The Combination of Afternoon and Midnight Salivary Cortisol Improves the Diagnosis of Cushing Syndrome.

IF 5.3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Luana Lionetto, Donatella De Bernardini, Giuseppe Costanzi, Roberta Maggio, Maria Elena Aloini, Guido Roberto, Francesca Ricci, Irene Biondo, Pina Lardo, Gerardo Salerno, Maurizio Simmaco, Antonio Stigliano
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引用次数: 0

Abstract

Background: The diagnosis of Cushing syndrome is challenging and often fraught with many pitfalls depending on several factors. We compare the diagnostic performance of AM serum cortisol; 24-hour urinary free cortisol; and 0800 h, 1400 h, and 2400 h salivary cortisol curve (SCC) in 1 mg dexamethasone suppression test positive and negative patients.

Methods: Eighty-three subjects performed measurements of SCC by the liquid chromatography tandem mass spectrometry method, exploiting the circadian rhythm of cortisol.

Results: The reproducibility and specificity of the test identify patients with hypercortisolism in 95% of cases at midnight. Interestingly, when considering 2 specific points (1400 h and 2400 h) on the SCC, the success rate rises to 100%.

Conclusion: The evaluation of the 1400 h and 2400 h assays led to detection of the total number of patients with Cushing syndrome. Salivary cortisol curve analysis is a non-invasive diagnostic strategy associated with elevated positive predictive value for hypercortisolism capable of enabling diagnosis. In addition, it can be considered for management of patient outcomes and monitoring of Cushing syndrome pharmacological treatment.

下午和午夜唾液皮质醇的结合改善了库欣综合征的诊断。
背景:库欣综合征的诊断是具有挑战性的,往往充满了许多陷阱取决于几个因素。比较AM血清皮质醇(SC)、24小时尿游离皮质醇(UFC)和0800 h、1400 h、2400 h唾液皮质醇曲线(SCC)对地塞米松抑制试验1mg (1mg- dst)阳性和阴性患者的诊断价值。方法:采用液相色谱串联质谱法(LC-MS/MS)测量83名受试者的SCC,利用皮质醇的昼夜节律。结果:该试验的重复性和特异性在95%的病例中识别出午夜时分的高皮质醇血症患者。有趣的是,当考虑SCC上的两个特定点(1400小时和2400小时)时,成功率上升到100%。结论:通过对1400h和2400h检测的评价,可以检测出库欣综合征患者的总人数。SCC是一种非侵入性诊断策略,与高皮质醇血症的阳性预测值升高相关,能够进行诊断。此外,还可考虑用于患者预后的管理和库欣综合征药物治疗的监测。
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
American Journal of Medicine
American Journal of Medicine 医学-医学:内科
CiteScore
6.30
自引率
3.40%
发文量
449
审稿时长
9 days
期刊介绍: The American Journal of Medicine - "The Green Journal" - publishes original clinical research of interest to physicians in internal medicine, both in academia and community-based practice. AJM is the official journal of the Alliance for Academic Internal Medicine, a prestigious group comprising internal medicine department chairs at more than 125 medical schools across the U.S. Each issue carries useful reviews as well as seminal articles of immediate interest to the practicing physician, including peer-reviewed, original scientific studies that have direct clinical significance and position papers on health care issues, medical education, and public policy.
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