Night Salivary Cortisol: Cut-Off Definition and Diagnostic Accuracy for Cushing’s Syndrome in a Portuguese Population |
author |
Lages, Adriana De Sousa |
author_facet |
Lages, Adriana De Sousa Frade, João Gonçalo Oliveira, Diana Paiva, Isabel Oliveira, Patrícia Rebelo-Marques, Alexandre Carrilho, Francisco |
author_role |
author |
author2 |
Frade, João Gonçalo Oliveira, Diana Paiva, Isabel Oliveira, Patrícia Rebelo-Marques, Alexandre Carrilho, Francisco |
author2_role |
author author author author author author |
dc.contributor.author.fl_str_mv |
Lages, Adriana De Sousa Frade, João Gonçalo Oliveira, Diana Paiva, Isabel Oliveira, Patrícia Rebelo-Marques, Alexandre Carrilho, Francisco |
dc.subject.por.fl_str_mv |
Circadian Rhythm Cushing Syndrome/diagnosis Diagnostic Techniques Endocrine Hydrocortisone Saliva Hydrocortisona Ritmo Circadiano Saliva Síndrome de Cushing/diagnóstico Técnicas de Diagnóstico Endócrino |
topic |
Circadian Rhythm Cushing Syndrome/diagnosis Diagnostic Techniques Endocrine Hydrocortisone Saliva Hydrocortisona Ritmo Circadiano Saliva Síndrome de Cushing/diagnóstico Técnicas de Diagnóstico Endócrino |
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. |
publishDate |
2019 |
dc.date.none.fl_str_mv |
2019-05-31 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11265 oai:ojs.www.actamedicaportuguesa.com:article/11265 |
url |
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11265 |
identifier_str_mv |
oai:ojs.www.actamedicaportuguesa.com:article/11265 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11265 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11265/5698 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11265/10686 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11265/10687 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11265/10688 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11265/10689 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11265/10823 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11265/10824 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11265/11018 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11265/11019 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11265/11066 |
dc.rights.driver.fl_str_mv |
Direitos de Autor (c) 2019 Acta Médica Portuguesa info:eu-repo/semantics/openAccess |
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Direitos de Autor (c) 2019 Acta Médica Portuguesa |
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openAccess |
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application/pdf image/png image/png image/png image/png application/pdf application/pdf application/pdf application/vnd.openxmlformats-officedocument.wordprocessingml.document application/pdf |
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Ordem dos Médicos |
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Ordem dos Médicos |
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Acta Médica Portuguesa; Vol. 32 No. 5 (2019): May; 381-387 Acta Médica Portuguesa; Vol. 32 N.º 5 (2019): Maio; 381-387 1646-0758 0870-399X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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