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Horm Metab Res 2021; 53(10): 662-671
DOI: 10.1055/a-1608-1720
Endocrine Care

Distinct Late-Night Salivary Cortisol Cut-Off Values for the Diagnosis of Hypercortisolism

Lukas van Baal
1   Department of Endocrinology, Diabetes and Metabolism, University Duisburg-Essen, Essen, Germany
,
Marc Wichert
2   Department of Clinical Chemistry, University Duisburg-Essen, Essen, Germany
,
Denise Zwanziger
1   Department of Endocrinology, Diabetes and Metabolism, University Duisburg-Essen, Essen, Germany
2   Department of Clinical Chemistry, University Duisburg-Essen, Essen, Germany
,
Henning Dralle
3   Division of Endocrine Surgery, University Duisburg-Essen, Essen, Germany
,
Frank Weber
3   Division of Endocrine Surgery, University Duisburg-Essen, Essen, Germany
,
Ilonka Kreitschmann-Andermahr
4   Department of Neurosurgery, University Duisburg-Essen, Essen, Germany
,
Dagmar Führer
1   Department of Endocrinology, Diabetes and Metabolism, University Duisburg-Essen, Essen, Germany
,
Nicole Unger
1   Department of Endocrinology, Diabetes and Metabolism, University Duisburg-Essen, Essen, Germany
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Abstract

Due to high morbidity and mortality of untreated hypercortisolism, a prompt diagnosis is essential. Measurement of late-night salivary cortisol provides a simple and non-invasive method. However, thresholds and reference ranges differ among studies. The goal of this study was to define a threshold of late-night salivary cortisol for the diagnosis of hypercortisolism based on the used assay. Moreover, the influence of different aetiologies of hypercortisolism and individual comorbidities were investigated. Prospective analyses of 217 patients, including 36 patients with proven hypercortisolism were carried out. A sum of 149 patients with suspicion of hypercortisolism but negative endocrine testing and 32 patients with hypercortisolism in remission served as control group. Late-night salivary cortisol was measured using an automated chemiluminescence immunoassay. Cut-off values were calculated by ROC analysis. The calculated cut-off value for the diagnosis of hypercortisolism was 10.1 nmol/l (sensitivity 94%; specificity 84%). Only slightly lower thresholds were obtained in patients with suspected hypercortisolism due to weight gain/obesity (9.1 nmol/l), hypertension or adrenal tumours (both 9.8 nmol/l) or pituitary adenomas (9.5 nmol/l). The late-night salivary cortisol threshold to distinguish between Cushing’s disease and Cushing’s disease in remission was 9.2 nmol/l. The cut-off value for the diagnosis of ectopic ACTH-production was 109.0 nmol/l (sensitivity 50%, specificity 92%). Late-night salivary cortisol is a convenient and reliable parameter for the diagnosis of hypercortisolism. Except for ectopic ACTH-production, thresholds considering different indications for evaluation of hypercortisolism were only slightly different. Therefore, they might only be useful if late-night salivary cortisol results near the established cut-off value are present.

Key words

Cushing’s syndrome - Cushing’s disease - late-night salivary cortisol - immunoassay


Publication History

Received: 06 May 2021

Accepted after revision: 13 August 2021

Article published online:
04 October 2021

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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