Cortisol salivar versus cortisol sérico para identificar hipercortisolismo subclínico em Incidentalomas Adrenais: simplicidade versus acurácia

• Ano de defesa: 2019
• Autor(a) principal: Correa, Marcelo Vieira [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Saliva cortisol; Dexamethasone suppression; Adrenal incidentaloma; Subclinical hypercortisolism; Cortisol de saliva; Supressão de dexametasona; Incidentaloma adrenal; Hipercortisolismo subclínico
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=7178034; https://repositorio.unifesp.br/handle/11600/59398

Objective: Subclinical hypercortisolism (SCH) leads to metabolic derangement and increased cardiovascular risk. Cortisol autonomy is defined by the overnight 1mg-dexamethasone suppression test (DST). Saliva cortisol is an easier, stress-free, and cost-effective alternative to serum cortisol. We compared 23h and post-1mg DST saliva with serum cortisol to identify SCH in adrenal incidentalomas (AI). Methods: 359 DST from 226 AI subjects (173F/53M; 19-83y) were analyzed retrospectively for saliva and serum cortisol. Three post-DST serum cortisol cutoffs were used to detect SCH: 1.8, 2.5, and the specific 5.0μg/dl. Post-DST and 23h saliva cortisol cutoffs were determined by ROC-curve analysis and their sensitivity(S) and specificity(E) calculated. Results: The 1.8μg/dl cutoff defined 137 SCH and 180 non-functioning adenomas (NFA): post-DST and 23h saliva cortisol S/E were: 75.2%/74.4% and 59.5%/65.9%, respectively. Using the 5.0μg/dl cortisol cutoff (22 SCH/295 NFA), post-DST and 23h saliva cortisol S/E were 86.4%/83.4% and 66.7%/80.4%, respectively. Using the 2.5μg/dl cutoff (89 SCH/228 NFA), post-DST and 23h saliva cortisol S/E were 80.9%/68.9% and 65.5%/62.8%, respectively. Conclusion: Saliva cortisol had acceptable performance only with the 5.0μg/dl cortisol cutoff, as in overt Cushing's syndrome. Lower cutoffs (1.8 and 2.5μg/dl) that identify larger samples of patients with poor metabolic outcomes, are less accurate for screening. These results may be attributed to pre-analytical factors and inherent patient conditions. Thus, saliva cortisol cannot replace serum cortisol on screening DST to identify SCH in patients with AI but can be used as an additional tool.