Ng C M, Lam T K, Au Yeung Y C, Choi C H, Iu Y P, Shek C C, Tiu S C
Department of Medicine, Queen Elizabeth Hospital, Jordan, Hong Kong.
Department of Pathology, Queen Elizabeth Hospital, Jordan, Hong Kong.
Hong Kong Med J. 2017 Dec;23(6):570-8. doi: 10.12809/hkmj176240. Epub 2017 Oct 13.
There is a pressing need to identify diagnostic testing for Cushing's syndrome that can be achieved with ease and at low cost. This study aimed to explore the usefulness of late-night and post-overnight 1-mg dexamethasone suppression salivary cortisone, as measured by liquid chromatography-tandem mass spectrometry, for investigation of hypercortisolism.
Salivary cortisone data of subjects were investigated according to a pre-specified protocol. Subjects were classified as having 'hypercortisolism' or 'eucortisolism' on the basis of histological or biochemical criteria. Receiver operating characteristic curves were drawn to identify the cut-off values and study their performance characteristics. We measured 24-hour urinary free cortisol; late-night salivary cortisol and cortisone; and post-overnight 1-mg dexamethasone suppression serum cortisol, and salivary cortisol and cortisone. Saliva and urine samples were assayed by liquid chromatography-tandem mass spectrometry.
In this study, 21 subjects were classified as having hypercortisolism and 78 as having eucortisolism. A late-night salivary cortisone cut-off of 13.50 nmol/L had a sensitivity of 94.7% and a specificity of 87.2%. After taking 1-mg dexamethasone the night before, a salivary cortisol cut-off of 0.85 nmol/L had a sensitivity of 76.2% and a specificity of 96.2%; a salivary cortisone cut-off of 7.45 nmol/L had a sensitivity of 85.7% and a specificity of 94.9%, while a salivary cortisone cut-off of 3.25 nmol/L had a sensitivity of 95.2% and a specificity of 79.5%. Many salivary cortisol samples were below the detection limit of liquid chromatography-tandem mass spectrometry. In comparison with salivary cortisol, salivary cortisone had a better correlation with total serum cortisol and better diagnostic performance following dexamethasone suppression.
Both late-night and post-overnight dexamethasone suppression salivary cortisone levels are of diagnostic value in the investigation of hypercortisolism.
迫切需要确定一种能够轻松且低成本实现的库欣综合征诊断检测方法。本研究旨在探讨通过液相色谱 - 串联质谱法测量的午夜及隔夜1毫克地塞米松抑制唾液皮质醇的效用，用于皮质醇增多症的调查。
根据预先指定的方案对受试者的唾液皮质醇数据进行调查。根据组织学或生化标准将受试者分为“皮质醇增多症”或“正常皮质醇血症”。绘制受试者工作特征曲线以确定临界值并研究其性能特征。我们测量了24小时尿游离皮质醇；午夜唾液皮质醇和皮质酮；以及隔夜1毫克地塞米松抑制后的血清皮质醇、唾液皮质醇和皮质酮。唾液和尿液样本通过液相色谱 - 串联质谱法进行检测。
在本研究中，21名受试者被分类为皮质醇增多症，78名受试者被分类为正常皮质醇血症。午夜唾液皮质酮临界值为13.50纳摩尔/升时，灵敏度为94.7%，特异性为87.2%。在前一晚服用1毫克地塞米松后，唾液皮质醇临界值为0.85纳摩尔/升时，灵敏度为76.2%，特异性为96.2%；唾液皮质酮临界值为7.45纳摩尔/升时，灵敏度为85.7%，特异性为94.9%，而唾液皮质酮临界值为3.25纳摩尔/升时，灵敏度为95.2%，特异性为79.5%。许多唾液皮质醇样本低于液相色谱 - 串联质谱法的检测限。与唾液皮质醇相比，唾液皮质酮与总血清皮质醇的相关性更好，并且在地塞米松抑制后具有更好的诊断性能。
午夜及隔夜地塞米松抑制唾液皮质醇水平在皮质醇增多症的调查中均具有诊断价值。
