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Salivary cortisol and cortisone in diagnosis of Cushings syndrome - a comparison of six different analytical methods
Umea Univ, Sweden.
Umea Univ, Sweden.
Umea Univ, Sweden.
Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry. Linköping University, Faculty of Medicine and Health Sciences.
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2023 (English)In: Clinical Chemistry and Laboratory Medicine, ISSN 1434-6621, E-ISSN 1437-4331, Vol. 61, no 10, p. 1780-1791Article in journal (Refereed) Published
Abstract [en]

Objectives: Salivary cortisol and cortisone at late night and after dexamethasone suppression test (DST) are increasingly used for screening of Cushings syndrome (CS). We aimed to establish reference intervals for salivary cortisol and cortisone with three liquid chromatography-tandem mass spectrometry (LC-MS/MS) techniques and for salivary cortisol with three immunoassays (IAs), and evaluate their diagnostic accuracy for CS.Methods: Salivary samples at 08:00 h, 23:00 h and 08:00 h after a 1-mg DST were collected from a reference population (n=155) and patients with CS (n=22). Sample aliquots were analyzed by three LC-MS/MS and three IA methods. After establishing reference intervals, the upper reference limit (URL) for each method was used to calculate sensitivity and specificity for CS. Diagnostic accuracy was evaluated by comparing ROC curves.Results: URLs for salivary cortisol at 23:00 h were similar for the LC-MS/MS methods (3.4-3.9 nmol/L), but varied between IAs: Roche (5.8 nmol/L), Salimetrics (4.3 nmol/L), Cisbio (21.6 nmol/L). Corresponding URLs after DST were 0.7-1.0, and 2.4, 4.0 and 5.4 nmol/L, respectively. Salivary cortisone URLs were 13.5-16.6 nmol/L at 23:00 h and 3.0-3.5 nmol/L at 08:00 h after DST. All methods had ROC AUCs =0.96.Conclusions: We present robust reference intervals for salivary cortisol and cortisone at 08:00 h, 23:00 h and 08:00 h after DST for several clinically used methods. The similarities between LC-MS/MS methods allows for direct comparison of absolute values. Diagnostic accuracy for CS was high for all salivary cortisol and cortisone LC-MS/MS methods and salivary cortisol IAs evaluated.

Place, publisher, year, edition, pages
WALTER DE GRUYTER GMBH , 2023. Vol. 61, no 10, p. 1780-1791
Keywords [en]
Cushings syndrome; immunoassay; LC-MS/MS; method comparison; salivary cortisol; salivary cortisone
National Category
Clinical Laboratory Medicine
Identifiers
URN: urn:nbn:se:liu:diva-194187DOI: 10.1515/cclm-2023-0141ISI: 000964106600001PubMedID: 37013440OAI: oai:DiVA.org:liu-194187DiVA, id: diva2:1760963
Note

Funding Agencies|Vasterbotten County Council

Available from: 2023-05-31 Created: 2023-05-31 Last updated: 2024-04-11Bibliographically approved

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Aardal-Eriksson, Elisabeth

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