This article is more than 5 years old. Information may no longer be current.
Late-night salivary cortisol could better diagnose recurrence of Cushing’s disease
Click Here to Manage Email Alerts
CHICAGO — Patients treated for Cushing’s disease with high levels of late-night salivary cortisol could improve their condition with prompt intervention, according to research presented at the joint meeting of the International Congress of Endocrinology and the Endocrine Society.
Ty Brian Carroll, MD, of the Medical College of Wisconsin, Milwaukee, and colleagues reviewed records from their institution to identify patients with Cushing’s disease (CD) who had symptom recurrence following transsphenoidal surgery (TSS) but normal urinary free cortisol (UFC) levels to investigate diagnostic difficulty.
“We feel therapeutic intervention in patients with clinical signs and symptoms of Cushing’s disease, as well as an elevated late-night salivary cortisol, even despite normal urinary free cortisol (UFC), may be of clinical benefit for them,” Carroll said during his presentation.
Of the study’s 10 female patients who had undergone primary TSS with recurrence after a mean of 3.5 years and normal UFC at the time, five showed a tumor on MRI. The patients, all with normal renal functioning, received tests for LNSC and UFC, as well as dexamethasone suppression testing (DST). Results showed normal UFC levels for all patients, with at least 1 elevated LNSC level; eight demonstrated abnormal DST.
Follow-up data was available for nine patients. Six had received pharmacological therapy (5 mifepristone, 1 cabergoline), and all showed clinical and/or biochemical improvement. In two cases of repeat TSS, pathology confirmed adrenocorticotropic hormone-staining pituitary adenoma and patients had clinical and biochemical remission. One patient with normal UFC and DST, but abnormal LNSC, had clinical improvements, lost 55 kg and resolved hypertension after bilateral adrenalectomy.
“Urinary free cortisol has long been thought to be the gold standard for screening and diagnosis of Cushing’s disease,” Carroll said. “However, our series corroborates several recent studies in showing late night salivary cortisol may be more sensitive in the detection of recurrent Cushing’s disease.” — by Allegra Tiver
For More Information: Carroll TB. Abstract OR02-2. Presented at: The joint meeting of the International Congress of Endocrinology and the Endocrine Society; June 21-24, 2014; Chicago.
Disclosures: Carroll reports being a consultant for Corcept.