肾上腺功能不全
内科学
医学
内分泌学
唾液
免疫分析
氢化可的松
地塞米松
曲线下面积
糖皮质激素
接收机工作特性
切断
地塞米松抑制试验
肾上腺疾病
胰岛素耐受试验
胰岛素
免疫学
抗体
胰岛素抵抗
胰岛素敏感性
葡萄糖稳态
物理
量子力学
作者
Timo Deutschbein,Martina Broecker-Preuß,Jörg Flitsch,Andrea Jaeger,Ricarda Althoff,Martin K. Walz,Klaus Mann,Stephan Petersenn
出处
期刊:European journal of endocrinology
[Bioscientifica]
日期:2012-04-01
卷期号:166 (4): 613-618
被引量:71
摘要
Salivary cortisol is increasingly used to assess patients with suspected hypo- and hypercortisolism. This study established disease-specific reference ranges for an automated electrochemiluminescence immunoassay (ECLIA).Unstimulated saliva from 62 patients with hypothalamic-pituitary disease was collected at 0800 h. A peak serum cortisol level below 500 nmol/l during the insulin tolerance test (ITT) was used to identify hypocortisolism. Receiver-operating characteristic (ROC) analysis allowed establishment of lower and upper cutoffs with at least 95% specificity for adrenal insufficiency and adrenal sufficiency. Saliva from 40 patients with confirmed hypercortisolism, 45 patients with various adrenal masses, and 115 healthy subjects was sampled at 2300 h and after low-dose dexamethasone suppression at 0800 h . ROC analysis was used to calculate thresholds with at least 95% sensitivity for hypercortisolism. Salivary cortisol was measured with an automated ECLIA.When screening for secondary adrenal insufficiency, a lower cutoff of 3.2 nmol/l and an upper cutoff of 13.2 nmol/l for unstimulated salivary cortisol allowed a highly specific diagnosis (i.e. similar to the ITT result) in 26% of patients. For identification of hypercortisolism, cutoffs of 6.1 nmol/l (sensitivity 95%, specificity 91%, area under the curve (AUC) 0.97) and 2.0 nmol/l (sensitivity 97%, specificity 86%, AUC 0.97) were established for salivary cortisol at 2300 h and for dexamethasone-suppressed salivary cortisol at 0800 h.The newly established thresholds facilitated initial screening for secondary adrenal insufficiency and allowed excellent identification of hypercortisolism. Measurement by an automated immunoassay will allow broader use of salivary cortisol as a diagnostic tool.
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