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Late-Night Salivary Cortisol for the Diagnosis of Cushing's Syndrome: A Meta-Analysis. Endocr Pract 2009 May 6:1-17



Pubmed ID



Objective: The current epidemic of obesity has made the diagnosis of Cushing's syndrome more compelling and requires a practical diagnostic test with high specificity and sensitivity to detect true Cushing's syndrome while avoiding false positive results. Here we report a meta-analysis of latenight salivary cortisol for the diagnosis of Cushing's syndrome.Methods: MEDLINE and EMBASE computer databases were searched to identify relevant articles. The titles and abstracts of all articles, as well as full text of relevant articles, were reviewed. After review by multiple authors, seven articles were identified that contain information sufficient to include in the analysis. Variables of interest were extracted by two of the authors. Discrepancies were resolved by mediation by a third author.Results: A total of 947 patients - 339 with Cushing's syndrome - were identified. Pooled data from the seven studies revealed a sensitivity of 92% (95% CI 88-94%), specificity of 96% (95% CI 94- 97%), and a diagnostic odds ratio of 312 (95% CI 92-1059). The likelihood ratio positive was 21 (95% CI 10-43) with a likelihood ratio negative of 0.08 (95% CI 0.02-0.32). The inconsistencies for each of these results measured by the I2 statistic ranged from moderate to high.Conclusion: This analysis demonstrates that late-night salivary cortisol has excellent diagnostic characteristics, and as such, is a robust, convenient diagnostic test for screening and diagnosis of Cushing's syndrome.

Author List

Carroll T, Raff H, Findling JW


Ty Carroll MD Staff Physician in the Multi-Specialty department at Medical College of Wisconsin
Hershel Raff PhD Professor in the Medicine department at Medical College of Wisconsin

jenkins-FCD Prod-484 8aa07fc50b7f6d102f3dda2f4c7056ff84294d1d