title: Diagnostics of hypercortisolism - comparison between the clinical usefulness of salivary and serum cortisol measurements.
abstract: BACKGROUND
  The aim of this study was the comparison of 24h urine free cortisol (UFC), serum cortisol at 11pm (SCM) and late-nightsalivary cortisol (LSC) in patients suspected for hypercortisolism, and an assessment of the usefulness of these measurements in diagnosingovert Cushing's (OCS) syndrome, pseudo Cushing's state (PCS) and subclinical Cushing's syndrome (SCS).
  
  
  METHODS
  The study group consisted of 82 patients, of whom four patients had SCS, three OCS and eight PCS. For measurementsof LSC, the ELISA method was used, and for UFC and SCM determination, chemiluminescent microparticle immunoassay was used.
  
  
  RESULTS
  The highest correlation coefficient characterised LSC and SCM (r = 0.72). Area under curve (AUC) for SCM and LSC in receiveroperating characteristic (ROC) for OCS was: 0.86 v. 0.74; for PCS: 0.83 v. 0.70; and for SCS: 0.74 v. 0.79.
  
  
  CONCLUSIONS
  Our findings suggest that LSC is more useful compared to SCM in diagnosing subclinical Cushing's syndrome. Moreover,LSC seems to be a valuable diagnostic criterion to distinguish pseudo Cushing's state. However, to obtain reliable cut-offs for LSC values,a larger group of hypercortisolic patients is needed.
authors.affiliation: Department of Endocrinology, Diabetology and Internal Diseases, Medical University of Bialystok, Poland. ukzuk85@wp.pl
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Żukowski
authors.forename: Janusz
authors.initials: J
authors.lastname: Myśliwiec
authors.forename: Maria
authors.initials: M
authors.lastname: Górska
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D002940:Circadian Rhythm; D003480:Cushing Syndrome / Q000097:blood* / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007118:Immunoassay / Q000379:methods; D008297:Male; D008875:Middle Aged; D047748:Pituitary ACTH Hypersecretion / Q000097:blood* / Q000175:diagnosis*; D015203:Reproducibility of Results; D012463:Saliva / Q000737:chemistry*
chemical_list: D015415:Biomarkers; D006854:Hydrocortisone