Variability of late-night salivary cortisol in Cushing disease: a prospective study
Open accessAbstract
Background: The frequency of variable hormonogenesis in patients with Cushing disease (CD) but without cyclical symptoms is unclear. Aim: To assess the frequency of variable hormonogenesis in patients presenting with CD. Methods: Over a 6-month period, patients with confirmed or suspected CD provided late-night salivary samples for up to 42 consecutive nights. Results: Of 19 patients confirmed to have CD, 16 provided at least 7 consecutive salivary samples, and 13 provided at least 21; these 16 patients are the subjects of this report. Twelve patients had at least three peak and two trough levels of late-night salivary cortisol (LNSC) but in only two patients were strict criteria for cyclical hormonogenesis fulfilled; variation was assessed as random in the others. Eight patients had de novo CD, and eight had recurrent/persistent disease. All patients with recurrent/persistent CD had two or more normal results, and in four of these patients, >50% of LNSC were normal. In six patients with de novo disease with at least one normal LNSC level, the maximum levels ranged from 1.55 to 15.5 times the upper limit of normal. Conclusions: Extreme fluctuations of cortisol production, measured by sequential LNSC, are common in CD. In newly diagnosed disease, this may only occasionally impair diagnostic ability, whereas in most patients with recurrent/persistent disease after pituitary surgery, LNSC is frequently within the reference range, with potential to cause diagnostic problems.
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Contamination with topical hydrocortisone would be suggested by a normal salivary cortisone concentration and a high cortisol to cortisone ratio.
“In this instance, contamination with topical hydrocortisone would be suggested by a normal salivary cortisone concentration and high cortisol to cortisone ratio (21).”
From Late-night salivary cortisol and cortisone should be the initial screening test for cushing's syndrome (2022) · cites this paper as [21]
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“However, the use of the LNSC may not be as accurate as previously thought in patients with de novo and recurrent/persistent Cushing disease, as shown by the wide fluctuations in sequentiallymeasured LNSC in a recent prospective analysis [33].”
Characterization of cyclic Cushing's disease using late night salivary cortisol testing
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- Authors
- Sandouk, Z., Johnston, P., Bunch, D., Wang, S., Bena, J., Hamrahian, A., & Kennedy, L.
- Affiliations
- University of Michigan (US)
- Royal Victoria Hospital (GB)
- Yale University (US)
- Cleveland Clinic (US)
- Cleveland Clinic Abu Dhabi (AE)
- Corresponding author
- Kennedy, Laurence
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2018-01-10
- Volume
- 103
- Issue
- 3
- Pages
- 983-990
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2783565305
- Cited by
- 39
- References
- 29
- Citations by year
- 2025: 5 · 2024: 3 · 2023: 4 · 2022: 7 · 2021: 5 · 2020: 8 · 2019: 3 · 2018: 4
- FWCI
- 3.98
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Cleveland Clinic
- 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, late-night salivary cortisol, pituitary surgery, diagnostic pitfalls
- MeSH terms
- Adult, Chronic Disease, Circadian Rhythm, Cushing Syndrome, Female, Humans, Hydrocortisone, Male, Middle Aged, Prospective Studies, Recurrence, Saliva
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