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Cited by 24Adrenal and Paraganglionic TumorsAdrenal Hormones and DisordersPituitary Gland Disorders and Treatments

Diagnostic accuracy of the different hormonal tests used for the diagnosis of autonomous cortisol secretion

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Araujo-Castro, Marta, García Cano, Ana, Jiménez Mendiguchía, Lucía, Escobar-Morreale, Héctor F., Valderrábano, Pablo·2021·Scientific Reports
DOI 10.1038/s41598-021-00011-4PMC PMC8519913
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Abstract

To evaluate the diagnostic accuracy of the different tests commonly used in the evaluation of adrenal incidentalomas (AIs) for the identification of autonomous cortisol secretion (ACS) and comorbidities potentially related to ACS. In a retrospective study of patients with AIs ≥ 1 cm, we evaluated the diagnostic reliability and validity of the dexamethasone suppression test (DST), urinary free cortisol (UFC), ACTH, late-night salivary cortisol (LNSC), and dehydroepiandrosterone-sulphate (DHEAS) for the diagnosis of comorbidities potentially related to ACS. Diagnostic indexes were also calculated for UFC, ACTH, LNSC, and DHEAS considering DST as the gold standard test for the diagnosis of ACS, using three different post-DST cortisol thresholds (138 nmol/L, 50 nmol/L and 83 nmol/L). We included 197 patients with AIs in whom the results of the five tests abovementioned were available. At diagnosis, 85.9% of patients with one or more AIs had any comorbidity potentially related to ACS, whereas 9.6% had ACS as defined by post-DST cortisol > 138 nmol/L. The reliability of UFC, ACTH, LNSC, and DHEAS for the diagnosis of ACS was low (kappa index < 0.30). Of them, LNSC reached the highest diagnosis accuracy for ACS identification (AUC = 0.696 [95% CI 0.626-0.759]). The diagnostic performances of these tests for comorbidities potentially related to ACS was poor; of them, the DST was the most accurate (AUC = 0.661 [95% CI 0.546-0.778]) and had the strongest association with these comorbidities (OR 2.6, P = 0.045). Patients presenting with increased values of both DST and LNSC had the strongest association with hypertension (OR 7.1, P = 0.002) and with cardiovascular events (OR 3.6, P = 0.041). In conclusion, LNSC was the test showing the highest diagnosis accuracy for the identification of ACS when a positive DST was used as the gold standard for its diagnosis. The DST test showed the strongest association with comorbidities potentially related to ACS. The definition of ACS based on the combination of elevated DST and LNSC levels improved the identification of patients with increased cardiometabolic risk.

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  • The limited number of studies published to date have shown that LNSC has a relatively low sensitivity for predicting ACS, and subsequently conclude that the test is not suitable for screening of this disorder.

    “The limited number of studies published to date have shown that LNSC has a relatively low sensitivity for predicting ACS, and subsequently conclude that the test is not suitable for screening of this disorder (11–16).”

    From The diagnostic value of salivary cortisol and salivary cortisone in patients with suspected hypercortisolism (2022) · cites this paper as [14]

  • All previous studies, regardless of analytical assay, have concluded that LNSC cannot be recommended as an exclusive screening method for ACS.

    “In fact, due to the low sensitivity, all previous studies, regardless of analytical assay, have concluded that LNSC cannot be recommended as an exclusive screening method for ACS (11–16).”

    From The diagnostic value of salivary cortisol and salivary cortisone in patients with suspected hypercortisolism (2022) · cites this paper as [14]

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Authors
Araujo-Castro, M., García Cano, A., Jiménez Mendiguchía, L., Escobar-Morreale, H. F., & Valderrábano, P.
Affiliations
  • Universidad de Alcalá (ES)
  • Instituto Ramón y Cajal de Investigación Sanitaria (ES)
ORCID
Venue
Scientific Reports
Publisher
Springer Science and Business Media LLC
Published
2021-10-15
Volume
11
Issue
1
Pages
20539-20539
ISSN
2045-2322 (ISSN-L)
DOI
10.1038/s41598-021-00011-4
PMC
PMC8519913
OpenAlex
W3205803325
Cited by
24
References
38
Citations by year
2026: 2 · 2025: 9 · 2024: 3 · 2023: 6 · 2022: 4
FWCI
3.05
Type
journal article
Language
en
Open access
Licence
Locations
  • Scientific Reports (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Sociedad de Endocrinología, Nutrición y Diabetes de la Comunidad de Madrid (BECA SENDIMAD de Ayuda a la Investigación en Endocrinología, Nutrición y Diabetes 2019)
  • IRYCIS (Convocatoria intramural de ayudas a proyectos de investigación de investigadores noveles, investigadores clínicos asociados y/o grupos emergentes del Hospital Universitario Ramón y Cajal 2019)
Topics
  • Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
Keywords
autonomous cortisol secretion, adrenal incidentaloma, dexamethasone suppression test, late-night salivary cortisol, urinary free cortisol, ACTH, dehydroepiandrosterone sulfate, diagnostic accuracy, hypertension, cardiovascular events, Cushing's disease, Cushing's syndrome
MeSH terms
Adrenocortical Hyperfunction, Adrenal Gland Neoplasms, Aged, Female, Humans, Hydrocortisone, Male, Middle Aged, Retrospective Studies

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