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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
"hypertension"
symptom
achondroplasia
acute rheumatic fever
adrenal incidentaloma
aniridia
aromatase deficiency
cadasil
child syndrome
cohen syndrome
congenital adrenal hyperplasia
congenital diaphragmatic hernia
cushing syndrome
cystinuria
erdheim-chester disease
erythropoietic protoporphyria
esophageal adenocarcinoma
fabry disease
familial hypocalciuric hypercalcemia
gm1 gangliosidosis
heparin-induced thrombocytopenia
hereditary cerebral hemorrhage with amyloidosis
holt-oram syndrome
homocystinuria without methylmalonic aciduria
hydrocephalus with stenosis of the aqueduct of sylvius
inclusion body myositis
kallmann syndrome
kindler syndrome
lamellar ichthyosis
lymphangioleiomyomatosis
pendred syndrome
primary effusion lymphoma
scrub typhus
severe combined immunodeficiency
sneddon syndrome
typhoid
von hippel-lindau disease
well-differentiated liposarcoma
werner syndrome
x-linked adrenoleukodystrophy
zellweger syndrome
This symptom has already been validated
