Evaluation of the effectiveness of midnight serum cortisol in the diagnostic procedures for Cushing's syndrome (original) (raw)
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Utility of a Single Late Night Plasma Cortisol and Acth for the Diagnosis of Cushing's Syndrome
Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 2017
To evaluate the diagnostic efficacy of various screening tests for the diagnosis of Cushing's syndrome (CS). 35 patients of Cushing's syndrome and 16 patients of pseudo-Cushing's syndrome were enrolled. Assessment of 24h urinary free cortisol (UFC), late night salivary cortisol (LNSC), over night dexamethasone suppression test (ONDST), late night plasma cortisol (LNPC) and ACTH on outpatient basis, and during sleep as well as in awake state after 48 hours of hospital admission. 24h UFC performed the best among screening tests with sensitivity, specificity and AUC of 96.0 %, 99% and 0.988, respectively at a cut-off of 144.6 μg/24h.A cut-off of 10.5 nmol/L for LNSC had sensitivity 85.7%, specificity 88.2 % and AUC 0.897.A cut-off of 412.4 nmol/L for MNC on outpatient basis had sensitivity 88.2%,specificity 91.2% and AUC 0.957.A cut-off of 215 nmol/L and 243.3nmol/L for MNC during sleep and awake state after acclimatization had sensitivity, specificity and AUC of 94.1%, 88....
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.
The Journal of Clinical Endocrinology and Metabolism, 1998
Cushing's syndrome (CS) may be difficult to distinguish from pseudo-Cushing states (PCS) based on physical findings or urinary glucocorticoid excretion. As the lack of diurnal variation in serum cortisol is characteristic of CS, we studied whether diurnal cortisol determinations could discriminate CS from PCS. Two hundred and sixtythree patients were evaluated: 240 had CS, and 23 had PCS. Urine was collected for 24 h for measurement of cortisol and 17-hydroxycorticosteroids (17OHCS). Blood was drawn at 2300, 2330, 0000, 0030, and 0100 h and at 0600, 0630, 0700, 0730, and 0800 h the next morning for serum cortisol determination. The main outcome measure was the sensitivity of these parameters for the diagnosis of CS at 100% specificity. A midnight cortisol value greater than 7.5 g/dL correctly identified 225 of 234 patients with CS and all PCS patients. This sensitivity (96%) was superior to that obtained for any other measure, including urinary cortisol (45%), 17OHCS (22%), any other individual cortisol time point (10-92%), the morning (23%) or the evening (93%) cortisol mean, and the ratio (11%) of morning to evening values. We conclude that at 100% specificity, a single serum cortisol value above 7.5 g/dL at midnight discriminates CS from PCS with higher sensitivity than 24-h urinary cortisol or 17OHCS, or other individual or combined measures of serum cortisol.
The Journal of Clinical Endocrinology & Metabolism, 2014
The comparison of variability, reproducibility, and diagnostic performance of late-night salivary cortisol (LNSF) and urinary free cortisol (UFC) using concurrent and consecutive samples in Cushing's syndrome (CS) is lacking. Objectives, Patients, and Methods: In a prospective study, we evaluated 3 simultaneous and consecutive samples of LNSF by RIA and UFC by liquid chromatography associated with tandem mass spectrometry in Cushing's disease (CD) patients (n ϭ 43), adrenal CS patients (n ϭ 9), and obese subjects (n ϭ 18) to compare their diagnostic performances. In CS patients, we also performed a modified CS severity index. Results: There was no difference in the coefficient of variation (percentage) between LNSF and UFC among the 3 samples obtained for each patient with Cushing's disease (35 Ϯ 26 vs 31 Ϯ 24), adrenal CS (28 Ϯ 14 vs 22 Ϯ 14), and obesity (39 Ϯ 37 vs 48 Ϯ 20). LNSF confirmed the diagnosis of hypercortisolism even in the presence of normal UFC in 17.3% of CS, whereas the inverse situation was not observed for UFC. The area under the receiver-operating characteristic curves for LNSF was 0.999 (95% credible interval [CI] 0.990-1.00) and for UFC was 0.928 (95% CI 0.809-0.987). The ratio between areas under the curve was 0.928 (95% CI 0.810-0.988), indicating better performance of LNSF than UFC in diagnosing CS. There was no association between the CS severity index and the degree of biochemical hypercortisolism. Conclusion: Our data show that despite similar variability between both methods, LNSF has a superior diagnostic performance than UFC and should be used as the primary biochemical diagnostic test for CS diagnosis.
The Journal of Clinical Endocrinology & Metabolism, 1998
Cushing's syndrome (CS) may be difficult to distinguish from pseudo-Cushing states (PCS) based on physical findings or urinary glucocorticoid excretion. As the lack of diurnal variation in serum cortisol is characteristic of CS, we studied whether diurnal cortisol determinations could discriminate CS from PCS. Two hundred and sixtythree patients were evaluated: 240 had CS, and 23 had PCS. Urine was collected for 24 h for measurement of cortisol and 17-hydroxycorticosteroids (17OHCS). Blood was drawn at 2300, 2330, 0000, 0030, and 0100 h and at 0600, 0630, 0700, 0730, and 0800 h the next morning for serum cortisol determination. The main outcome measure was the sensitivity of these parameters for the diagnosis of CS at 100% specificity. A midnight cortisol value greater than 7.5 g/dL correctly identified 225 of 234 patients with CS and all PCS patients. This sensitivity (96%) was superior to that obtained for any other measure, including urinary cortisol (45%), 17OHCS (22%), any other individual cortisol time point (10-92%), the morning (23%) or the evening (93%) cortisol mean, and the ratio (11%) of morning to evening values. We conclude that at 100% specificity, a single serum cortisol value above 7.5 g/dL at midnight discriminates CS from PCS with higher sensitivity than 24-h urinary cortisol or 17OHCS, or other individual or combined measures of serum cortisol.
Open Journal of Endocrine and Metabolic Diseases, 2013
Background: Diagnosis of Cushing's Syndrome (CS) at the right time and with the right method is getting more important for the patients and clinicians due to high mortality rate. The most appropriate laboratory test will provide great benefits in terms of cost-effectiveness in the well-chosen group of patients. Selection of the high risk group is of crucial importance for the true diagnosis and treatment on time. Aim: The aim of this study was to evaluate the worth of the midnight salivary cortisol and to establish other effective factors in the graduation of clinical suspect of CS. Material and Methods: 115 patients were evaluated in weight, height, body mass index (BMI), waist/hip ratio, systolic, diastolic blood pressures, hirsutism, weight gain, purple-stria, plethore, buffalo-hump, supraclavicular fullness, temporal fat cushion, acnea, moonface, proximal muscle weakness, lower limb edema, ecchymosis, loss of libido, depression, diabetes mellitus, hypertension, allopecia of all patients were noted in the evaluation forms (23 findings). Patients were grouped according to clinical scores, low (<8), medium (8-16) and high (>16). Results: When we compare the groups in terms of midnight salivary cortisol, morning salivary cortisol after overnight dexamethasone suppression test, we found statistically significant relationship between the low and high clinical score groups, as well as between medium and high score groups (p: 0.0001). Urinary free cortisol was statistically significant only between low and high clinical score groups (p: 0.0001). Conclusion: This clinical scoring system which includes clinical signs and laboratory findings both, can be used for selection of the high risk group.