Clinical utility of late-night and post-overnight dexamethasone suppression salivary cortisone for the investigation of Cushing's syndrome
| Autor: | C M Ng, T K Lam, Y C Au Yeung, C C Shek, Y P Iu, S C Tiu, C H Choi |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Saliva Hydrocortisone Anti-Inflammatory Agents 030209 endocrinology & metabolism Urine Sensitivity and Specificity Dexamethasone Salivary Glands 03 medical and health sciences Cushing syndrome Young Adult 0302 clinical medicine Predictive Value of Tests Internal medicine Urinary free cortisol medicine Humans Cushing Syndrome Aged Aged 80 and over S syndrome business.industry General Medicine Middle Aged medicine.disease Circadian Rhythm Cortisone Dexamethasone suppression Endocrinology ROC Curve 030220 oncology & carcinogenesis Female business medicine.drug Chromatography Liquid |
| Zdroj: | Hong Kong medical journal = Xianggang yi xue za zhi. 23(6) |
| ISSN: | 1024-2708 |
| Popis: | Introduction There is a pressing need to identify diagnostic testing for Cushing's syndrome that can be achieved with ease and at low cost. This study aimed to explore the usefulness of late-night and post-overnight 1-mg dexamethasone suppression salivary cortisone, as measured by liquid chromatography-tandem mass spectrometry, for investigation of hypercortisolism. Methods Salivary cortisone data of subjects were investigated according to a pre-specified protocol. Subjects were classified as having 'hypercortisolism' or 'eucortisolism' on the basis of histological or biochemical criteria. Receiver operating characteristic curves were drawn to identify the cut-off values and study their performance characteristics. We measured 24-hour urinary free cortisol; late-night salivary cortisol and cortisone; and post-overnight 1-mg dexamethasone suppression serum cortisol, and salivary cortisol and cortisone. Saliva and urine samples were assayed by liquid chromatography-tandem mass spectrometry. Results In this study, 21 subjects were classified as having hypercortisolism and 78 as having eucortisolism. A late-night salivary cortisone cut-off of 13.50 nmol/L had a sensitivity of 94.7% and a specificity of 87.2%. After taking 1-mg dexamethasone the night before, a salivary cortisol cut-off of 0.85 nmol/L had a sensitivity of 76.2% and a specificity of 96.2%; a salivary cortisone cut-off of 7.45 nmol/L had a sensitivity of 85.7% and a specificity of 94.9%, while a salivary cortisone cut-off of 3.25 nmol/L had a sensitivity of 95.2% and a specificity of 79.5%. Many salivary cortisol samples were below the detection limit of liquid chromatography-tandem mass spectrometry. In comparison with salivary cortisol, salivary cortisone had a better correlation with total serum cortisol and better diagnostic performance following dexamethasone suppression. Conclusions Both late-night and post-overnight dexamethasone suppression salivary cortisone levels are of diagnostic value in the investigation of hypercortisolism. |
| Databáze: | OpenAIRE |
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