Morning Salivary Cortisone Versus Serum Cortisol in the Overnight Dexamethasone Suppression Test (ODNST): Evaluation in a Clinical Setting.

IF 3 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Mathilde Mordaunt, Adrian Heald, Waseem Majeed, Rupinder Kochhar, Akheel Syed, Rajshekhar N Mudaliar, Ramadan Alshames, Fahmy Hanna, David Marshall, Brian Keevil, Anthony A Fryer
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引用次数: 0

Abstract

Introduction: Saliva hormone measurement is increasingly being applied in everyday clinical practice. In relation to salivary cortisone measurement, there is a particular advantage, with minimal chance of cross-reaction with prescribed glucocorticoids and greater convenience. We evaluated the utility of salivary cortisone measurement in patients undergoing an overnight dexamethasone suppression test (ONDST).

Methods: Individuals undergoing an ONDST had parallel measurement of serum cortisol and salivary cortisone at 0900 following midnight dexamethasone (1 mg). Salivary cortisone was measured by electrospray positive liquid chromatography tandem mass spectrometry. The threshold for adequate suppression of salivary cortisone was< 2.7nmol/L; serum cortisol was< 50nmol/L.

Results: Results for 34 individuals which included 21% men (mean age 49.4 years) and 79% women (mean age 56.7 years) were analysed. Serum cortisol did not suppress in 22/34 cases. Salivary cortisone did not suppress in two of the cases where cortisol did suppress. We found a strong correlation between 0900 salivary cortisone and serum cortisol after 1 mg ONDST (r2 = 0.65, p = 0.009). When performance of post-dexamethasone salivary cortisone (< 2.7nmol/L) alone in relation to suppression of serum cortisol (< 50nmol/L) was analysed all but 2 individuals were correctly classified. They had values for post dexamethasone salivary cortisone/serum cortisol of respectively 5.9/23 nmol/L (presented with unexplained fatigue, case 25) and 7/32 nmol/L (investigated for cyclical Cushing's Syndrome that was excluded, case 29). Agreement was 94.1%, kappa 0.87, p < 0.0001. The sensitivity of salivary cortisone for potential Cushing's syndrome as indicated by the post-dexamethasone 0900 serum cortisol was 100% (all cases of potential cortisol excess (0900 cortisol > 50nmol/L) were picked up) and specificity of 84.6% with a positive predictive value of 90.5% of salivary cortisone (using serum cortisol as the standard) and negative predictive value of 100% in relation to ruling out cortisol excess.

Conclusion: We have provided further evidence that ONDST salivary cortisone has potential to be the first-line test for suspected Cushing's syndrome, not requiring venepuncture or attendance at hospital, with 100% sensitivity and reasonable specificity. Application of the salivary cortisone test has the potential for significant savings of money and time in this and other contexts.

简介唾液激素测量正越来越多地应用于日常临床实践中。唾液中可的松的测量具有特别的优势,与处方糖皮质激素发生交叉反应的几率最小,而且更加方便。我们评估了唾液可的松测量在接受隔夜地塞米松抑制试验(ONDST)患者中的实用性:方法:接受 ONDST 的患者在午夜服用地塞米松(1 毫克)后,于 9 点同时测量血清皮质醇和唾液中的可的松。唾液可的松采用电喷雾正离子液相色谱串联质谱法进行测量。结果:分析了 34 人的结果,其中 21% 为男性(平均年龄 49.4 岁),79% 为女性(平均年龄 56.7 岁)。在 22/34 例病例中,血清皮质醇没有受到抑制。在皮质醇受到抑制的两个病例中,唾液中的可的松也没有受到抑制。我们发现,1 毫克 ONDST 后,9 点唾液可的松与血清皮质醇之间存在很强的相关性(r2 = 0.65,p = 0.009)。当检测到地塞米松后唾液皮质酮(50nmol/L)时,特异性为 84.6%,唾液皮质酮的阳性预测值为 90.5%(以血清皮质醇为标准),而在排除皮质醇过量方面的阴性预测值为 100%:我们进一步证明,ONDST唾液可的松有可能成为疑似库欣综合征的一线检测方法,无需静脉穿刺或到医院就诊,灵敏度为100%,特异性合理。唾液可的松检测的应用有可能在这一领域和其他领域节省大量的金钱和时间。
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来源期刊
Clinical Endocrinology
Clinical Endocrinology 医学-内分泌学与代谢
CiteScore
6.40
自引率
3.10%
发文量
192
审稿时长
1 months
期刊介绍: Clinical Endocrinology publishes papers and reviews which focus on the clinical aspects of endocrinology, including the clinical application of molecular endocrinology. It does not publish papers relating directly to diabetes care and clinical management. It features reviews, original papers, commentaries, correspondence and Clinical Questions. Clinical Endocrinology is essential reading not only for those engaged in endocrinological research but also for those involved primarily in clinical practice.
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