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The role of salivary cortisol measured by liquid chromatography-tandem mass spectrometry in the diagnosis of subclinical hypercortisolism.
[adrenal incidentaloma]
The
use
of
late
-
night
salivary
cortisol
(
LNSalC
)
for
diagnosing
subclinical
hypercortisolism
(
SH
)
is
debated
.
No
data
are
available
regarding
the
role
of
LNSalC
as
measured
by
liquid
chromatography-tandem
mass
spectrometry
(
LC
-
MS
/
MS
)
in
SH
diagnosis
.
The
aim
of
this
study
was
to
evaluate
the
diagnostic
accuracy
of
LNSalC
measured
by
LC
-
MS
/
MS
in
SH
.
Cross-sectional
prospective
study
of
outpatients
.
In
70
consecutive
patients
with
adrenal
incidentalomas
(
AI
)
,
without
signs
and
symptoms
of
hypercortisolism
,
we
diagnosed
SH
in
the
presence
of
at
least
two
of
the
following
:
cortisol
after
1
 
mg
overnight
dexamethasone
suppression
test
(
1
 
mg
DST
)
>
83
 
nmol
/
l
,
24
-
h
urinary
free
cortisol
(
UFC
)
>
193
 
nmol
/
24
 
h
,
and
morning
ACTH
<
2
.
2
 
pmol
/
l
.
The
LNSalC
levels
by
LC
-
MS
/
MS
at
2300
 
h
(
normal
values
<
2
.
8
 
nmol
/
l
)
and
the
presence
of
hypertension
,
type
2
diabetes
mellitus
(
T
2
DM
)
,
and
osteoporosis
(
OP
)
were
assessed
.
The
increased
LNSalC
levels
(
>
2
.
8
 
nmol
/
l
)
had
an
83
.
3
%
specificity
(
SP
)
and
a
31
.
3
%
sensitivity
(
SN
)
for
predicting
the
biochemical
diagnosis
of
SH
.
The
increased
LNSalC
had
an
85
.
2
%
SP
and
a
55
.
6
%
SN
for
predicting
the
presence
of
hypertension
,
T
2
DM
,
and
OP
,
while
the
combination
of
LNSalC
>
1
.
4
 
nmol
/
l
(
cutoff
with
100
%
SN
)
plus
1
 
mg
DST
>
50
 
nmol
/
l
had
an
88
.
9
%
SN
and
an
85
.
2
%
SP
(
similar
to
SH
criterion
at
enrollment
)
.
In
AI
patients
,
LNSalC
measured
by
LC
-
MS
/
MS
appears
to
be
useful
in
combination
with
1
 
mg
DST
for
diagnosing
SH
,
while
it
is
not
useful
as
a
single
criterion
.
Diseases
Validation
Diseases presenting
"osteoporosis"
symptom
achondroplasia
adrenal incidentaloma
allergic bronchopulmonary aspergillosis
aromatase deficiency
congenital adrenal hyperplasia
cushing syndrome
cutaneous mastocytosis
dentinogenesis imperfecta
erythropoietic protoporphyria
fabry disease
familial hypocalciuric hypercalcemia
familial mediterranean fever
inclusion body myositis
kallmann syndrome
oligodontia
pyomyositis
werner syndrome
x-linked adrenoleukodystrophy
This symptom has already been validated
