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Exp Clin Endocrinol Diabetes 2005; 113(4): 225-230
DOI: 10.1055/s-2005-837667
Article

J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Salivary Cortisol Measurement - a Reliable Method for the Diagnosis of Cushing's Syndrome

M. Trilck1 , J. Flitsch1 , D. K. Lüdecke1 , R. Jung2 , S. Petersenn3
  • 1Pituitary Unit, Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
  • 2Institute of Clinical Chemistry, University Hospital Hamburg-Eppendorf, Hamburg, Germany
  • 3Department of Endocrinology, University Hospital Essen, Germany
Further Information

Publication History

Received: January 19, 2004 First decision: May 6, 2004

Accepted: November 19, 2004

Publication Date:
13 May 2005 (online)

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Re: Trilck M, Flitsch J, Lüdecke DK, Jung R, Petersenn S: Salivary Cortisol Measurement - a Reliable Method for the Diagnosis of Cushing's SyndromeExp Clin Endocrinol Diabetes 2005; 113(07): 409-409
DOI: 10.1055/s-2005-865867

Abstract

The measurement of cortisol in saliva is becoming more widely accepted as a screening test for the diagnosis of hypercortisolism. Since 1986, cortisol measurement in saliva has been continuously used in our department. In this study we compared salivary cortisol profiles from proven Cushing's disease patients with profiles from healthy subjects and obese children. The purpose was to evaluate the predictive value of the method for the diagnosis of hypercortisolism and to define cut-off levels to exclude or identify hypercortisolism. Cortisol in saliva was measured in 150 Cushing's disease patients (30 children, 120 adults, ranging from age 4 - 70), 100 healthy subjects (55 children, 45 adults, ranging from age 6 - 60), and 31 children (age 7 - 15) with an age-related body-mass-index above the 90th percentile. Generally, five saliva samples were taken over the day at 6 : 00 - 8 : 00 a.m., 11 : 00 - 12 : 00 a.m., 4 : 00 - 6 : 00 p.m., 7 : 00 - 8 : 00 p.m., and 10 : 00 p.m. The samples were measured using a radioimmuno-assay (INCSTAR Corporation, Stillwater, Minnesota, USA). For healthy subjects, morning levels of cortisol in saliva between 3 - 19 µg/l were found. These levels dropped to levels in between < 1 - 11 µg/l at 11 : 00 - 12 : 00 a.m., < 1 - 6 µg/l at 4 : 00 - 6 : 00 p.m., < 1 - 4.5 µg/l at 7 : 00 - 8 : 00 p.m., and < 1 - 2.9 µg/l at 10 : 00 p.m. The measured values showed a correlation with age, height, and weight. In Cushing's disease patients, the circadian salivary cortisol rhythm was missing, compared to healthy subjects. There was no significant difference in salivary cortisol levels or circadian rhythm between healthy or obese children. We found a high sensitivity for the detection of hypercortisolism at the 10 : 00 p.m. salivary cortisol measurement. The following, age dependent cut-off levels for salivary cortisol at 10 : 00 p.m. were calculated for the exclusion of hypercortisolism. Age 6 - 10: 1.0 µg/l (sensitivity 100 %, specificity 87.5 %); age 11 - 15: 1.7 µg/l (sensitivity 100 %, specificity 100 %); age 16 - 20: 1.9 µg/l (sensitivity 94.7 %, specificity 90.5 %); age 21 - 60: 1.6 µg/l (sensitivity 100 %, specificity 90.9 %). For the proof of Cushing's syndrome, the following age dependent cut-off levels at 10 : 00 p.m. were found: age 6 - 10: 1.9 µg/l (sensitivity 100 %, specificity 80 %); age 11 - 15: 1.7 µg/l (sensitivity 100 %, specificity 100 %); age 16 - 20: 2.5 µg/l (sensitivity 100 %, specificity 84.2 %); age 21 - 60: 1.9 µg/l (sensitivity 100 %, specificity 87.6 %). The cortisol assessment in saliva is a sensitive and reliable method to discriminate normocortisolemic from hypercortisolemic patients. From our view, the major advantages of this method are the reliability, non-invasiveness, and use in ambulatory patients.

Key words

Cushing's disease - Cushing's syndrome - cortisol - saliva - RIA

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Dr. Jörg Flitsch

Bereich Hypophysenchirurgie (Leiter: Dr. D.K. Lüdecke)
Neurochirurgische Klinik
Universitätskrankenhaus Hamburg-Eppendorf

Martinistraße 52

20246 Hamburg

Germany

Phone: + 4940428032765

Fax: + 49 4 04 28 03 59 82

Email: flitsch@uke.uni-hamburg.de