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Saliva versus serum cortisol to identify subclinical hypercortisolism in adrenal incidentalomas: simplicity versus accuracy.
Vieira-Correa, M; Giorgi, R B; Oliveira, K C; Hayashi, L F; Costa-Barbosa, F A; Kater, C E.
Afiliação
  • Vieira-Correa M; From the Adrenal and Hypertension Unit, Division of Endocrinology and Metabolism, Department of Medicine, Federal University of São Paulo School of Medicine (Escola Paulista de Medicina/Universidade Federal de São Paulo), Rua Pedro de Toledo, 781-13th Floor, São Paulo, SP, 04039-032, Brazil.
  • Giorgi RB; From the Adrenal and Hypertension Unit, Division of Endocrinology and Metabolism, Department of Medicine, Federal University of São Paulo School of Medicine (Escola Paulista de Medicina/Universidade Federal de São Paulo), Rua Pedro de Toledo, 781-13th Floor, São Paulo, SP, 04039-032, Brazil.
  • Oliveira KC; From the Adrenal and Hypertension Unit, Division of Endocrinology and Metabolism, Department of Medicine, Federal University of São Paulo School of Medicine (Escola Paulista de Medicina/Universidade Federal de São Paulo), Rua Pedro de Toledo, 781-13th Floor, São Paulo, SP, 04039-032, Brazil.
  • Hayashi LF; From the Adrenal and Hypertension Unit, Division of Endocrinology and Metabolism, Department of Medicine, Federal University of São Paulo School of Medicine (Escola Paulista de Medicina/Universidade Federal de São Paulo), Rua Pedro de Toledo, 781-13th Floor, São Paulo, SP, 04039-032, Brazil.
  • Costa-Barbosa FA; From the Adrenal and Hypertension Unit, Division of Endocrinology and Metabolism, Department of Medicine, Federal University of São Paulo School of Medicine (Escola Paulista de Medicina/Universidade Federal de São Paulo), Rua Pedro de Toledo, 781-13th Floor, São Paulo, SP, 04039-032, Brazil.
  • Kater CE; From the Adrenal and Hypertension Unit, Division of Endocrinology and Metabolism, Department of Medicine, Federal University of São Paulo School of Medicine (Escola Paulista de Medicina/Universidade Federal de São Paulo), Rua Pedro de Toledo, 781-13th Floor, São Paulo, SP, 04039-032, Brazil. kater@u
J Endocrinol Invest ; 42(12): 1435-1442, 2019 Dec.
Article em En | MEDLINE | ID: mdl-31456173
PURPOSE: Subclinical hypercortisolism (SCH) leads to metabolic derangements and increased cardiovascular risk. Cortisol autonomy is defined by the overnight 1 mg dexamethasone suppression test (DST). Saliva cortisol is an easier, stress-free, and cost-effective alternative to serum cortisol. We compared 23 h and post-1 mg DST saliva with serum cortisol to identify SCH in adrenal incidentalomas (AI). METHODS: We analyzed 359 DST obtained retrospectively from 226 AI subjects (173F/53 M; 19-83 years) for saliva and serum cortisol. We used three post-DST serum cortisol cutoffs to uncover SCH: 1.8, 2.5, and 5.0 µg/dL. We determined post-DST and 23 h saliva cortisol cutoffs by ROC curve analysis and calculated their sensitivities (S) and specificities (E). RESULTS: The sensitive 1.8 µg/dL cutoff defined 137 SCH and 180 non-functioning adenomas (NFA): post-DST and 23 h saliva cortisol S/E were: 75.2%/74.4% and 59.5%/65.9%, respectively. Using the specific 5.0 µg/dL cortisol cutoff (22 SCH/295 NFA), post-DST and 23 h saliva cortisol S/E were 86.4%/83.4% and 66.7%/80.4%, respectively. Using the intermediate 2.5 µg/dL cutoff (89 SCH/228 NFA), post-DST and 23 h saliva cortisol S/E were 80.9%/68.9% and 65.5%/62.8%, respectively. CONCLUSION: Saliva cortisol showed acceptable performance only with the 5.0 µg/dL cortisol cutoff, as in overt Cushing's syndrome. Lower cutoffs (1.8 and 2.5 µg/dL) that identify larger samples of patients with poor metabolic outcomes are less accurate for screening. These results may be attributed to pre-analytical factors and inherent patient conditions. Thus, saliva cortisol cannot replace serum cortisol to identify SCH among patients with AI for screening DST.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Hidrocortisona / Neoplasias das Glândulas Suprarrenais / Síndrome de Cushing Tipo de estudo: Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: J Endocrinol Invest Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Brasil País de publicação: Itália
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Hidrocortisona / Neoplasias das Glândulas Suprarrenais / Síndrome de Cushing Tipo de estudo: Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: J Endocrinol Invest Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Brasil País de publicação: Itália