Clinical utility of late-night and post-overnight dexamethasone suppression salivary cortisone for the investigation of Cushing’s syndrome
Open accessAbstract
INTRODUCTION: There is a pressing need to identify diagnostic testing for Cushing's syndrome that can be achieved with ease and at low cost. This study aimed to explore the usefulness of late-night and post-overnight 1-mg dexamethasone suppression salivary cortisone, as measured by liquid chromatography-tandem mass spectrometry, for investigation of hypercortisolism. METHODS: Salivary cortisone data of subjects were investigated according to a pre-specified protocol. Subjects were classified as having 'hypercortisolism' or 'eucortisolism' on the basis of histological or biochemical criteria. Receiver operating characteristic curves were drawn to identify the cut-off values and study their performance characteristics. We measured 24-hour urinary free cortisol; late-night salivary cortisol and cortisone; and post-overnight 1-mg dexamethasone suppression serum cortisol, and salivary cortisol and cortisone. Saliva and urine samples were assayed by liquid chromatography-tandem mass spectrometry. RESULTS: In this study, 21 subjects were classified as having hypercortisolism and 78 as having eucortisolism. A late-night salivary cortisone cut-off of 13.50 nmol/L had a sensitivity of 94.7% and a specificity of 87.2%. After taking 1-mg dexamethasone the night before, a salivary cortisol cut-off of 0.85 nmol/L had a sensitivity of 76.2% and a specificity of 96.2%; a salivary cortisone cut-off of 7.45 nmol/L had a sensitivity of 85.7% and a specificity of 94.9%, while a salivary cortisone cut-off of 3.25 nmol/L had a sensitivity of 95.2% and a specificity of 79.5%. Many salivary cortisol samples were below the detection limit of liquid chromatography-tandem mass spectrometry. In comparison with salivary cortisol, salivary cortisone had a better correlation with total serum cortisol and better diagnostic performance following dexamethasone suppression. CONCLUSIONS: Both late-night and post-overnight dexamethasone suppression salivary cortisone levels are of diagnostic value in the investigation of hypercortisolism.
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The authors and others have shown that salivary cortisol and cortisone after DST have high diagnostic accuracy for Cushing's syndrome, but many methods lack an established diagnostic cut-off.
“We and others have shown salivary cortisol and cortisone after DST to have high diagnostic accuracy for CS, but many methods lack an established cut-off for diagnosis [2-5, 41, 42].”
From Salivary cortisol and cortisone in diagnosis of Cushing's syndrome: a comparison of six different analytical methods (2023) · cites this paper as [4]
The current study established upper reference limits for salivary cortisol after DST of 0.7-1.0 nmol/L for LC-MS/MS methods and 2.4-5.4 nmol/L for immunoassays.
“The current study established the URLs for salivary cortisol after DST to 0.7-1.0nmol/L for the LC-MS/MS methods and 2.4-5.4 nmol/L for the IAs, which is in line with previous smaller studies [3,4,43].”
From Salivary cortisol and cortisone in diagnosis of Cushing's syndrome: a comparison of six different analytical methods (2023) · cites this paper as [4]
Salivary cortisone upper reference limits for late-night samples (13.5-16.6 nmol/L) and after DST (3.0-3.5 nmol/L) compare well with other studies.
“Salivary cortisone URLs for late-night samples (13.5-16.6 nmol/L) and after DST (3.0-3.5 nmol/L) compare well with other studies [3,4].”
From Salivary cortisol and cortisone in diagnosis of Cushing's syndrome: a comparison of six different analytical methods (2023) · cites this paper as [4]
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- Authors
- Department of Medicine, Q. E. H., Ng, C., Lam, T., Au Yeung, Y., Choi, C., Iu, Y., Shek, C., & Tiu, S.
- Affiliations
- Queen Elizabeth Hospital (CN)
- Venue
- Hong Kong Medical Journal
- Publisher
- Hong Kong Academy of Medicine Press
- Published
- 2017-10-13
- Volume
- 23
- Issue
- 6
- Pages
- 570-8
- ISSN
- 1024-2708 (ISSN-L)
- OpenAlex
- W2761992482
- Cited by
- 11
- References
- 30
- Citations by year
- 2025: 3 · 2024: 1 · 2023: 3 · 2021: 1 · 2020: 3
- FWCI
- 0.65
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- Hong Kong Medical Journal (publishedVersion, cc-by-nc-nd)
- 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
- hypercortisolism, salivary cortisone, salivary cortisol, dexamethasone suppression test, diagnostic thresholds, sensitivity and specificity, 24-hour urinary free cortisol, liquid chromatography-tandem mass spectrometry
- MeSH terms
- Adult, Aged, Aged, 80 and over, Anti-Inflammatory Agents, Chromatography, Liquid, Circadian Rhythm, Cortisone, Cushing Syndrome, Dexamethasone, Female, Humans, Hydrocortisone, Male, Middle Aged, Predictive Value of Tests, ROC Curve, Saliva, Salivary Glands, Sensitivity and Specificity, Young Adult
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