From the Adrenal and Hypertension Unit, Division of Endocrinology and Metabolism, Department of Medicine, Federal University of São Paulo School of Medicine (Escola Paulista de Medicina/Universidade Federal de São Paulo), Rua Pedro de Toledo, 781-13th Floor, São Paulo, SP, 04039-032, Brazil.
J Endocrinol Invest. 2019 Dec;42(12):1435-1442. doi: 10.1007/s40618-019-01104-8. Epub 2019 Aug 27.
Subclinical hypercortisolism (SCH) leads to metabolic derangements and increased cardiovascular risk. Cortisol autonomy is defined by the overnight 1 mg dexamethasone suppression test (DST). Saliva cortisol is an easier, stress-free, and cost-effective alternative to serum cortisol. We compared 23 h and post-1 mg DST saliva with serum cortisol to identify SCH in adrenal incidentalomas (AI).
We analyzed 359 DST obtained retrospectively from 226 AI subjects (173F/53 M; 19-83 years) for saliva and serum cortisol. We used three post-DST serum cortisol cutoffs to uncover SCH: 1.8, 2.5, and 5.0 μg/dL. We determined post-DST and 23 h saliva cortisol cutoffs by ROC curve analysis and calculated their sensitivities (S) and specificities (E).
The sensitive 1.8 μg/dL cutoff defined 137 SCH and 180 non-functioning adenomas (NFA): post-DST and 23 h saliva cortisol S/E were: 75.2%/74.4% and 59.5%/65.9%, respectively. Using the specific 5.0 μg/dL cortisol cutoff (22 SCH/295 NFA), post-DST and 23 h saliva cortisol S/E were 86.4%/83.4% and 66.7%/80.4%, respectively. Using the intermediate 2.5 μg/dL cutoff (89 SCH/228 NFA), post-DST and 23 h saliva cortisol S/E were 80.9%/68.9% and 65.5%/62.8%, respectively.
Saliva cortisol showed acceptable performance only with the 5.0 μg/dL cortisol cutoff, as in overt Cushing's syndrome. Lower cutoffs (1.8 and 2.5 μg/dL) that identify larger samples of patients with poor metabolic outcomes are less accurate for screening. These results may be attributed to pre-analytical factors and inherent patient conditions. Thus, saliva cortisol cannot replace serum cortisol to identify SCH among patients with AI for screening DST.
亚临床皮质醇增多症（SCH）可导致代谢紊乱和心血管风险增加。皮质醇自主性由 overnight 1mg 地塞米松抑制试验（DST）定义。唾液皮质醇是一种更简单、无压力且具有成本效益的替代血清皮质醇的方法。我们比较了 23 小时和 1mg DST 后唾液与血清皮质醇，以确定肾上腺意外瘤（AI）中的 SCH。
我们分析了 226 例 AI 患者（173 例女性/53 例男性；19-83 岁）回顾性获得的 359 次 DST 中的唾液和血清皮质醇。我们使用三个 DST 后血清皮质醇切点来发现 SCH：1.8、2.5 和 5.0μg/dL。我们通过 ROC 曲线分析确定了 DST 后和 23 小时唾液皮质醇切点，并计算了它们的敏感性（S）和特异性（E）。
敏感的 1.8μg/dL 切点定义了 137 例 SCH 和 180 例无功能腺瘤（NFA）：DST 后和 23 小时唾液皮质醇 S/E 分别为：75.2%/74.4%和 59.5%/65.9%。使用特异性 5.0μg/dL 皮质醇切点（22 例 SCH/295 例 NFA），DST 后和 23 小时唾液皮质醇 S/E 分别为 86.4%/83.4%和 66.7%/80.4%。使用中间的 2.5μg/dL 切点（89 例 SCH/228 例 NFA），DST 后和 23 小时唾液皮质醇 S/E 分别为 80.9%/68.9%和 65.5%/62.8%。
仅使用 5.0μg/dL 皮质醇切点，唾液皮质醇的表现可以接受，就像明显的库欣综合征一样。较低的切点（1.8 和 2.5μg/dL）识别出代谢结果较差的大量患者，用于筛查的准确性较低。这些结果可能归因于分析前因素和患者固有状况。因此，唾液皮质醇不能替代血清皮质醇用于筛查 AI 患者的 DST 以识别 SCH。
