Biochemical diagnosis of Cushing’s disease: Screening and confirmatory testing
Abstract
Due to the variable clinical features and its rarity diagnosis of Cushing's disease (CD) is often delayed. Clearly, awareness for CD needs to be raised, accompanied by the availability of simple and accurate screening tests. Late-night salivary cortisol (LNSC), 1 mg dexamethasone suppression test (DST), and urinary free cortisol (UFC) have all been extensively studied, demonstrating high sensitivity and specificity for the diagnosis of Cushing's syndrome. However, each of those well-established tests has its own distinctive features, making it preferable in specific clinical conditions and patient groups. To choose the most appropriate test in individual patients, an expert endocrinologist should be consulted. This review will discuss the pitfalls for each of those tests.
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The late-night salivary cortisol upper reference limits for the LC-MS/MS and immunoassay methods in this study were comparable to those in previous smaller studies, with a somewhat higher value for the Cisbio immunoassay.
“The LNSC URLs for the LC-MS/ MS and IA methods included in our study were comparable with previous smaller studies [13,[35][36][37], with a somewhat higher value for the Cisbio IA [29].”
From Salivary cortisol and cortisone in diagnosis of Cushing's syndrome: a comparison of six different analytical methods (2023) · cites this paper as [29]
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Pituitary tumors, ACTH-secreting
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All about dexamethasone testing in Cushing's syndrome
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- Authors
- Petersenn, S.
- Corresponding author
- Petersenn, Stephan
- ORCID
- Petersenn, Stephan
- Venue
- Best Practice & Research Clinical Endocrinology & Metabolism
- Publisher
- Elsevier BV
- Published
- 2021-01
- Volume
- 35
- Issue
- 1
- Pages
- 101519
- ISSN
- 1521-690X (ISSN-L)
- OpenAlex
- W3137302139
- Cited by
- 33
- References
- 104
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 7 · 2023: 7 · 2022: 5 · 2021: 2
- FWCI
- 0.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Best Practice & Research Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- Cushing's disease, Cushing's syndrome, biochemical diagnosis, screening test, late-night salivary cortisol, dexamethasone suppression test, urinary free cortisol, sensitivity and specificity, diagnostic pitfalls
- MeSH terms
- Cushing Syndrome, Dexamethasone, Diagnosis, Differential, Diagnostic Techniques, Endocrine, Humans, Hydrocortisone, Mass Screening, Saliva, Sensitivity and Specificity, Pituitary ACTH Hypersecretion, Validation Studies as Topic
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