The DOI matches its Crossref record; 41 of the 43 references it cites were found in a registry or an index.
Late-Night Salivary Cortisol for Diagnosis of Overt and Subclinical Cushing’s Syndrome in Hospitalized and Ambulatory Patients
Abstract
CONTEXT: Neither precise evaluation of pertinent thresholds nor comparison of the diagnostic performance of late-night salivary cortisol (NSC) between inpatient and outpatient settings has been conducted. The usefulness of NSC for the screening of "subclinical" Cushing's syndrome is still unknown. OBJECTIVES: The aim of the study was to compare the influence of inpatient and outpatient settings on the diagnostic performance of NSC and assess its usefulness as a screening test for subclinical Cushing's syndrome. DESIGN: Consecutive patients were investigated prospectively with two salivary collections, first as inpatients and then as outpatients. PARTICIPANTS: Forty-two obese subjects participated in the study, as well as nine patients cured of Cushing's disease, 13 with overt Cushing's syndrome, 14 showing mild recurrence of Cushing's disease, and 48 with adrenal incidentalomas [23 subclinical cortisol-secreting adenomas (SCSA), 25 nonsecreting adenomas]. MAIN OUTCOME MEASURES: Reproducibility of NSC and diagnostic performance were measured using receiver operating characteristic analysis. RESULTS: NSC in controls was similar between inpatient and outpatient settings. The diagnostic performance of NSC across the different patient groups was similar irrespective of the setting. A threshold of 12 nmol/liter yielded 100% sensitivity and specificity in overt Cushing's syndrome. Optimal performance in subclinical Cushing's syndrome required lower thresholds. NSC showed acceptable performance in diagnosing recurrence of Cushing's disease (90% sensitivity, 91.8% specificity). On the contrary, NSC was similar between patients with SCSA and nonsecreting adenomas. CONCLUSIONS: Our data validate the outpatient bed sampling strategy for NSC with no need for specific outpatient threshold. NSC may be helpful to detect mild recurrence of Cushing's disease after surgery but is of little value in identifying SCSA amongst adrenal incidentalomas.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“most studies have found that LNSC (regardless of assay method) has a poor sensitivity in patients with mild cortisol excess (formerly known as subclinical CS) [20, 56, 62-76]”
From Prospective Evaluation of Late-Night Salivary Cortisol and Cortisone by EIA and LC-MS/MS in Suspected Cushing Syndrome (2020) · cites this paper as [67]
Experimental — accuracy not yet measuredIn the citing paper
“Some authors found a low sensitivity of MSaC in identifying SH (31,32), whereas others showed that subjects with either consistent or frequent elevations of this parameter may actually have SH (69).”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [31]
In the citing paper
“Overall, in these studies, the different parameters showed a good specificity (90 -98%, using 1-mg DST) but, generally, a poor sensitivity (41-86% using ACTH levels).”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [31]
In the citing paper
“The altered circadian rhythm, evaluated by either MSaC or MSeC, and UFC levels were not found to be sensitive enough for diagnosing SH (31,32).”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [31]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline.
Nieman, L. K., Biller, B. M. K., Findling, J. W., Newell-Price, J., Savage, M. O., Stewart, P. M., & Montori, V. M. (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-0125 · Cited by 2,718
Management of the clinically inapparent adrenal mass ("incidentaloma")
Grumbach, M. M., Biller, B. M. K., Braunstein, G. D., Campbell, K. K., Carney, J. A., Godley, P. A., Harris, E. L., Lee, J. K. T., Oertel, Y. C., Posner, M. C., et al. (2003) · Annals of Internal Medicine · doi:10.7326/0003-4819-138-5-200303040-00013 · Cited by 945
A Survey on Adrenal Incidentaloma in Italy
Mantero, F. (2000) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.85.2.637 · Cited by 907
Adrenal Masses: Characterization with Combined Unenhanced and Delayed Enhanced CT
Caoili, E. M., KOROBKIN, M. T., Francis, I. R., Cohan, R. H., Platt, J. F., Dunnick, N. R., & Raghupathi, K. I. (2002) · Radiology · doi:10.1148/radiol.2223010766 · Cited by 684
Prevalence and natural history of adrenal incidentalomas
Barzon, L., Sonino, N., Fallo, F., Palu, G., & Boscaro, M. (2003) · European Journal of Endocrinology · doi:10.1530/eje.0.1490273 · Cited by 642
Characterization of the normal temporal pattern of plasma corticosteroid levels.
KRIEGER, D. T., ALLEN, W., RIZZO, F., & KRIEGER, H. P. (1971) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-32-2-266 · Cited by 549
Rossi, R., Tauchmanovà, L., Luciano, A., Martino, M. D., Battista, C., Viscovo, L. D., Nuzzo, V., & Lombardi, G. (2000) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.85.4.6515 · Cited by 416
Tauchmanovà, L., Rossi, R., Biondi, B., Pulcrano, M., Nuzzo, V., Palmieri, E.-A., Fazio, S., & Lombardi, G. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2001-011766 · Cited by 400
Salivary cortisol measurement: a practical approach to assess pituitary-adrenal function.
LAUDAT, M. H., CERDAS, S., FOURNIER, C., GUIBAN, D., GUILHAUME, B., & LUTON, J. P. (1988) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-66-2-343 · Cited by 393
Reincke, M., Nieke, J., Krestin, G. P., Saeger, W., Allolio, B., & Winkelmann, W. (1992) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.75.3.1517373 · Cited by 346
Cited by
Sorted by citations
Items 101–129 of 129
Adrenal Causes of Cushing’s Syndrome
Cavagnini, F., & Giraldi, F. P. (2015) · Elsevier eBooks · doi:10.1016/b978-0-323-18907-1.00103-7 · Cited by 5
Goyal, A., Attri, B., Gupta, Y., Kalaivani, M., Jyotsna, V. P., & Tandon, N. (2023) · Clinical Endocrinology · doi:10.1111/cen.14920 · Cited by 5
D’Aurizio, F., Tozzoli, R., Dorizzi, R., Brescia, V., Esposito, E., Fortunato, A., Giovanella, L., & Guzzaloni, G. (2015) · La Rivista Italiana della Medicina di Laboratorio - Italian Journal of Laboratory Medicine · doi:10.1007/s13631-015-0088-0 · Cited by 3
Turcu, A. F., & Auchus, R. J. (2016) · Springer eBooks · doi:10.1007/978-3-319-45950-9_10 · Cited by 4
Żukowski, Ł., Myśliwiec, J., & Górska, M. (2013) · Endokrynologia Polska · doi:10.5603/ep.2013.0003 · Cited by 4
Inder, W. J. (2016) · Clinical Endocrinology · doi:10.1111/cen.13244 · Cited by 3
Cushing Syndrome: Presentation, Diagnosis, and Treatment, Including Subclinical Cushing Syndrome
Neychev, V. K. (2016) · Springer eBooks · doi:10.1007/978-3-319-44136-8_9 · Cited by 3
Endocrine hypertension in pregnancy
Jebasingh, F., & Thomas, N. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-96120-2.00004-2 · Cited by 2
Exploration biologique de la fonction corticotrope
Fulla, Y., Guignat, L., Dugué, M.-A., Assié, G., & BERTAGNA, X. Y. (2009) · Revue Francophone des Laboratoires · doi:10.1016/s1773-035x(09)70249-7 · Cited by 3
Hormonal evaluation of adrenal incidentalomas
Loupp, A.-G. L., Cariou, B., Drui, D., Graveline, N., Masson, D., & Bach‐Ngohou, K. (2014) · Annales de biologie clinique · doi:10.1684/abc.2014.1013 · Cited by 2
Special Aspects of Cushing’s Syndrome: Cyclic Cushing’s Syndrome
Albiger, N. M. E., & Mantero, F. (2010) · Humana Press eBooks · doi:10.1007/978-1-60327-449-4_23 · Cited by 2
Ballerini, M. G., Freire, A. V., Rodríguez, M. E., Valle, S. S., Castro, S., Arcari, A. J., Bergadá, I., & Ropelato, M. G. (2023) · Hormone Research in Paediatrics · doi:10.1159/000530939 · Cited by 2
Performance of afternoon (16:00 h) serum cortisol for the diagnosis of Cushing’s syndrome
Dupuis, H., Merlen, E., Elices-Diez, J., Balayé, P., Cortet, C., Jannin, A., Cao, C. D., Douillard, C., SOULEZ, B., Ramdane, N., et al. (2025) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm-2025-0133 · Cited by 2
Khan, S. (2011) · The Journal of the Royal College of Physicians of Edinburgh · doi:10.4997/jrcpe.2011.215 · Cited by 1
A variable course of Cushing’s disease in a 7 year old: diagnostic dilemma
Kochar, I. S., Ramachandran, S., & Sethi, A. (2018) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem-2018-0133 · Cited by 1
Cushing's Syndrome Missed in Pregnancy
Sudarshanan, A., Koshy, R., Mannath, S., Fernandez, C., & Jacob, K. (2024) · Cureus · doi:10.7759/cureus.70930
Relevance and perspective concept of investigation of subclinical Cushing syndrome.
Kuznetsov, N. S., Latkina, N. V., & Kaminarskaya, Y. A. (2016) · Endocrine Surgery · doi:10.14341/serg2016113-22 · Cited by 1
Advances in our understanding of the prognosis of adrenal incidentaloma
Mackay, I., & Aspinall, S. R. (2016) · Expert Review of Endocrinology & Metabolism · doi:10.1080/17446651.2016.1233055 · Cited by 1
Martin, M. D., Giraldi, F. P., & Cavagnini, F. (2010) · Humana Press eBooks · doi:10.1007/978-1-60327-449-4_6
Adrenal Incidentaloma and Subclinical Hypercortisolism
Goddard, G. M., & Geer, E. B. (2015) · Springer eBooks · doi:10.1007/978-1-4939-2059-4_22
Adrenal Cushing’s Syndrome: Updates on Overt and Mild Hypercortisolism
Escobar, J. S., Ravikumar, A., & Levine, A. C. (2017) · Contemporary Endocrinology · doi:10.1007/978-3-319-62470-9_10
(2009) · Current Opinion in Endocrinology Diabetes and Obesity · doi:10.1097/med.0b013e32832eb365
Alexandraki, K., & Grossman, A. B. (2022) · Springer eBooks · doi:10.1007/978-3-030-90684-9_8
Baudry, C., Waintrop, C., & Mosnier-Pudar, H. (2011) · EMC - Endocrinologie - Nutrition · doi:10.1016/s1155-1941(11)53860-0
Nunes, M.-L., & Tabarin, A. (2011) · EMC - Endocrinologie - Nutrition · doi:10.1016/s1155-1941(11)53091-4
Self-citationAutomated MRI-based brain volumetric analysis in women with polycystic ovary syndrome
BAŞPINAR, N., Şalk, S., & Ersoz, A. (2026) · BMC Medical Imaging · doi:10.1186/s12880-026-02336-w
Bueling, Z., Douri, D. R., Berg, A. H., Garrity, C. E., Olson, B. M., Riehl, B., Westby, C. M., Swan, J. T., Ghozy, S. A., Rabadi, I. A., et al. (2026) · Endocrine Practice · doi:10.1016/j.eprac.2026.09.121
Metadata
- Authors
- Nunes, M.-L., Vattaut, S., Corcuff, J.-B., Rault, A., Loiseau, H., Gatta, B., Valli, N., Letenneur, L., & Tabarin, A.
- Affiliations
- Inserm (FR)
- Corresponding author
- Tabarin, Antoine
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2009-02
- Volume
- 94
- Issue
- 2
- Pages
- 456-462
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W1969322965
- Cited by
- 129
- References
- 43
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 3 · 2023: 4 · 2022: 1 · 2021: 4 · 2020: 5 · 2019: 5 · 2018: 8 · 2017: 5 · 2016: 9 · 2015: 6 · 2014: 13 · 2013: 9 · 2012: 11
- FWCI
- 10.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- 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
- late-night salivary cortisol, subclinical Cushing's syndrome, adrenal incidentaloma, diagnostic thresholds, screening test performance, obesity
- MeSH terms
- Adrenal Cortex Neoplasms, Ambulatory Care, Circadian Rhythm, Cushing Syndrome, Female, Hospitalization, Humans, Hydrocortisone, Inpatients, Male, Outpatients, Recurrence, Saliva, Sensitivity and Specificity, Time Factors, Case-Control Studies, Adrenocortical Adenoma, Incidental Findings
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
