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Late-Night Salivary Cortisol: Cut-Off Definition and Diagnostic Accuracy for Cushing’s Syndrome in a Portuguese Population

2019-05-31Journal article Open access
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datacite.subject.fosCiências Médicas::Ciências da Saúde
datacite.subject.fosCiências Médicas::Medicina Clínica
datacite.subject.fosCiências Médicas::Medicina Básica
datacite.subject.sdg03:Saúde de Qualidade
dc.contributor.authorLages, Adriana De Sousa
dc.contributor.authorOliveira, Diana
dc.contributor.authorPaiva , Isabel
dc.contributor.authorOliveira, Patrícia
dc.contributor.authorRebelo-Marques, Alexandre
dc.contributor.authorCarrilho, Francisco
dc.contributor.authorFrade, João Gonçalo Leal de Oliveira e Silva
dc.date.accessioned2025-12-09T17:03:57Z
dc.date.available2025-12-09T17:03:57Z
dc.date.issued2019-05-31
dc.description.abstractIntroduction: Diagnosis of Cushing’s syndrome remains a challenge in clinical endocrinology. Even though late-night salivary cortisol is used as screening tool, individualized cut-off levels for each population must be defined.Material and Methods: Three groups of subjects were studied: normal subjects, suspected and proven Cushing’s syndrome. Salivary cortisol was measured using an automated electrochemiluminescence assay. The functional sensitivity of the assay is 0.018 μg/dL. The diagnostic cut-off level was defined by Receiver Operating Characteristic curve and Youden’s J index.Results: We studied 127 subjects: 57 healthy volunteers, 39 patients with suspected and 31 with proven Cushing’s syndrome. 2.5th- 97.5th percentile of the late-night salivary cortisol concentrations in normal subjects was 0.054 to 0.1827 μg/dL. Receiver Operating Characteristic curve analysis showed an area under the curve of 0.9881 (p < 0.0001). A cut-off point of 0.1 μg/dL provided a sensitivity of 96.77% (95% CI 83.3 - 99.92%) and specificity of 91.23% (95% CI 80.7 - 97.09%). There was a significant correlation between late-night salivary cortisol and late-night serum cortisol (R = 0.6977; p < 0.0001) and urinary free cortisol (R = 0.5404; p = 0.0025) in proven Cushing’s syndrome group.Discussion: The mean ± SD late-night salivary cortisol concentration in patients with proven Cushing’s syndrome (0.6798 ± 0.52 μg/dL) was significantly higher (p < 0.0001). In our population, the late-night salivary cortisol cut-off was 0.1 μg/dL with high sensitivity and specificity.Conclusion: Late-night salivary cortisol has excellent diagnostic accuracy, making it a highly reliable, noninvasive, screening tool for outpatient assessment. Given its convenience and diagnostic accuracy, late-night salivary cortisol may be added to other traditional screening tests on hypercortisolismeng
dc.identifier.citationLages, A. D. S., Frade, J. G., Oliveira, D., Paiva, I., Oliveira, P., Rebelo-Marques, A., & Carrilho, F. (2019). Late-Night Salivary Cortisol: Cut-Off Definition and Diagnostic Accuracy for Cushing’s Syndrome in a Portuguese Population. Acta Médica Portuguesa, 32(5), 381–387. https://doi.org/10.20344/amp.11265
dc.identifier.doi10.20344/amp.11265
dc.identifier.issn1646-0758
dc.identifier.issn0870-399X
dc.identifier.urihttp://hdl.handle.net/10400.8/14963
dc.language.isoeng
dc.peerreviewedyes
dc.publisherOrdem dos Médicos
dc.relation.hasversionhttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11265/5698
dc.relation.ispartofActa Médica Portuguesa
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectCircadian Rhythm
dc.subjectCushing Syndrome/diagnosis
dc.subjectDiagnostic Techniques
dc.subjectEndocrine
dc.subjectHydrocortisone
dc.subjectSaliva
dc.titleLate-Night Salivary Cortisol: Cut-Off Definition and Diagnostic Accuracy for Cushing’s Syndrome in a Portuguese Populationeng
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage387
oaire.citation.issue5
oaire.citation.startPage381
oaire.citation.titleActa Médica Portuguesa
oaire.citation.volume32
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85
person.familyNameFrade
person.givenNameJoão Gonçalo Leal de Oliveira e Silva
person.identifier.ciencia-id5C11-74B9-E2D7
person.identifier.orcid0000-0001-5037-5335
relation.isAuthorOfPublicationbe5c7047-4b0c-4031-8916-45ba2e2f7603
relation.isAuthorOfPublication.latestForDiscoverybe5c7047-4b0c-4031-8916-45ba2e2f7603

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