Journal of the New Zealand Medical Association, 20-April-2012, Vol 125 No 1353
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Is late-night salivary cortisol a better screening test for possible cortisol excess than standard screening tests in obese patients with Type 2 diabetes?
Elna Ellis, Paul K L Chin, Penelope J Hunt, Helen Lunt, John G Lewis, Steven G Soule
To compare the performance, in terms of specificity for cortisol excess, of late-night salivary cortisol with 24-hour urine-free cortisol (24hr UFC) and overnight 1mg dexamethasone suppression test (1mg DST) in a group of obese T2DM patients.
Forty obese patients with T2DM without clinical features of Cushing’s syndrome were recruited. Plasma, urinary and salivary cortisol were measured directly by an enzyme-linked immunosorbent assay using monoclonal antibodies. The specificities of the three tests using various cutoffs were calculated and compared, employing the assumption that none of the patients had hypercortisolism.
The patients had a mean age and BMI of 56 years (range 31–75) and 37kg/m2 (31–56) respectively. All 40 provided late-night salivary cortisol samples. Thirty-eight patients completed all three tests. Two patients only completed two screening tests. The specificities of late-night salivary cortisol (cutoff 10nmol/L), 24hr UFC (400nmol) and 1mg DST (50nmol/L) were 70% (95% CI 53–83%), 90% (76–97%) and 72% (55–85%) respectively. The specificity of late-night salivary cortisol was significantly less than 24hr UFC (P=0.039) but not 1mg DST (P>0.99).
Late-night salivary cortisol has a poor specificity for cortisol excess in obese patients with T2DM with 24hr UFC showing significantly better specificity in our population.
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