title: Significantly high level of late-night free cortisol to creatinine ratio in urine specimen in patients with subclinical Cushing's syndrome.
abstract: OBJECTIVE
  Absence of a late-night cortisol nadir is a consistent biochemical abnormality in patients with cortisol-producing adenoma. We evaluated the abnormality of late-night urinary free cortisol to creatinine ratio (late-night UFCCR) in patients with subclinical Cushing's syndrome (SCS).
  
  
  METHODS
  Fifty-eight patients with incidentally detected adrenocortical adenomas [SCS: 9; nonfunctioning adenoma (NF): 49] were enrolled as subjects. Values measured in all patients were urinary free cortisol accumulated between 9:00 p.m. and 11:00 p.m. (late-night UFCCR), serum cortisol at 11:00 p.m. (midnight serum cortisol: MSC), serum cortisol after 1-mg overnight dexamethasone suppression test (1 mg-DST) and 24-h urinary free cortisol (UFC).
  
  
  RESULTS
  Median late-night UFCCR value in SCS was significantly higher than that in NF (P < 0·001). Significant correlations were observed between late-night UFCCR and each of serum cortisol after 1 mg-DST and MSC (r = 0·537, P < 0·001 and r = 0·556, P < 0·001, respectively). There was no significant correlation between serum cortisol after 1 mg-DST and 24-h UFC (r = 0·211, P = 0·112). In receiver operating characteristic analysis for diagnosis of SCS, the areas under the curves of late-night UFCCR and 24-h UFC were 0·937 (95% confidence interval 0·865-1·008) and 0·726 (0·874-0·999), respectively. Late-night UFCCR cut-off value of 4·9 nmol/μmol Cre showed a sensitivity of 100% and a specificity of 76·6%.
  
  
  CONCLUSIONS
  Patients with SCS showed higher late-night UFCCR values than those with NF. Late-night UFCCR was significantly correlated with autonomous cortisol production findings. Diagnostic performance of late-night UFCCR was superior to 24-h UFC. These results suggest that late-night UFCCR might represent one of the simple and reliable tests for SCS diagnosis.
authors.affiliation: Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Tsuguka
authors.initials: T
authors.lastname: Shiwa
authors.forename: Kenji
authors.initials: K
authors.lastname: Oki
authors.forename: Kiminori
authors.initials: K
authors.lastname: Yamane
authors.forename: Masayasu
authors.initials: M
authors.lastname: Yoneda
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Awaya
authors.forename: Shuhei
authors.initials: S
authors.lastname: Nakanishi
authors.forename: Nobuoki
authors.initials: N
authors.lastname: Kohno
mesh_terms: D000368:Aged; D003404:Creatinine / Q000652:urine*; D003480:Cushing Syndrome / Q000652:urine*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000652:urine*; D008297:Male; D008875:Middle Aged; D013997:Time Factors
chemical_list: D003404:Creatinine; D006854:Hydrocortisone