Skip to main content

Advertisement

SpringerLink
Log in

Specificity of late-night salivary cortisol measured by automated electrochemiluminescence immunoassay for Cushing’s disease in an obese population

  • Original Article
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Purpose

Data about the specificity of late-night salivary cortisol (LNSC) in obese subjects are still conflicting. Therefore, with this study, we aimed to evaluate the specificity of LNSC measurement in an obese cohort with or without type 2 diabetes mellitus (T2DM) using an automated electrochemiluminescence immunoassay (ECLIA).

Methods

A total number of 157 patients involving 40 healthy subjects (HS) with BMI < 25 kg/m2, 83 obese subjects (OS) with BMI ≥ 35 kg/m2, and 34 histopathologically proven Cushing’s disease (CD) were included. All patients underwent LNSC testing. Salivary cortisol was measured at 11 p.m. for all groups using an ECLIA. Reference range was established using values of LNSCs of HS and ROC curves were used to determine diagnostic cutoffs.

Results

In the HS group, mean LNSC was 4.7 nmol/l (SD ± 3.1), while the OS group had a mean value of 10.9 nmol/l (SD ± 7.5) and the CD group of 19.9 nmol/l (SD ± 15.4). All groups differed significantly (p < 0.001). The ROC analysis of CD against HS alone showed a sensitivity of 85.3% and a specificity of 87.5% with a cut-off value of 8.3 nmol/l. The ROC analysis between OS and CD showed a maximum sensitivity of 67.6% and specificity of 78.3% for a cut-off value of 12.3 nmol/l. Taken both (HS and OS) groups together against the CD group, ROC analysis showed a maximum sensitivity of 67.6% and specificity of 85.4% for a cut-off value of 12.3 nmol/l. No correlation was found between BMI, T2DM, and LNSC for all groups.

Conclusions

In our obese cohort, we found that LNSC assayed by ECLIA had a low specificity in the diagnosis of CD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Nieman LK, Biller BMK, Findling JW et al (2008) The diagnosis of Cushing’s disease: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 93(5):1526–1540

    Article  CAS  Google Scholar 

  2. Mechanick JI, Youdim A, Jones DB et al (2013) Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery. Surg Obes Relat Dis 9:159–191

    Article  Google Scholar 

  3. Beko G, Varga I, Glaz E et al (2010) Cutoff values of midnight salivary cortisol for the diagnosis of overt hypercortisolism are highly influenced by methods. Clin Chim Acta 411(5–6):364–367

    Article  CAS  Google Scholar 

  4. Bukan A, Dere H, Jadhav S et al (2015) The performance and reproducibility of late-night salivary cortisol estimation by enzyme immunoassay for screening cushing disease. Endocr Pract 21(2):158–164

    Article  Google Scholar 

  5. Ellis E, Chin PKL, Hunt PJ et al (2012) Is late-night salivary cortisol a better screening test for possible cortisol excess than standard screening tests in obese patients with Type 2 diabetes? N Z Med J 125(1353):47–58

    PubMed  Google Scholar 

  6. Belaya ZE, Iljin AV, Melnichenko GA et al (2012) Diagnostic performance of late-night salivary cortisol measured by automated electrochemiluminescence immunoassay in obese and overweight patients referred to exclude Cushing’s syndrome. Endocrine 41(3):494–500

    Article  CAS  Google Scholar 

  7. Yaneva M, Kirilov G, Zacharieva S (2009) Midnight salivary cortisol, measured by highly sensitive electrochemiluminescence immunoassay, for the diagnosis of Cushing’s syndrome. Cent Eur J Med 4(1):59–64

    CAS  Google Scholar 

  8. Deutschbein T, Petersenn S (2013) Screening for Cushing’s syndrome: new immunoassays require adequate normative data. Horm Metab Res 45(2):118–123

    Article  CAS  Google Scholar 

  9. Putignano P, Toja P, Dubini A et al (2003) Midnight salivary cortisol versus urinary free and midnight serum cortisol as screening tests for cushing’s syndrome. J Clin Endocrinol Metab 88(9):4153–4157

    Article  CAS  Google Scholar 

  10. Baid SK, Rubino D, Sinaii N, Ramsey S, Frank A, Nieman LK (2009) Specificity of screening tests for cushing’s syndrome in an overweight and obese population. J Clin Endocrinol Metab 94(10):3857–3864

    Article  CAS  Google Scholar 

  11. Raff H, Magill SB (2016) Is the hypothalamic-pituitary-adrenal axis disrupted in type 2 diabetes mellitus? Endocrine 54(2):273–275

    Article  CAS  Google Scholar 

  12. Donath MY, Shoelson SE (2011) Type 2 diabetes as an inflammatory disease. Nat Rev Immunol 11(2):98–107

    Article  CAS  Google Scholar 

  13. Cucak H, Grunnet LG, Rosendahl A (2014) Accumulation of M1-like macrophages in type 2 diabetic islets is followed by a systemic shift in macrophage polarization. J Leukoc Biol 95(1):149–160

    Article  Google Scholar 

  14. Steffensen C, Thomsen H, Dekkers OM et al (2016) Low positive predictive value of midnight salivary cortisol measurement to detect hypercortisolism in type 2 diabetes. Clin Endocrinol (Oxf) 85:202–206

    Article  CAS  Google Scholar 

  15. Liu H, Bravata DM, Cabaccan J et al (2005) Elevated late-night salivary cortisol levels in elderly male type 2 diabetic veterans. Clin Endocrinol (Oxf) 63(6):642–649

    Article  CAS  Google Scholar 

  16. Valentine AR, Raff H, Liu H et al (2011) Salivary cortisol increases after bariatric surgery in women. Horm Metab Res 43(8):587–590

    Article  CAS  Google Scholar 

  17. Putignano P, Dubini A, Toja P et al (2001) Salivary cortisol measurement in normal-weight, obese and anorexic women: comparison with plasma cortisol. Eur J Endocrinol 145(2):165–171

    Article  CAS  Google Scholar 

  18. Trilck M, Flitsch J, Lüdecke DK et al (2005) Salivary cortisol measurement—a reliable method for the diagnosis of Cushing’s syndrome. Exp Clin Endocrinol Diabetes 113(4):225–230

    Article  CAS  Google Scholar 

  19. Ceccato F, Barbot M, Zilio M, Ferasin S, De Lazzari P, Lizzul L, Boscaro M, Scaroni C (2015) Age and the metabolic syndrome affect salivary cortisol rhythm: data from a community sample. Hormones (Athens) 14(3):392–398. https://doi.org/10.14310/horm.2002.1591

    Article  Google Scholar 

  20. Oltmanns KM, Dodt B, Schultes B et al (2006) Cortisol correlates with metabolic disturbances in a population study of type 2 diabetic patients. Eur J Endocrinol 154(2):325–331

    Article  CAS  Google Scholar 

  21. Coelli S, Farias CB, Soares AA, Crescente GM, Hirakata VN, Souza LB, Czepielewski MA, Camargo JL, Silveiro SP (2017) Influence of age, gender and body mass index on late-night salivary cortisol in healthy adults. Clin Chem Lab Med 55(12):1954–1961. https://doi.org/10.1515/cclm-2016-1100)

    Article  CAS  Google Scholar 

  22. Javorsky BR, Carroll TB, Tritos NA et al (2015) Discovery of Cushing’s syndrome after bariatric surgery: multicenter series of 16 patients. Obes Surg 25(12):2306–2313

    Article  Google Scholar 

Download references

Author information

Author notes

  1. J. Aberle, C. Schulze zur Wiesch, and J. Flitsch have contributed equally to the manuscript.

Authors and Affiliations

  1. Department for Endocrinology and Diabetology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    J. Aberle, C. Schulze zur Wiesch, J. Veigel, F. Reining, A. Lautenbach & N. Riedel

  2. Department for Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    J. Flitsch & R. Rotermund

  3. Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    G. Schön

  4. Institute of Clinical Chemistry, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    R. Jung

Authors
  1. J. Aberle
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Schulze zur Wiesch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Flitsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Veigel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Schön
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R. Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. F. Reining
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Lautenbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. R. Rotermund
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. N. Riedel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to N. Riedel.

Ethics declarations

Conflict of interest

Research support was given by a grant from Novartis Pharma covering laboratory costs. No author received direct or indirect support for the submitted work. Dr. Flitsch received personal fees from Novartis Pharma and Ipsen Pharma outside the submitted work.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent has been obtained from each subject after full explanation of the purpose and nature of all procedures used.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aberle, J., Schulze zur Wiesch, C., Flitsch, J. et al. Specificity of late-night salivary cortisol measured by automated electrochemiluminescence immunoassay for Cushing’s disease in an obese population. J Endocrinol Invest 41, 1325–1331 (2018). https://doi.org/10.1007/s40618-018-0870-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40618-018-0870-8

Keywords

Search

Navigation