Nocturnal Salivary Cortisol Is an Accurate Non-Invasive Test to Assess Endogenous Hypercortisolism in Children with Obesity and a Clinical Phenotype Suspicious for Cushing’s Syndrome
Authors' conclusion
Salivary cortisol at 11 p.m. is an accurate, feasible, and non-invasive first-line test to assess endogenous hypercortisolism in children with obesity and clinical suspicion of CS. The nSC was also useful in showing that the circadian rhythm of cortisol was preserved in children with exogenous obesity. In patients with nSC ≥8.0 nmol/L, other biochemical assessments and imaging studies are needed to further confirm the aetiology.
Study context
- Population
- Children aged 2–18 years, BMI-SDS ≥2.0, follow-up >2 years; 10 confirmed cushing's syndrome (CS) cases vs controls with obesity and features strongly indicative of or suggestive of CS75/112 met inclusion
- Comparison
- Nocturnal salivary cortisol (nSC) vs percentage decrease of cortisol at night (%D) for diagnosing CS
- Outcome
- Sensitivity, specificity, PPV and NPV with 95% CI by ROC for nSC and %D
Methodological detailsdiagnostic accuracy, Salivary cortisol by electrochemiluminescence assay (lower limit of quantification 2.0 nmol/L)
- Diagnostic accuracy
- Salivary cortisol by electrochemiluminescence assay (lower limit of quantification 2.0 nmol/L)
Main finding
As reported in the abstract
Diagnostic accuracy for endogenous hypercortisolism (CS)
| Group | Cut-off | Sensitivity | Specificity | PPV | NPV | Diagnostic efficiency | Overall diagnostic accuracy |
|---|---|---|---|---|---|---|---|
| nSC | ≥8 nmol/L | 1.0 (0.69-1.0) | 1.0 (0.85-1.0) | 1.0 (0.69-0.99) | 1.0(0.85-0.99) | 100% | |
| %D | 50% | 81% |
Cut-off
nSC≥8 nmol/L
%D50%
Sensitivity
nSC1.0 (0.69-1.0)
%D— not stated in the abstract
Specificity
nSC1.0 (0.85-1.0)
%D— not stated in the abstract
PPV
nSC1.0 (0.69-0.99)
%D— not stated in the abstract
NPV
nSC1.0(0.85-0.99)
%D— not stated in the abstract
Diagnostic efficiency
nSC100%
%D— not stated in the abstract
Overall diagnostic accuracy
nSC— not stated in the abstract
%D81%
- Controls with %D below the cut-off
- 6/22
Observational data: associations, not effects.
Further findings
Salivary cortisol in controls, nSC vs mSC
- Only controls decreased nSC vs mSC; nSC median (IQR) 2.0 [2.0-2.5] nmol/L vs mSC 6.9 [4.8-10.4] nmol/L
- P < 0.0001
Original publication
Nocturnal Salivary Cortisol Is an Accurate Non-Invasive Test to Assess Endogenous Hypercortisolism in Children with Obesity and a Clinical Phenotype Suspicious for Cushing’s Syndrome. Horm Res Paediatr. Published 9 August 2024. doi:10.
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