Screening for subclinical Cushing's Syndrome in Type 2 Diabetes Mellitus: Low false-positive rates with nocturnal salivary cortisol
Date
2010
Authors
Gagliardi, L.
Chapman, I.
O'Loughlin, P.
Torpy, D.
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Journal article
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Hormone and Metabolic Research, 2010; 42(4):280-284
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L. Gagliardi, I. M. Chapman, P. O'Loughlin, D. J. Torpy
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Abstract
The diagnosis of subclinical Cushing's syndrome (SCS) is important, but its relative rarity amongst patients with common metabolic disorders requires a simple test with a low false-positive rate. Using nocturnal salivary cortisol (NSC), which we first validated in patients with suspected and proven Cushing's syndrome, we screened 106 overweight patients with type 2 diabetes mellitus, a group at high risk of SCS and nontumoral hypothalamic-pituitary-adrenal axis perturbations. Our hypothesis was that a lower false-positive rate with NSC was likely, compared with that reported with the dexamethasone suppression test (DST) (10-20%), currently the foundation of diagnosis of SCS. No participant had clinically apparent Cushing's syndrome. Three participants had an elevated NSC but further testing excluded SCS. In this study, NSC had a lower false-positive rate (3%) than previously reported for the DST. Given the reported excellent performance of NSC in detection of hypercortisolism, the low false-positive rate in SCS suggests NSC may be superior to the DST for SCS screening. The NSC and DST should be compared directly in metabolic disorder patients; although our data suggest the patient group will need to be substantially larger to definitively determine the optimal screening test.
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© Georg Thieme Verlag KG Stuttgart · New York