Nunes Marie-Laure, Vattaut Stéphanie, Corcuff Jean-Benoît, Rault Alexandre, Loiseau Hugues, Gatta Blandine, Valli Nathalie, Letenneur Luc, Tabarin Antoine
Department of Endocrinology, University Hospital of Bordeaux, Haut Lévêque, Pessac, France.
J Clin Endocrinol Metab. 2009 Feb;94(2):456-62. doi: 10.1210/jc.2008-1542. Epub 2008 Nov 11.
Neither precise evaluation of pertinent thresholds nor comparison of the diagnostic performance of late-night salivary cortisol (NSC) between inpatient and outpatient settings has been conducted. The usefulness of NSC for the screening of "subclinical" Cushing's syndrome is still unknown.
The aim of the study was to compare the influence of inpatient and outpatient settings on the diagnostic performance of NSC and assess its usefulness as a screening test for subclinical Cushing's syndrome.
Consecutive patients were investigated prospectively with two salivary collections, first as inpatients and then as outpatients.
Forty-two obese subjects participated in the study, as well as nine patients cured of Cushing's disease, 13 with overt Cushing's syndrome, 14 showing mild recurrence of Cushing's disease, and 48 with adrenal incidentalomas [23 subclinical cortisol-secreting adenomas (SCSA), 25 nonsecreting adenomas].
Reproducibility of NSC and diagnostic performance were measured using receiver operating characteristic analysis.
NSC in controls was similar between inpatient and outpatient settings. The diagnostic performance of NSC across the different patient groups was similar irrespective of the setting. A threshold of 12 nmol/liter yielded 100% sensitivity and specificity in overt Cushing's syndrome. Optimal performance in subclinical Cushing's syndrome required lower thresholds. NSC showed acceptable performance in diagnosing recurrence of Cushing's disease (90% sensitivity, 91.8% specificity). On the contrary, NSC was similar between patients with SCSA and nonsecreting adenomas.
Our data validate the outpatient bed sampling strategy for NSC with no need for specific outpatient threshold. NSC may be helpful to detect mild recurrence of Cushing's disease after surgery but is of little value in identifying SCSA amongst adrenal incidentalomas.
尚未对相关阈值进行精确评估，也未对住院和门诊环境下深夜唾液皮质醇（NSC）的诊断性能进行比较。NSC用于筛查“亚临床”库欣综合征的效用仍不清楚。
本研究旨在比较住院和门诊环境对NSC诊断性能的影响，并评估其作为亚临床库欣综合征筛查试验的效用。
对连续的患者进行前瞻性研究，采集两次唾液样本，第一次是住院时，第二次是门诊时。
42名肥胖受试者、9名库欣病已治愈的患者、13名显性库欣综合征患者、14名库欣病轻度复发患者以及48名肾上腺偶发瘤患者[23例亚临床皮质醇分泌腺瘤（SCSA），25例无分泌功能腺瘤]参与了本研究。
使用受试者操作特征分析来测量NSC的可重复性和诊断性能。
住院和门诊环境下对照组的NSC相似。无论在哪种环境下，不同患者组中NSC的诊断性能相似。12 nmol/升的阈值在显性库欣综合征中产生了100%的敏感性和特异性。亚临床库欣综合征的最佳性能需要更低的阈值。NSC在诊断库欣病复发方面表现出可接受的性能（敏感性90%，特异性91.8%）。相反，SCSA患者和无分泌功能腺瘤患者的NSC相似。
我们的数据验证了NSC的门诊床位采样策略，无需特定的门诊阈值。NSC可能有助于检测手术后库欣病的轻度复发，但在肾上腺偶发瘤中识别SCSA方面价值不大。
