title: Usefulness of salivary cortisol in the diagnosis of hypercortisolism: comparison with serum and urinary cortisol.
abstract: OBJECTIVE
  Several tests have been proposed to diagnose patients with Cushing's syndrome (CS). The aims of the study were: i) to evaluate the performance of salivary cortisol (SC) in hypercortisolism and ii) to compare SC with serum cortisol (SeC) and urinary cortisol.
  
  
  METHODS
  This was a diagnostic study. Twenty-seven patients with untreated Cushing's disease (CD untr), 21 women consuming oral contraceptive pill (OCP), 18 pregnant women, and 89 healthy subjects (controls) were enrolled.
  
  
  METHODS
  SC and SeC at baseline and after the low-dose dexamethasone suppression test (LDDST) and urinary free cortisol (UFC) were measured.
  
  
  RESULTS
  Midnight SC had a sensitivity of 100% in the CD untr group and a specificity of 97.7% in the controls. Specificity remained high (95.2%) in women taking OCP, while in pregnant women, it decreased to 83.3%. SC after the LDDST showed a sensitivity of 96.3% in the CD untr group; specificity was 97.7% in the controls and 90.5% in OCP women. Midnight SeC had a sensitivity of 100% in the CD untr group. SeC after the LDDST had a sensitivity of 100% in the CD untr group while specificity was 97.7% in the controls and 61.9% in women taking OCP. For UFC, sensitivity was 92.6% in the CD untr group while specificity was 97.7% in the controls and 100% in the OCP group.
  
  
  CONCLUSIONS
  SC is a reliable parameter for the diagnosis of severe hypercortisolism, with high sensitivity and specificity. In women during pregnancy or taking OCP, the measurement of SC, identifying the free fraction, could be helpful to exclude CS.
authors.affiliation: Department of Endocrinology and Metabolism, University of Pisa, Ospedale Cisanello, via Paradisa 2, 56124 Pisa, Italy. lmanetti@endoc.med.unipi.it
authors.forename: Luca
authors.initials: L
authors.lastname: Manetti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rossi
authors.forename: Lucia
authors.initials: L
authors.lastname: Grasso
authors.forename: Valentina
authors.initials: V
authors.lastname: Raffaelli
authors.forename: Ilaria
authors.initials: I
authors.lastname: Scattina
authors.forename: Simone
authors.initials: S
authors.lastname: Del Sarto
authors.forename: Mirco
authors.initials: M
authors.lastname: Cosottini
authors.forename: Aldo
authors.initials: A
authors.lastname: Iannelli
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gasperi
authors.forename: Fausto
authors.initials: F
authors.lastname: Bogazzi
authors.forename: Enio
authors.initials: E
authors.lastname: Martino
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002940:Circadian Rhythm; D003276:Contraceptives, Oral / Q000494:pharmacology; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology / Q000652:urine; D003907:Dexamethasone; D005260:Female; D005938:Glucocorticoids; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000378:metabolism* / Q000652:urine; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology / Q000652:urine; D012463:Saliva / Q000378:metabolism*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D003276:Contraceptives, Oral; D005938:Glucocorticoids; D003907:Dexamethasone; D006854:Hydrocortisone