title: Performance of salivary cortisol in the diagnosis of Cushing's syndrome, adrenal incidentaloma, and adrenal insufficiency.
abstract: OBJECTIVE
  Salivary cortisol has recently been suggested for studies on the hypothalamic-pituitary-adrenal (HPA) axis. The lack of circadian rhythm is a marker of Cushing's syndrome (CS), and some authors have reported that low salivary cortisol levels may be a marker of adrenal insufficiency. The aim of our study was to define the role of salivary cortisol in specific diagnostic settings of HPA axis disease.
  
  
  METHODS
  We analyzed morning salivary cortisol (MSC) and late-night salivary CORTISOL (LNSC) levels in 406 SUBJECTS: 52 patients with Cushing's disease (CD), 13 with ectopic CS, 17 with adrenal CS, 27 with CD in remission (a mean follow-up of 66±39 months), 45 with adrenal incidentaloma, 73 assessed as having CS and then ruled out for endogenous hypercortisolism, 75 with adrenal insufficiency, and 104 healthy subjects.
  
  
  RESULTS
  A LNSC value above 5.24  ng/ml differentiated CS patients from controls with high sensitivity (96.3%) and specificity (97.1%); we found higher LNSC levels in ectopic CS patients than in CD patients. We found no difference in MSC and LNSC levels between patients with CD in remission and healthy subjects. Both MSC and LNSC levels were higher in patients with adrenal incidentaloma than in healthy controls. A MSC value below 2.65 ng/ml distinguished patients with adrenal insufficiency from controls with high sensitivity (97.1%) and specificity (93.3%).
  
  
  CONCLUSIONS
  Salivary cortisol is a useful tool to assess endogenous cortisol excess or adrenal insufficiency and to evaluate stable CD in remission.
authors.affiliation: Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Via Ospedale, 105, 35128 Padova, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Ceccato
authors.forename: Mattia
authors.initials: M
authors.lastname: Barbot
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Zilio
authors.forename: Sergio
authors.initials: S
authors.lastname: Ferasin
authors.forename: Gianluca
authors.initials: G
authors.lastname: Occhi
authors.forename: Andrea
authors.initials: A
authors.lastname: Daniele
authors.forename: Sara
authors.initials: S
authors.lastname: Mazzocut
authors.forename: Maurizio
authors.initials: M
authors.lastname: Iacobone
authors.forename: Corrado
authors.initials: C
authors.lastname: Betterle
authors.forename: Franco
authors.initials: F
authors.lastname: Mantero
authors.forename: Carla
authors.initials: C
authors.lastname: Scaroni
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000378:metabolism; D000309:Adrenal Insufficiency / Q000175:diagnosis* / Q000378:metabolism; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D002940:Circadian Rhythm; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000378:metabolism; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis; D010913:Pituitary-Adrenal System / Q000378:metabolism; D011237:Predictive Value of Tests; D012372:ROC Curve; D012463:Saliva / Q000378:metabolism*; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D006854:Hydrocortisone