title: The role of salivary cortisol measured by liquid chromatography-tandem mass spectrometry in the diagnosis of subclinical hypercortisolism.
abstract: OBJECTIVE
  The use of late-night salivary cortisol (LNSalC) for diagnosing subclinical hypercortisolism (SH) is debated. No data are available regarding the role of LNSalC as measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) in SH diagnosis. The aim of this study was to evaluate the diagnostic accuracy of LNSalC measured by LC-MS/MS in SH.
  
  
  METHODS
  Cross-sectional prospective study of outpatients.
  
  
  METHODS
  In 70 consecutive patients with adrenal incidentalomas (AI), without signs and symptoms of hypercortisolism, we diagnosed SH in the presence of at least two of the following: cortisol after 1 mg overnight dexamethasone suppression test (1  mg DST) >83  nmol/l, 24-h urinary free cortisol (UFC) >193  nmol/24  h, and morning ACTH <2.2  pmol/l. The LNSalC levels by LC-MS/MS at 2300  h (normal values <2.8  nmol/l) and the presence of hypertension, type 2 diabetes mellitus (T2DM), and osteoporosis (OP) were assessed.
  
  
  RESULTS
  The increased LNSalC levels (>2.8  nmol/l) had an 83.3% specificity (SP) and a 31.3% sensitivity (SN) for predicting the biochemical diagnosis of SH. The increased LNSalC had an 85.2% SP and a 55.6% SN for predicting the presence of hypertension, T2DM, and OP, while the combination of LNSalC >1.4  nmol/l (cutoff with 100% SN) plus 1 mg DST >50  nmol/l had an 88.9% SN and an 85.2% SP (similar to SH criterion at enrollment).
  
  
  CONCLUSIONS
  In AI patients, LNSalC measured by LC-MS/MS appears to be useful in combination with 1 mg DST for diagnosing SH, while it is not useful as a single criterion.
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy. serena.palmieri@hotmail.it
authors.forename: S
authors.initials: S
authors.lastname: Palmieri
authors.forename: V
authors.initials: V
authors.lastname: Morelli
authors.forename: E
authors.initials: E
authors.lastname: Polledri
authors.forename: S
authors.initials: S
authors.lastname: Fustinoni
authors.forename: R
authors.initials: R
authors.lastname: Mercadante
authors.forename: L
authors.initials: L
authors.lastname: Olgiati
authors.forename: C
authors.initials: C
authors.lastname: Eller Vainicher
authors.forename: E
authors.initials: E
authors.lastname: Cairoli
authors.forename: V V
authors.initials: VV
authors.lastname: Zhukouskaya
authors.forename: P
authors.initials: P
authors.lastname: Beck-Peccoz
authors.forename: I
authors.initials: I
authors.lastname: Chiodini
mesh_terms: D000302:Adrenal Cortex / Q000187:drug effects / Q000378:metabolism; D000310:Adrenal Gland Neoplasms / Q000503:physiopathology; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D002851:Chromatography, High Pressure Liquid; D002940:Circadian Rhythm; D003430:Cross-Sectional Studies; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D003907:Dexamethasone; D005260:Female; D005938:Glucocorticoids; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism* / Q000652:urine; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012463:Saliva / Q000378:metabolism*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D021241:Spectrometry, Mass, Electrospray Ionization; D053719:Tandem Mass Spectrometry
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone