Scalp hair cortisol for diagnosis of Cushing’s syndrome (original) (raw)
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The Journal of Clinical Endocrinology & Metabolism, 2012
Background: Measurement of cortisol in 24-h urine collections and midnight saliva are standard screening tests for Cushing's syndrome (CS). These tests reflect cortisol levels during a maximum of 24 h and do not provide historical information. Therefore, they can yield normal results in case of cyclic CS, which is a rare disorder that is characterized by alternating episodes of endogenous cortisol excess and normal cortisol secretion. The measurement of cortisol in scalp hair is a novel tool that might be helpful to establish the diagnosis of (cyclic) CS. Our aim was to study whether hair cortisol timelines correspond with clinical course in patients with CS and whether we could create retrospective timelines of cortisol exposure that correspond with symptomatic periods in patients suspected of cyclic CS.
Neuroendocrinology
Background/Aims: The current diagnostic workup of Cushing’s syndrome (CS) requires various tests which only capture short-term cortisol exposure, whereas patients with endogenous CS generally have elevated cortisol levels over longer periods of time. Scalp hair assessment has emerged as a convenient test in capturing glucocorticoid concentrations over long periods of time. The aim of this multicenter, multinational, prospective, case-control study was to evaluate the diagnostic efficacy of scalp hair glucocorticoids in screening of endogenous CS. Methods: We assessed the diagnostic performances of hair cortisol (HairF), hair cortisone (HairE), and the sum of both (sumHairF+E), as measured by a state-of-the-art LC-MS/MS technique, in untreated patients with confirmed endogenous CS (n = 89) as well as in community controls (n = 295) from the population-based Lifelines cohort study. Results: Both glucocorticoids were significantly elevated in CS patients when compared to controls. A hi...
Diagnostic tests for Cushing's syndrome differ from published guidelines: data from ERCUSYN
European journal of endocrinology, 2017
To evaluate which tests are performed to diagnose hypercortisolism in patients included in the European Registry on Cushing's syndrome (ERCUSYN), and to examine if their use differs from the current guidelines. We analyzed data on the diagnostic tests performed in 1341 patients with Cushing's syndrome (CS) who have been entered into the ERCUSYN database between January 1, 2000 and January 31, 2016 from 57 centers in 26 European countries. Sixty-seven percent had pituitary-dependent CS (PIT-CS), 24% had adrenal-dependent CS (ADR-CS), 6% had CS from an ectopic source (ECT-CS) and 3% were classified as having CS from other causes (OTH-CS). Of the first-line tests, urinary free cortisol (UFC) test was performed in 78% of patients, overnight 1 mg dexamethasone suppression test (DST) in 60% and late-night salivary cortisol (LSaC) in 25%. Use of LSaC increased in the last five years as compared with previous years (P < 0.01). Use of HDDST was slightly more frequent in the last 5...
European Journal of Endocrinology, 2005
Objective: It is presently unclear whether the accuracy of midnight serum cortisol (F24) in the diagnosis of Cushing’s syndrome (CS) may be replicated under usual conditions of clinical care. The aim of the present study was to assess retrospectively the effectiveness of F24 for confirming the diagnosis in a consecutive series of 106 patients, in 78 of whom a definitive diagnosis of CS was made. Design and methods: We have compared the results of F24, urinary free cortisol (UFC) and the overnight 1 mg dexamethasone suppression test (DST) with the definitive clinical diagnosis. Receiver operating characteristic (ROC) analysis has been performed to define the best cutoff values, the sensitivity (Se) and the specificity (Sp) of the tests. Results: The best cutoff value for F24 was 8.3 μg/dl (Se 91.8%; Sp 96.4%). The best cutoff value for the DST was 4.0 μg/dl (Se 89.2%; Sp 90.9%). The best cutoff value for UFC was 238 μg/24 h (Se 73.2%; Sp 96.3%). The area under the curve of F24 was si...
Clinical Endocrinology, 1998
OBJECTIVE The collection of urine over 24 h to measure free cortisol (UFC) is used to diagnose Cushing's syndrome. However, a complete collection of urine is not easy to achieve and the sampling is frequently inaccurate, so a 24 h collection for the determination of UFC excretion is used as a confirmatory rather than a screening test for Cushing's syndrome. Our objective was to evaluate a more convenient urine collection for screening patients suspected of Cushing's syndrome. DESIGN We have studied the possibility of using night-time (from 2000 h to 0800 h) UFC excretion as a screening test for Cushing's syndrome ('overnight UFC'). PATIENTS Thirty patients with proven Cushing's syndrome were studied before treatment (21 cases of Cushing's disease, two cases of ectopic ACTH secretion, seven of adrenal adenoma). The results were compared to those from 150 control obese subjects. MEASUREMENTS Overnight UFC, and creatininuria (UC), were evaluated at least once in the patients and in all subjects. The 24 h-UFC and UC were determined at least once in the patients and in 56 control subjects. RESULTS The overnight UFC/UC ratio clearly separated all but one patient of the two groups: 194 Ϯ 386 vs 5·7 Ϯ 3·4 nmol/mmol (P < 0·0005) (ranges 16·2-2024 vs 0·6-17·4, Cushing's syndrome vs controls, respectively). The only patient with Cushing's syndrome who Correspondence: Professor Antoine Tabarin, Service d'Endocrinologie, Hôpital de Haut-Lévèque, 33604 Bordeaux-Pessac, France. Fax: þ33 556 55 68 06.
An accurate, non-invasive approach to diagnose Cushing's syndrome in at-risk populations
Steroids, 2013
The prevalence of Cushing's syndrome (CS) in at-risk populations in developing countries remains uncertain. Evening urinary cortisol (UFC(22-23)) and salivary cortisol after treatment with 1-mg DST (SAFdex) have seldom been used as diagnostic tools in these populations. (1) To establish the prevalence of CS in adults with cortisol-related morbidities using UFC22-23 and SAFdex as markers along with all first-line diagnostic tests recommended for CS; and (2) to assess the performance of each test and define a non-invasive diagnostic approach for CS in at-risk outpatient subjects. A total of 128 outpatients were evaluated, including type 1 and 2 diabetic patients with poor metabolic control (DM1 and DM2), hypertensive subjects with central obesity (HBP) and premenopausal women with osteoporosis (OS). Controls included 100 healthy volunteers and 23 patients with CS. Total urinary cortisol (UFC), UFC(22-23), late-night salivary cortisol (SAF23) and suppression of cortisol levels in s...