title: Is late-night salivary cortisol a better screening test for possible cortisol excess than standard screening tests in obese patients with Type 2 diabetes?
abstract: OBJECTIVE
  To compare the performance, in terms of specificity for cortisol excess, of late-night salivary cortisol with 24-hour urine-free cortisol (24hr UFC) and overnight 1mg dexamethasone suppression test (1mg DST) in a group of obese T2DM patients.
  
  
  METHODS
  Forty obese patients with T2DM without clinical features of Cushing's syndrome were recruited. Plasma, urinary and salivary cortisol were measured directly by an enzyme-linked immunosorbent assay using monoclonal antibodies. The specificities of the three tests using various cutoffs were calculated and compared, employing the assumption that none of the patients had hypercortisolism.
  
  
  RESULTS
  The patients had a mean age and BMI of 56 years (range 31-75) and 37 kg/m² (31-56) respectively. All 40 provided late-night salivary cortisol samples. Thirty-eight patients completed all three tests. Two patients only completed two screening tests. The specificities of late-night salivary cortisol (cutoff 10 nmol/L), 24hr UFC (400 nmol) and 1mg DST (50 nmol/L) were 70% (95% CI 53-83%), 90% (76-97%) and 72% (55-85%) respectively. The specificity of late-night salivary cortisol was significantly less than 24 hr UFC (P=0.039) but not 1mg DST (P>0.99).
  
  
  CONCLUSIONS
  Late-night salivary cortisol has a poor specificity for cortisol excess in obese patients with T2DM with 24 hr UFC showing significantly better specificity in our population.
authors.affiliation: Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Elna
authors.initials: E
authors.lastname: Ellis
authors.forename: Paul K L
authors.initials: PK
authors.lastname: Chin
authors.forename: Penelope J
authors.initials: PJ
authors.lastname: Hunt
authors.forename: Helen
authors.initials: H
authors.lastname: Lunt
authors.forename: John G
authors.initials: JG
authors.lastname: Lewis
authors.forename: Steven G
authors.initials: SG
authors.lastname: Soule
mesh_terms: D000328:Adult; D000368:Aged; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis* / Q000097:blood / Q000652:urine; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D012463:Saliva / Q000737:chemistry*; D013997:Time Factors; D016482:Urinalysis
chemical_list: D006854:Hydrocortisone