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Cited by 30Pituitary Gland Disorders and TreatmentsAdrenal Hormones and DisordersAdrenal and Paraganglionic Tumors

Screening for subclinical Cushing’s syndrome in type 2 diabetes mellitus: low false-positive rates with nocturnal salivary cortisol

Gagliardi, L., Chapman, I. M., O’Loughlin, P., Torpy, D. J.·2010·Hormone and Metabolic Research
DOI 10.1055/s-0029-1246191
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Abstract

The diagnosis of subclinical Cushing's syndrome (SCS) is important, but its relative rarity amongst patients with common metabolic disorders requires a simple test with a low false-positive rate. Using nocturnal salivary cortisol (NSC), which we first validated in patients with suspected and proven Cushing's syndrome, we screened 106 overweight patients with type 2 diabetes mellitus, a group at high risk of SCS and nontumoral hypothalamic-pituitary-adrenal axis perturbations. Our hypothesis was that a lower false-positive rate with NSC was likely, compared with that reported with the dexamethasone suppression test (DST) (10-20%), currently the foundation of diagnosis of SCS. No participant had clinically apparent Cushing's syndrome. Three participants had an elevated NSC but further testing excluded SCS. In this study, NSC had a lower false-positive rate (3%) than previously reported for the DST. Given the reported excellent performance of NSC in detection of hypercortisolism, the low false-positive rate in SCS suggests NSC may be superior to the DST for SCS screening. The NSC and DST should be compared directly in metabolic disorder patients; although our data suggest the patient group will need to be substantially larger to definitively determine the optimal screening test.

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  • The prevalence of previously unsuspected Cushing syndrome in patients with type 2 diabetes ranges from 0% to 9.4%.

    “The association between DM and CS has been examined in various studies, which have shown a prevalence of previously unsuspected CS in patients with type  DM ranging from % to .% (Table ) (-).”

    From Glucose Metabolism Abnormalities in Cushing Syndrome: From Molecular Basis to Clinical Management (2017) · cites this paper as [253]

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Authors
Gagliardi, L., Chapman, I. M., O’Loughlin, P., & Torpy, D. J.
Affiliations
  • The University of Adelaide (AU)
  • Royal Adelaide Hospital (AU)
  • South Australia Pathology (AU)
ORCID
Venue
Hormone and Metabolic Research
Publisher
Georg Thieme Verlag KG
Published
2010-01-29
Volume
42
Issue
04
Pages
280-284
ISSN
  • 0018-5043 (ISSN-L)
  • 1439-4286
DOI
10.1055/s-0029-1246191
OpenAlex
W1994140519
Cited by
29
References
0
Citations by year
2025: 3 · 2024: 1 · 2022: 1 · 2021: 3 · 2019: 3 · 2018: 3 · 2017: 4 · 2016: 2 · 2015: 3 · 2014: 2 · 2013: 1 · 2012: 2
FWCI
0.97
Type
journal article
Language
en
Open access
closed
Locations
  • Hormone and Metabolic Research (publishedVersion)
  • PubMed (publishedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
Keywords
subclinical Cushing's syndrome, type 2 diabetes, dexamethasone suppression test, false positive rate, screening, hypercortisolism, hypothalamic-pituitary-adrenal axis, overweight patients
MeSH terms
Adrenocorticotropic Hormone, Adult, Aged, Cushing Syndrome, Darkness, Diabetes Mellitus, Type 2, False Positive Reactions, Female, Humans, Hydrocortisone, Male, Mass Screening, Middle Aged, Saliva

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