title: Diagnostic characteristics of late-night salivary cortisol using liquid chromatography-tandem mass spectrometry.
abstract: OBJECTIVE
  The objective of the study was to describe the diagnostic performance of a commercially available late-night salivary cortisol (NSC) assay using liquid chromatography tandem mass spectrometry.
  
  
  METHODS
  We retrospectively identified 90 patients who had one or more NSC determinations: 52 patients in whom Cushing syndrome (CS) was excluded or could not be confirmed [group 1 (G1)] and 38 patients in whom CS was confirmed [group 2 (G2)]. Eighteen healthy volunteers served as controls.
  
  
  RESULTS
  Baseline demographics in all groups were similar with regards to age, ethnicity, gender, and body mass index. NSC levels [median (range)] were higher in G2, 381 (64-13,500) ng/dl [10.51 (1.77-372.46) nmol/liter], compared with controls, 19.3 (2.1-416) ng/dl [0.53 (0.06-11.48) nmol/liter], and G1, 26 (4-176) ng/dl [0.72 (0.11-4.86) nmol/liter, P < 0.001]. The highest combined sensitivity (92%) and specificity (92%) was achieved at a cut point of 107 ng/dl (2.95 nmol/liter). Two or more NSCs were done in 32 of 52 G1 and 31 of 38 G2 patients. In G1 eight of 32 (25%) had at least one elevated [>100 ng/dl (2.76 nmol/liter)] NSC including two in whom both NSCs were elevated. In contrast, four of 31 (13%) in G2 had at least one normal NSC including one with four of five normal NSC values. None of the patients with CS had a NSC less than 60 ng/dl (<1.66 nmol/liter). Comparing G1 and G2, obtaining more than one saliva sample did not improve the diagnostic accuracy of NSC measurement (P = 0.64).
  
  
  CONCLUSIONS
  The liquid chromatography tandem mass spectrometry assay to measure NSC is a simple and reliable test to screen patients suspected to have CS. Clinicians should be aware of appropriate cutoff values for proper interpretation of NSC and use additional tests when necessary.
authors.affiliation: Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: R Kurdi
authors.initials: RK
authors.lastname: Zerikly
authors.forename: L
authors.initials: L
authors.lastname: Amiri
authors.forename: C
authors.initials: C
authors.lastname: Faiman
authors.forename: M
authors.initials: M
authors.lastname: Gupta
authors.forename: R J
authors.initials: RJ
authors.lastname: Singh
authors.forename: B
authors.initials: B
authors.lastname: Nutter
authors.forename: L
authors.initials: L
authors.lastname: Kennedy
authors.forename: B
authors.initials: B
authors.lastname: Hatipoglu
authors.forename: R J
authors.initials: RJ
authors.lastname: Weil
authors.forename: A H
authors.initials: AH
authors.lastname: Hamrahian
mesh_terms: D049913:ACTH-Secreting Pituitary Adenoma / Q000150:complications / Q000175:diagnosis / Q000378:metabolism; D000236:Adenoma / Q000150:complications / Q000175:diagnosis / Q000378:metabolism; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002853:Chromatography, Liquid / Q000379:methods; D002940:Circadian Rhythm / Q000502:physiology; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D003940:Diagnostic Techniques, Endocrine / Q000592:standards; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012189:Retrospective Studies; D012463:Saliva / Q000737:chemistry* / Q000378:metabolism; D012680:Sensitivity and Specificity; D053719:Tandem Mass Spectrometry / Q000379:methods* / Q000592:standards; D013997:Time Factors; D055815:Young Adult
chemical_list: D006854:Hydrocortisone