Neoplastic hypercortisolism: Cut-off values for late-night salivary cortisol & cortisone

IF 3.2 3区医学 Q2 MEDICAL LABORATORY TECHNOLOGY

Clinica Chimica Acta Pub Date : 2025-04-16 DOI:10.1016/j.cca.2025.120310

Karlijn Koops , Peter H. Bisschop , Annemieke C. Heijboer , Jacquelien J. Hillebrand

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引用次数: 0

Abstract

Objectives

One of the recommended initial tests for diagnosing neoplastic hypercortisolism is the measurement of late-night salivary cortisol (Cortisol_LNSa). Published cut-off values for Cortisol_LNSa and late-night salivary cortisone (Cortisone_LNSa) vary widely between studies. This study aims to establish cut-off values for Cortisol_LNSa and Cortisone_LNSa using liquid chromatography-tandem mass spectrometry and to determine which salivary hormone performs better in distinguishing between people with and without neoplastic hypercortisolism.

Methods

A retrospective study was conducted on subjects screened for endogenous hypercortisolism at Amsterdam UMC between December 2015 and February 2022. 25 subjects with and 430 subjects without neoplastic hypercortisolism were included. The diagnosis neoplastic hypercortisolism was confirmed by histology and postoperative clinical features, not on biochemical tests, and excluded based on a follow-up of at least 12 months without progressive clinical signs of neoplastic hypercortisolism. Salivary samples were collected between 22:00–23:59 h and Cortisol_LNSa and Cortisone_LNSa concentrations were measured using liquid chromatography-tandem mass spectrometry.

Results

The median Cortisol_LNSa was 7.8 nmol/L for subjects with and 0.8 nmol/L for subjects without neoplastic hypercortisolism (p < 0.001). The median Cortisone_LNSa was 35.5 nmol/L and 5.3 nmol/L, respectively (p < 0.001). Optimal diagnostic accuracy was established at 2.25 nmol/L for Cortisol_LNSa (sensitivity 92 %, specificity 89 %, positive predictive value 32.9 %, negative predictive value 99.5 %) and 15.5 nmol/L for Cortisone_LNSa (sensitivity 93.8 %, specificity 94.5 %, positive predictive value 46.9 %, negative predictive value 99.7 %).

Conclusions

We established cut-off values for Cortisol_LNSa and Cortisone_LNSa for the diagnosis of neoplastic hypercortisolism. Cortisone_LNSa provided the highest diagnostic accuracy and we therefore recommend it as the preferred salivary measurement.

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肿瘤性高皮质醇症：深夜唾液皮质醇和可的松的临界值

目的诊断肿瘤性高皮质醇症的推荐初始检测之一是测量深夜唾液皮质醇（皮质醇lnsa）。已发表的皮质醇lnsa和深夜唾液可的松（CortisoneLNSa）的临界值在不同的研究中差异很大。本研究旨在利用液相色谱-串联质谱法建立cortissollnsa和CortisoneLNSa的临界值，并确定哪种唾液激素在区分肿瘤性高皮质醇症患者和非肿瘤性高皮质醇症患者方面表现更好。方法对2015年12月至2022年2月在阿姆斯特丹UMC筛查的内源性高皮质醇症患者进行回顾性研究。纳入25例肿瘤性高皮质醇血症患者和430例非肿瘤性高皮质醇血症患者。肿瘤性高皮质醇症的诊断是通过组织学和术后临床特征，而不是生化检查来证实的，并且根据至少12个月的随访，没有进行性的肿瘤性高皮质醇症临床体征来排除。22:00-23:59 h采集唾液样本，采用液相色谱-串联质谱法测定皮质醇lnsa和皮质醇elnsa浓度。结果肿瘤性高皮质醇血症患者的中位皮质醇lnsa为7.8 nmol/L，非肿瘤性高皮质醇血症患者的中位皮质醇lnsa为0.8 nmol/L (p <；0.001)。中位CortisoneLNSa分别为35.5 nmol/L和5.3 nmol/L (p <；0.001)。CortisoneLNSa的最佳诊断准确率分别为2.25 nmol/L（敏感性92%，特异性89%，阳性预测值32.9%，阴性预测值99.5%）和15.5 nmol/L（敏感性93.8%，特异性94.5%，阳性预测值46.9%，阴性预测值99.7%）。结论我们建立了cortissollnsa和CortisoneLNSa诊断肿瘤性高皮质醇症的临界值。CortisoneLNSa提供了最高的诊断准确性，因此我们推荐它作为首选的唾液测量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinica Chimica Acta 医学-医学实验技术

CiteScore

10.10

自引率

2.00%

发文量

1268

审稿时长

23 days

期刊介绍： The Official Journal of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Clinica Chimica Acta is a high-quality journal which publishes original Research Communications in the field of clinical chemistry and laboratory medicine, defined as the diagnostic application of chemistry, biochemistry, immunochemistry, biochemical aspects of hematology, toxicology, and molecular biology to the study of human disease in body fluids and cells. The objective of the journal is to publish novel information leading to a better understanding of biological mechanisms of human diseases, their prevention, diagnosis, and patient management. Reports of an applied clinical character are also welcome. Papers concerned with normal metabolic processes or with constituents of normal cells or body fluids, such as reports of experimental or clinical studies in animals, are only considered when they are clearly and directly relevant to human disease. Evaluation of commercial products have a low priority for publication, unless they are novel or represent a technological breakthrough. Studies dealing with effects of drugs and natural products and studies dealing with the redox status in various diseases are not within the journal''s scope. Development and evaluation of novel analytical methodologies where applicable to diagnostic clinical chemistry and laboratory medicine, including point-of-care testing, and topics on laboratory management and informatics will also be considered. Studies focused on emerging diagnostic technologies and (big) data analysis procedures including digitalization, mobile Health, and artificial Intelligence applied to Laboratory Medicine are also of interest.