ArticleJournal of endocrinological investigation2019
The diagnostic accuracy of increased late night salivary cortisol for Cushing's syndrome: a real-life prospective study.
Article in Journal of endocrinological investigation, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 1 of them a synthesis that pooled it.
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Who cites it
29 citing papers in PubMed, 1 synthesis or guideline pooled it, 38 citations in OpenAlex.
- Who and how to screen for Cushing's syndrome: the position statement of the Italian Society of Endocrinology.Journal of endocrinological investigation · 2026Guideline
- The Chronobiology of Hormone Administration: "Doctor, What Time Should I Take My Medication?"Endocrine reviews · 2025Review
- Hypertension and Cushing's syndrome: hunt for the red flag.Journal of endocrinological investigation · 2025Review
- Who and how to screen for endogenous hypercortisolism in a high-risk population: a special issue of the journal of endocrinological investigations.Journal of endocrinological investigation · 2025Article
- Cushing syndrome in paediatric population: who and how to screen.Journal of endocrinological investigation · 2025Review
- Who and how to screen for endogenous hypercortisolism in adrenal and pituitary incidentaloma.Journal of endocrinological investigation · 2025Review
- Who and how to screen for endogenous hypercortisolism in type 2 diabetes mellitus or obesity.Journal of endocrinological investigation · 2025Review
- Development of diagnostic algorithm for Cushing's syndrome: a tertiary centre experience.Journal of endocrinological investigation · 2024Article
- Food-induced cortisol secretion is comparable in lean and obese male subjects.Endocrine connections · 2023Article
- Pitfalls in the Diagnosis and Management of Hypercortisolism (Cushing Syndrome) in Humans; A Review of the Laboratory Medicine Perspective.Diagnostics (Basel, Switzerland) · 2023Review
- Progress in salivary glands: Endocrine glands with immune functions.Frontiers in endocrinology · 2023Review
- Simultaneous Measurement of Cortisol, Cortisone, Dexamethasone and Additional Exogenous Corticosteroids by Rapid and Sensitive LC-MS/MS Analysis.Molecules (Basel, Switzerland) · 2022Article
- Frequently asked questions and answers (if any) in patients with adrenal incidentaloma.Journal of endocrinological investigation · 2021Review
- Second-Line Tests in the Diagnosis of Adrenocorticotropic Hormone-Dependent Hypercortisolism.Annals of laboratory medicine · 2021Review
- The diagnostic utility of late night salivary cortisol (LNSF) and cortisone (LNSE) in Cushing's syndrome.Irish journal of medical science · 2021Article
- Glucocorticoid Withdrawal-An Overview on When and How to Diagnose Adrenal Insufficiency in Clinical Practice.Diagnostics (Basel, Switzerland) · 2021Review
- Neutrophil-Lymphocyte Ratio as an Initial Screening Biomarker for Differential Diagnosis of Cushing's Syndrome from Nonfunctional Adenoma in Patients with an Adrenal Mass.BioMed research international · 2021Article
- Reference ranges of late-night salivary cortisol and cortisone measured by LC-MS/MS and accuracy for the diagnosis of Cushing's syndrome.Journal of endocrinological investigation · 2020Article
- Treatment with Intravenous Methylprednisolone in Patients with Graves' Orbitopathy Significantly Affects Adrenal Function: Assessment of Serum, Salivary Cortisol and Serum Dehydroepiandrosterone Sulfate.Journal of clinical medicine · 2020Article
- Prospective Evaluation of Late-Night Salivary Cortisol and Cortisone by EIA and LC-MS/MS in Suspected Cushing Syndrome.Journal of the Endocrine Society · 2020Article
Corrections and comments
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
INTRODUCTION AND
aimA prompt diagnosis of Cushing's Syndrome (CS) in high-risk populations is mandatory: 1-mg dexamethasone suppression test (1-mg DST), late night salivary cortisol (LNSC), and urinary-free cortisol (UFC) are recommended, despite thresholds calculated in retrospective studies. Our aim was to study the diagnostic accuracy of LNSC measured with chemiluminescence assay in a prospective study, confirming discrepancies with mass spectrometry (MS). MATERIALS AND
methodsWe enrolled 117 controls and 164 suspected CS (CS = 47, non-CS = 117). In case of increased LNSC, high clinical suspicion of CS or adrenal incidentaloma, patients were hospitalized to exclude/confirm CS.
resultsLNSC levels were higher in patients with suspected CS, CS, and non-CS than controls. Considering 16 nmol/L as threshold for CS, overall LNSC revealed SE 97% and SP 84% in the whole group of subjects considered, achieving positive/negative likelihood ratio of 5.56/0.045, respectively. 35 out of 81 subjects with increased LNSC were non-CS (15 diabetic and 20 obese): considering only those patients with increased likelihood to have a CS (the non-CS patients) SP decreased to 70%, and further reduced to 60% if we discharged subjects with adrenal incidentaloma. MS analyses reduced partially the number of false-positive LNSC.
conclusionsLNSC measured in automated chemiluminescence is reliable in clinical practice: it present a high diagnostic accuracy to exclude hypercortisolism in patients with normal cortisol levels. MS could be used to reduce the number of false-positive results; nevertheless, some non-CS subjects with functional hypercortisolism could have a mild impairment of cortisol rhythm.
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