Late-night salivary cortisol has a better performance than urinary free cortisol in the diagnosis of Cushing’s syndrome

Elias, Paula C. L.; Martinez, Edson Z.; Barone, Bruno F. C.; Mermejo, Livia M.; Castro, Margaret; Moreira, Ayrton C.

doi:10.1210/jc.2013-4262

Cited by 90Pituitary Gland Disorders and TreatmentsAdrenal Hormones and DisordersAdrenal and Paraganglionic Tumors

Late-night salivary cortisol has a better performance than urinary free cortisol in the diagnosis of Cushing’s syndrome

Elias, Paula C. L., Martinez, Edson Z., Barone, Bruno F. C., Mermejo, Livia M., Castro, Margaret, Moreira, Ayrton C.·2014·The Journal of Clinical Endocrinology & Metabolism

DOI 10.1210/jc.2013-4262

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Abstract

CONTEXT: 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 = 43), adrenal CS patients (n = 9), and obese subjects (n = 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 ± 26 vs 31 ± 24), adrenal CS (28 ± 14 vs 22 ± 14), and obesity (39 ± 37 vs 48 ± 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.

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A meta-analysis by Carroll et al. concluded that LNSC is a robust and convenient test to screen and diagnose Cushing's syndrome, with a diagnostic sensitivity of 92% and a specificity of 96%.
“A meta-analysis by Carroll et al. concluded that LNSC is a robust and convenient test to screen and diagnose CS. Similar to our own analysis, the authors found that LNSC had a diagnostic sensitivity of 92% and a specificity of 96% (18).”
From Late-night salivary cortisol and cortisone should be the initial screening test for cushing's syndrome (2022) · cites this paper as [18]

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Authors: Elias, P. C. L., Martinez, E. Z., Barone, B. F. C., Mermejo, L. M., Castro, M., & Moreira, A. C.
Affiliations: Division of Endocrinology Department of Medicine (P.C.L.E., B.F.C.B., L.M.M., M.C., A.C.M.), Sao Paulo 14049-900, Brazil
Division of Statistics Department of Social Medicine (E.Z.M.), Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo 14049-900, Brazil
ORCID: Elias, Paula C. L.
Castro, Margaret
Moreira, Ayrton C.
Venue: The Journal of Clinical Endocrinology & Metabolism
Publisher: The Endocrine Society
Published: 2014-06-01
Volume: 99
Issue: 6
Pages: 2045-2051
ISSN: 0021-972X (ISSN-L)
1945-7197
DOI: 10.1210/jc.2013-4262
OpenAlex: W2089534293
Cited by: 90
References: 44
Citations by year: 2026: 5 · 2025: 6 · 2024: 3 · 2023: 4 · 2022: 4 · 2021: 8 · 2020: 10 · 2019: 5 · 2018: 10 · 2017: 11 · 2016: 10 · 2015: 8 · 2014: 6
FWCI: 9.38
Type: journal article
Language: en
Open access: closed
Locations: The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
PubMed (publishedVersion)
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: Cushing's syndrome, Cushing's disease, late-night salivary cortisol, urinary free cortisol, diagnostic accuracy, adrenal Cushing's syndrome, obesity
MeSH terms: Adolescent, Adult, Aged, Circadian Rhythm, Cushing Syndrome, Diagnostic Techniques, Endocrine, Female, Humans, Hydrocortisone, Male, Middle Aged, Saliva, Reproducibility of Results, Young Adult

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Late-night salivary cortisol has a better performance than urinary free cortisol in the diagnosis of Cushing’s syndrome

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