Department of Endocrinology and Metabolism, University of Pisa, Ospedale Cisanello, via Paradisa 2, 56124 Pisa, Italy.
Eur J Endocrinol. 2013 Feb 15;168(3):315-21. doi: 10.1530/EJE-12-0685. Print 2013 Mar.
Several tests have been proposed to diagnose patients with Cushing's syndrome (CS). The aims of the study were: i) to evaluate the performance of salivary cortisol (SC) in hypercortisolism and ii) to compare SC with serum cortisol (SeC) and urinary cortisol.
This was a diagnostic study. Twenty-seven patients with untreated Cushing's disease (CD untr), 21 women consuming oral contraceptive pill (OCP), 18 pregnant women, and 89 healthy subjects (controls) were enrolled.
SC and SeC at baseline and after the low-dose dexamethasone suppression test (LDDST) and urinary free cortisol (UFC) were measured.
Midnight SC had a sensitivity of 100% in the CD untr group and a specificity of 97.7% in the controls. Specificity remained high (95.2%) in women taking OCP, while in pregnant women, it decreased to 83.3%. SC after the LDDST showed a sensitivity of 96.3% in the CD untr group; specificity was 97.7% in the controls and 90.5% in OCP women. Midnight SeC had a sensitivity of 100% in the CD untr group. SeC after the LDDST had a sensitivity of 100% in the CD untr group while specificity was 97.7% in the controls and 61.9% in women taking OCP. For UFC, sensitivity was 92.6% in the CD untr group while specificity was 97.7% in the controls and 100% in the OCP group.
SC is a reliable parameter for the diagnosis of severe hypercortisolism, with high sensitivity and specificity. In women during pregnancy or taking OCP, the measurement of SC, identifying the free fraction, could be helpful to exclude CS.
已经提出了几种测试来诊断库欣综合征（CS）患者。本研究的目的是：i）评估唾液皮质醇（SC）在皮质醇增多症中的表现，ii）比较 SC 与血清皮质醇（SeC）和尿皮质醇。
这是一项诊断研究。招募了 27 名未经治疗的库欣病（CD untr）患者、21 名服用口服避孕药（OCP）的女性、18 名孕妇和 89 名健康受试者（对照组）。
测量了基线时和低剂量地塞米松抑制试验（LDDST）后以及尿游离皮质醇（UFC）的 SC 和 SeC。
午夜 SC 在 CD untr 组中的敏感性为 100%，在对照组中的特异性为 97.7%。在服用 OCP 的女性中，特异性仍然很高（95.2%），而在孕妇中，特异性降至 83.3%。LDDST 后的 SC 在 CD untr 组中的敏感性为 96.3%；特异性为 97.7%在对照组和 90.5%在 OCP 女性中。午夜 SeC 在 CD untr 组中的敏感性为 100%。LDDST 后的 SeC 在 CD untr 组中的敏感性为 100%，而在对照组中的特异性为 97.7%，在服用 OCP 的女性中特异性为 61.9%。对于 UFC，在 CD untr 组中的敏感性为 92.6%，而特异性为 97.7%在对照组和 100%在 OCP 组中。
SC 是诊断严重皮质醇增多症的可靠参数，具有高敏感性和特异性。在怀孕期间或服用 OCP 的女性中，测量 SC，识别游离分数，可能有助于排除 CS。
