SFEBES2008 Poster Presentations Endocrine tumours and neoplasia (31 abstracts)
Screening for Cushing’s syndrome in the diabetic clinic using nocturnal salivary cortisol
Karen Mullan 1 , Neil Black 1 , Colin Burgess 2 , Hillary Leslie 2 , Athinia Thiraviaraj 1 , Brian Sheridan 2 & Brew Atkinson 1
1Regional Centre for Endocrinology and Diabetes and 2Regional Endocrine Laboratory, Royal Victoria Hospital, Belfast, UK.
Sub-clinical Cushing’s syndrome has, in recent years, been described among diabetic populations but no consensus has emerged about the value of screening. We enrolled 201 consecutive diabetics attending clinic and 80 controls. Local ethics committee approval was obtained. Patients with at least 2 of the following 3 criteria were offered screening: HbA1c≥7%, BMI≥25 and history of hypertension or BP≥140/90. An 11 pm salivary sample was stored at room temperature overnight and posted to the laboratory the following day. An adapted autodelfia cortisol assay was used. Results are expressed as mean ±S.E.M. The diabetic group were aged 60.5±0.8 years, BMI 32.3±0.4 and HbA1c 8.4±0.1%. Fifty five per cent were men. Nightime salivary cortisols were similar in the two groups (8.5±1.0 nmol/l diabetics vs 8.7±3.2 nmol/l controls). Forty seven patients had a value >10 nmol/l (23%) which was set as a very conservative value above which to investigate diabetic patients further. Of these, 35 agreed to further testing (75%) which is comparable to previous studies. Thirty-four patients had a 1mg overnight dexamethasone test with 28 suppressing to ≤60 nmol/l while 1 other had a normal 24 h urinary free cortisol (UFC). Of the 6 patients who failed the 1 mg test, 4 had a 48 h low dose (0.5 mg) dexamethasone test all suppressing to ≤60 mmol/l and 2 others who refused this test had repeatedly normal UFCs. The 1–3% pickup rates of the three series recently published have not been realised at our centre. Outpatient nightime saliva testing are feasible for patients with a high index of suspicion as samples are stable, did not get lost and the process was patient friendly.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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