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Carmen A. Carrasco, Joël Coste, Laurence Guignat, Lionel Groussin, Marie Annick Dugué, Stéphane Gaillard, Xavier Bertagna, Jérôme Bertherat, Midnight Salivary Cortisol Determination for Assessing the Outcome of Transsphenoidal Surgery in Cushing’s Disease, The Journal of Clinical Endocrinology & Metabolism, Volume 93, Issue 12, 1 December 2008, Pages 4728–4734, https://doi.org/10.1210/jc.2008-1171
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Context: Midnight salivary cortisol (MSC) is now recognized as a reliable index for Cushing’s syndrome diagnosis but has to be validated for the follow-up of treated patients.
Objective: Our objective was to evaluate MSC for assessing the outcome of transsphenoidal surgery (TSS) in patients with Cushing’s disease (CD).
Design: We conducted a retrospective cohort study in a single center.
Patients and Methods: Sixty-eight patients treated by TSS between 1996 and 2006 and followed for at least 6 months with postoperative MSC were included. Mean follow-up (± sd) was 45 ± 31 months. Morning plasma cortisol was determined 5 d after TSS, and MSC and urinary cortisol (UC) were determined 6–12 months after surgery. The remission group included hypocortisolic (morning plasma cortisol < 50 ng/ml and/or insufficient response to cosyntropin) and eucortisolic (midnight plasma cortisol < 75 ng/ml and normal UC) patients. Patients in the treatment failure group had high midnight plasma cortisol and UC concentrations.
Results: Fifty patients (74%) were in remission. Mean MSC was 0.7 ± 0.4 ng/ml (range, 0.4–2.1 ng/ml) and 6.5 ± 6.5 ng/ml (range, 2.1–27.2 ng/ml) for the remission and treatment failure groups, respectively (P = 0.001). A cutoff of 2 ng/ml for MSC gave a sensitivity of 100% and a specificity of 98% for treatment failure diagnosis, whereas UC less than 90 μg/d had a sensitivity of 71% and specificity of 98%. Postsurgical morning plasma cortisol less than or equal to 18 ng/ml had a sensitivity of 93% and specificity of 74%.
Conclusions: MSC is a simple, robust marker of remission after TSS for CD.