Variability of late-night salivary cortisol in Cushing disease: a prospective study.

Variability of late-night salivary cortisol in Cushing disease: a prospective study.

J Clin Endocrinol Metab. 2018 Jan 10;:

Authors: Sandouk Z, Johnston P, Bunch D, Wang S, Bena J, Hamrahian A, Kennedy L

Abstract
Background: The frequency of variable hormonogenesis in patients with Cushing disease (CD) but without cyclical symptoms is unclear.
Aim: To assess the frequency of variable hormonogenesis in patients presenting with Cushing disease.
Methods: Over a 6-month period patients with confirmed or suspected Cushing disease provided late-night salivary samples for up to 42 consecutive nights.
Results: Of 19 patients confirmed to have CD 16 provided at least seven consecutive salivary samples and 13 provided at least 21; these 16 patients are the subjects of this report. Twelve patients had at least 3 peak and 2 trough levels of LNSC, but in only two patients were strict criteria for cyclical hormonogenesis fulfilled - variation was assessed as random in the others. Eight patients had de novo CD, and eight had recurrent/persistent disease. All patients with recurrent/persistent Cushing disease had two or more normal results, and in four of these patients >50% of LNSC were normal. In six patients with de novo disease with at least one normal LNSC level the maximum levels ranged from 1.55 to 15.5 times the upper limit of normal.
Conclusions: Extreme fluctuations of cortisol production, measured by sequential LNSC, are common in Cushing disease. In newly diagnosed disease this may only occasionally impair diagnostic ability, whereas in most patients with recurrent/persistent disease after pituitary surgery LNSC is frequently within the reference range, with potential to cause diagnostic problems.

PMID: 29329418 [PubMed - as supplied by publisher]

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