Midnight Salivary Cortisol Determination for Assessing the Outcome of Transsphenoidal Surgery in Cushing's Disease Export

@article{citeulike:3748286, abstract = {Context: Midnight salivary cortisol (MSC) is now recognized as a reliable index for Cushing's syndrome diagnosis but has to be validated for the follow-up of treated patients. Objective: Our objective was to evaluate MSC for assessing the outcome of transsphenoidal surgery (TSS) in patients with Cushing's disease (CD). Design: We conducted a retrospective cohort study in a single center. Patients and Methods: Sixty-eight patients treated by TSS between 1996 and 2006 and followed for at least 6 months with postoperative MSC were included. Mean follow-up ({+/-} SD) was 45 {+/-} 31 months. Morning plasma cortisol was determined 5 d after TSS, and MSC and urinary cortisol (UC) were determined 6-12 months after surgery. The remission group included hypocortisolic (morning plasma cortisol < 50 ng/ml and/or insufficient response to cosyntropin) and eucortisolic (midnight plasma cortisol < 75 ng/ml and normal UC) patients. Patients in the treatment failure group had high midnight plasma cortisol and UC concentrations. Results: Fifty patients (74\%) were in remission. Mean MSC was 0.7 {+/-} 0.4 ng/ml (range, 0.4-2.1 ng/ml) and 6.5 {+/-} 6.5 ng/ml (range, 2.1-27.2 ng/ml) for the remission and treatment failure groups, respectively (P = 0.001). A cutoff of 2 ng/ml for MSC gave a sensitivity of 100\% and a specificity of 98\% for treatment failure diagnosis, whereas UC less than 90 {micro}g/d had a sensitivity of 71\% and specificity of 98\%. Postsurgical morning plasma cortisol less than or equal to 18 ng/ml had a sensitivity of 93\% and specificity of 74\%. Conclusions: MSC is a simple, robust marker of remission after TSS for CD. 10.1210/jc.2008-1171}, author = {Carrasco, Carmen A. and Coste, Joel and Guignat, Laurence and Groussin, Lionel and Dugue, Marie A. and Gaillard, Stephane and Bertagna, Xavier and Bertherat, Jerome}, citeulike-article-id = {3748286}, citeulike-linkout-0 = {http://dx.doi.org/10.1210/jc.2008-1171}, citeulike-linkout-1 = {http://jcem.endojournals.org/cgi/content/abstract/93/12/4728}, citeulike-linkout-2 = {http://view.ncbi.nlm.nih.gov/pubmed/18728161}, citeulike-linkout-3 = {http://www.hubmed.org/display.cgi?uids=18728161}, day = {1}, doi = {10.1210/jc.2008-1171}, journal = {J Clin Endocrinol Metab}, keywords = {cushing, diagnosis, therapy}, month = {December}, number = {12}, pages = {4728--4734}, posted-at = {2008-12-04 16:54:40}, priority = {2}, title = {Midnight Salivary Cortisol Determination for Assessing the Outcome of Transsphenoidal Surgery in Cushing's Disease}, url = {http://dx.doi.org/10.1210/jc.2008-1171}, volume = {93}, year = {2008} }

TY - JOUR ID - citeulike:3748286 L3 - citeulike-article-id:3748286 N2 - Context: Midnight salivary cortisol (MSC) is now recognized as a reliable index for Cushing's syndrome diagnosis but has to be validated for the follow-up of treated patients. Objective: Our objective was to evaluate MSC for assessing the outcome of transsphenoidal surgery (TSS) in patients with Cushing's disease (CD). Design: We conducted a retrospective cohort study in a single center. Patients and Methods: Sixty-eight patients treated by TSS between 1996 and 2006 and followed for at least 6 months with postoperative MSC were included. Mean follow-up ({+/-} SD) was 45 {+/-} 31 months. Morning plasma cortisol was determined 5 d after TSS, and MSC and urinary cortisol (UC) were determined 6-12 months after surgery. The remission group included hypocortisolic (morning plasma cortisol < 50 ng/ml and/or insufficient response to cosyntropin) and eucortisolic (midnight plasma cortisol < 75 ng/ml and normal UC) patients. Patients in the treatment failure group had high midnight plasma cortisol and UC concentrations. Results: Fifty patients (74%) were in remission. Mean MSC was 0.7 {+/-} 0.4 ng/ml (range, 0.4-2.1 ng/ml) and 6.5 {+/-} 6.5 ng/ml (range, 2.1-27.2 ng/ml) for the remission and treatment failure groups, respectively (P = 0.001). A cutoff of 2 ng/ml for MSC gave a sensitivity of 100% and a specificity of 98% for treatment failure diagnosis, whereas UC less than 90 {micro}g/d had a sensitivity of 71% and specificity of 98%. Postsurgical morning plasma cortisol less than or equal to 18 ng/ml had a sensitivity of 93% and specificity of 74%. Conclusions: MSC is a simple, robust marker of remission after TSS for CD. 10.1210/jc.2008-1171 IS - 12 JF - J Clin Endocrinol Metab EP - 4734 TI - Midnight Salivary Cortisol Determination for Assessing the Outcome of Transsphenoidal Surgery in Cushing's Disease VL - 93 SP - 4728 KW - cushing KW - diagnosis KW - therapy AU - Carrasco, Carmen AU - Coste, Joel AU - Guignat, Laurence AU - Groussin, Lionel AU - Dugue, Marie AU - Gaillard, Stephane AU - Bertagna, Xavier AU - Bertherat, Jerome PY - 2008/12/01/ UR - http://dx.doi.org/10.1210/jc.2008-1171 ER -