Screening for subclinical Cushing's syndrome in type 2 diabetes mellitus: low false-positive rates with nocturnal salivary cortisol

Hormone and Metabolic Research = Hormon- Und Stoffwechselforschung = Hormones Et Métabolisme
L GagliardiD J Torpy

Abstract

The diagnosis of subclinical Cushing's syndrome (SCS) is important, but its relative rarity amongst patients with common metabolic disorders requires a simple test with a low false-positive rate. Using nocturnal salivary cortisol (NSC), which we first validated in patients with suspected and proven Cushing's syndrome, we screened 106 overweight patients with type 2 diabetes mellitus, a group at high risk of SCS and nontumoral hypothalamic-pituitary-adrenal axis perturbations. Our hypothesis was that a lower false-positive rate with NSC was likely, compared with that reported with the dexamethasone suppression test (DST) (10-20%), currently the foundation of diagnosis of SCS. No participant had clinically apparent Cushing's syndrome. Three participants had an elevated NSC but further testing excluded SCS. In this study, NSC had a lower false-positive rate (3%) than previously reported for the DST. Given the reported excellent performance of NSC in detection of hypercortisolism, the low false-positive rate in SCS suggests NSC may be superior to the DST for SCS screening. The NSC and DST should be compared directly in metabolic disorder patients; although our data suggest the patient group will need to be substantially larger to d...Continue Reading

Citations

Mar 7, 2012·Endocrine·Roberta GiordanoEmanuela Arvat
Apr 18, 2014·Endocrine·Askin GungunesTuncay Delibasi
Jan 13, 2015·Pituitary·Ilan Shimon
Jun 30, 2016·European Journal of Endocrinology·Charlotte SteffensenJens Otto L Jørgensen
Mar 2, 2017·Current Opinion in Endocrinology, Diabetes, and Obesity·Guido Di Dalmazi
Sep 26, 2013·The Journal of International Medical Research·Qian ZhangJuming Lu
Dec 14, 2011·Diabetes/metabolism Research and Reviews·Therese KrarupClaus Hagen
Mar 9, 2019·Endocrine·Marta Araujo-CastroMónica Marazuela
Jan 5, 2021·Journal of Endocrinological Investigation·L GiovanelliI Chiodini
Apr 6, 2021·Best Practice & Research. Clinical Endocrinology & Metabolism·Carmen ArestaIacopo Chiodini
Jul 30, 2021·Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists·Carmen ArestaIacopo Chiodini

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