Reference intervals of salivary cortisol and cortisone and their diagnostic accuracy in Cushing’s syndrome
Objective The challenge of diagnosing Cushing’s syndrome (CS) calls for high precision biochemical screening. This study aimed to establish robust reference intervals for, and compare the diagnostic accuracy of, salivary cortisol and cortisone in late-night samples and after a low-dose (1 mg) dexame...
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| Veröffentlicht in: | European journal of endocrinology 2020-06, Vol.182 (6), p.569-582 |
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| creator | Bäcklund, Nils Brattsand, Göran Israelsson, Marlen Ragnarsson, Oskar Burman, Pia Edén Engström, Britt Høybye, Charlotte Berinder, Katarina Wahlberg, Jeanette Olsson, Tommy Dahlqvist, Per |
| description | Objective The challenge of diagnosing Cushing’s syndrome (CS) calls for high precision biochemical screening. This study aimed to establish robust reference intervals for, and compare the diagnostic accuracy of, salivary cortisol and cortisone in late-night samples and after a low-dose (1 mg) dexamethasone suppression test (DST). Design and methods Saliva samples were collected at 08:00 and 23:00 h, and at 08:00 h, after a DST, from 22 patients with CS and from 155 adult reference subjects. We also collected samples at 20:00 and 22:00 h from 78 of the reference subjects. Salivary cortisol and cortisone were analysed with liquid chromatography-tandem mass spectrometry. The reference intervals were calculated as the 2.5th and 97.5th percentiles of the reference population measurements. Diagnostic accuracies of different tests were compared, based on areas under the receiver-operating characteristic curves. Results The upper reference limits of salivary cortisol and cortisone at 23:00 h were 3.6 nmol/L and 13.5 nmol/L, respectively. Using these reference limits, CS was detected with a sensitivity (95% CI) of 90% (70–99%) and specificity of 96% (91–98%) for cortisol, and a 100% (84–100%) sensitivity and 95% (90–98%) specificity for cortisone. After DST, cortisol and cortisone upper reference limits were 0.79 nmol/L and 3.5 nmol/L, respectively. CS was detected with 95% (75–100%) sensitivity and 96% (92–99%) specificity with cortisol, and 100% (83–100%) sensitivity and 94% (89–97%) specificity with cortisone. No differences in salivary cortisol or cortisone levels were found between samples collected at 22:00 and 23:00 h. Conclusion Salivary cortisol and cortisone in late-night samples and after DST showed high accuracy for diagnosing CS, salivary cortisone being slightly, but significantly better. |
| doi_str_mv | 10.1530/EJE-19-0872 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_swepub_ki_se_472490</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2399872920</sourcerecordid><originalsourceid>FETCH-LOGICAL-b692t-d7de896680d4d2926fe8d650d2fbb961c7e271a1e3f65fc95ca5d323275e29663</originalsourceid><addsrcrecordid>eNqNkstu1DAUhiMEotPCij2KxJIGfIsTL6thuGkkJASIneXYJ1OXTDy1k6LZ8Rq8Hk_CSWcGVh11Yfmiz5_t4z_LnlHyipacvF58XBRUFaSu2INsRkWlClnz7w-zGamJKIQU_CQ7TemKEIpj8jg74YxRLstqlnWfoYUIvYXc9wPEG9OlPLR5Mp2_MXGb2xAHn0KXm94dJj3czoZL8DF33qz6kAZvc2PtGI3doiqfj-nS96s_v36nPG17F8ManmSPWvTD031_ln19u_gyf18sP737ML9YFo1UbChc5aBWUtbECccUky3UTpbEsbZplKS2AlZRQ4G3smytKq0pHWecVSUw3MfPsmLnTT9hMzZ6E_0a36KD8Xq_9ANHoEXFhCLIL-_ku3GDrcE2bWgaAMlrrmXLhBYOnG6YEFoKwUtJhZLCHT1-hTpcWt3a8LK0pMif38m_8d8udIgrPY5aCEoJP6r_j69HTWuCJbkfHyLyBO9T34_vPPIVpmmq9osdv4nheoQ06Kswxh4_WDOuFMZSsanGL3eUjSGlCO0_LyV6yrHGHGuq9JRjpJ_vnWOzxiIf2ENwEaA7oPEhWQ_94FtvzVHpX7JAAP4</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2399872920</pqid></control><display><type>article</type><title>Reference intervals of salivary cortisol and cortisone and their diagnostic accuracy in Cushing’s syndrome</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>MEDLINE</source><creator>Bäcklund, Nils ; Brattsand, Göran ; Israelsson, Marlen ; Ragnarsson, Oskar ; Burman, Pia ; Edén Engström, Britt ; Høybye, Charlotte ; Berinder, Katarina ; Wahlberg, Jeanette ; Olsson, Tommy ; Dahlqvist, Per</creator><creatorcontrib>Bäcklund, Nils ; Brattsand, Göran ; Israelsson, Marlen ; Ragnarsson, Oskar ; Burman, Pia ; Edén Engström, Britt ; Høybye, Charlotte ; Berinder, Katarina ; Wahlberg, Jeanette ; Olsson, Tommy ; Dahlqvist, Per</creatorcontrib><description>Objective The challenge of diagnosing Cushing’s syndrome (CS) calls for high precision biochemical screening. This study aimed to establish robust reference intervals for, and compare the diagnostic accuracy of, salivary cortisol and cortisone in late-night samples and after a low-dose (1 mg) dexamethasone suppression test (DST). Design and methods Saliva samples were collected at 08:00 and 23:00 h, and at 08:00 h, after a DST, from 22 patients with CS and from 155 adult reference subjects. We also collected samples at 20:00 and 22:00 h from 78 of the reference subjects. Salivary cortisol and cortisone were analysed with liquid chromatography-tandem mass spectrometry. The reference intervals were calculated as the 2.5th and 97.5th percentiles of the reference population measurements. Diagnostic accuracies of different tests were compared, based on areas under the receiver-operating characteristic curves. Results The upper reference limits of salivary cortisol and cortisone at 23:00 h were 3.6 nmol/L and 13.5 nmol/L, respectively. Using these reference limits, CS was detected with a sensitivity (95% CI) of 90% (70–99%) and specificity of 96% (91–98%) for cortisol, and a 100% (84–100%) sensitivity and 95% (90–98%) specificity for cortisone. After DST, cortisol and cortisone upper reference limits were 0.79 nmol/L and 3.5 nmol/L, respectively. CS was detected with 95% (75–100%) sensitivity and 96% (92–99%) specificity with cortisol, and 100% (83–100%) sensitivity and 94% (89–97%) specificity with cortisone. No differences in salivary cortisol or cortisone levels were found between samples collected at 22:00 and 23:00 h. Conclusion Salivary cortisol and cortisone in late-night samples and after DST showed high accuracy for diagnosing CS, salivary cortisone being slightly, but significantly better.</description><identifier>ISSN: 0804-4643</identifier><identifier>ISSN: 1479-683X</identifier><identifier>EISSN: 1479-683X</identifier><identifier>DOI: 10.1530/EJE-19-0872</identifier><identifier>PMID: 32213657</identifier><language>eng</language><publisher>England: Bioscientifica Ltd</publisher><subject>80 and over ; Accuracy ; Adrenocorticotropic hormone ; Adult ; Aged ; Aged, 80 and over ; Analytical Chemistry ; Analytisk kemi ; Area Under Curve ; area under the curve ; Chemical Sciences ; chemistry ; Circadian Rhythm ; Clinical Study ; Cortisol ; cortisone ; Cortisone - analysis ; Cushing syndrome ; Cushing Syndrome - diagnosis ; Dexamethasone ; Endocrinology and Diabetes ; Endokrinologi och diabetes ; Female ; Hormones ; human ; Humans ; hydrocortisone ; Hydrocortisone - analysis ; Kemi ; Liquid chromatography ; Male ; mass screening ; Mass Screening - methods ; Mass Screening - statistics & numerical data ; Mass spectroscopy ; Middle Aged ; Natural Sciences ; Naturvetenskap ; Nervous system diseases ; Pituitary ; procedures ; receiver operating characteristic ; reference value ; Reference Values ; ROC Curve ; Saliva ; Saliva - chemistry ; Sensitivity and Specificity ; Tandem Mass Spectrometry ; time factor ; Time Factors ; very elderly ; Young Adult</subject><ispartof>European journal of endocrinology, 2020-06, Vol.182 (6), p.569-582</ispartof><rights>2020 European Society of Endocrinology</rights><rights>Copyright BioScientifica Ltd. Jun 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b692t-d7de896680d4d2926fe8d650d2fbb961c7e271a1e3f65fc95ca5d323275e29663</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32213657$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-174306$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-109618$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-180275$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-441103$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttps://gup.ub.gu.se/publication/296151$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttps://lup.lub.lu.se/record/bbee6383-6f24-4ded-b244-64435614964d$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:146151326$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Bäcklund, Nils</creatorcontrib><creatorcontrib>Brattsand, Göran</creatorcontrib><creatorcontrib>Israelsson, Marlen</creatorcontrib><creatorcontrib>Ragnarsson, Oskar</creatorcontrib><creatorcontrib>Burman, Pia</creatorcontrib><creatorcontrib>Edén Engström, Britt</creatorcontrib><creatorcontrib>Høybye, Charlotte</creatorcontrib><creatorcontrib>Berinder, Katarina</creatorcontrib><creatorcontrib>Wahlberg, Jeanette</creatorcontrib><creatorcontrib>Olsson, Tommy</creatorcontrib><creatorcontrib>Dahlqvist, Per</creatorcontrib><title>Reference intervals of salivary cortisol and cortisone and their diagnostic accuracy in Cushing’s syndrome</title><title>European journal of endocrinology</title><addtitle>Eur J Endocrinol</addtitle><description>Objective The challenge of diagnosing Cushing’s syndrome (CS) calls for high precision biochemical screening. This study aimed to establish robust reference intervals for, and compare the diagnostic accuracy of, salivary cortisol and cortisone in late-night samples and after a low-dose (1 mg) dexamethasone suppression test (DST). Design and methods Saliva samples were collected at 08:00 and 23:00 h, and at 08:00 h, after a DST, from 22 patients with CS and from 155 adult reference subjects. We also collected samples at 20:00 and 22:00 h from 78 of the reference subjects. Salivary cortisol and cortisone were analysed with liquid chromatography-tandem mass spectrometry. The reference intervals were calculated as the 2.5th and 97.5th percentiles of the reference population measurements. Diagnostic accuracies of different tests were compared, based on areas under the receiver-operating characteristic curves. Results The upper reference limits of salivary cortisol and cortisone at 23:00 h were 3.6 nmol/L and 13.5 nmol/L, respectively. Using these reference limits, CS was detected with a sensitivity (95% CI) of 90% (70–99%) and specificity of 96% (91–98%) for cortisol, and a 100% (84–100%) sensitivity and 95% (90–98%) specificity for cortisone. After DST, cortisol and cortisone upper reference limits were 0.79 nmol/L and 3.5 nmol/L, respectively. CS was detected with 95% (75–100%) sensitivity and 96% (92–99%) specificity with cortisol, and 100% (83–100%) sensitivity and 94% (89–97%) specificity with cortisone. No differences in salivary cortisol or cortisone levels were found between samples collected at 22:00 and 23:00 h. Conclusion Salivary cortisol and cortisone in late-night samples and after DST showed high accuracy for diagnosing CS, salivary cortisone being slightly, but significantly better.</description><subject>80 and over</subject><subject>Accuracy</subject><subject>Adrenocorticotropic hormone</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analytical Chemistry</subject><subject>Analytisk kemi</subject><subject>Area Under Curve</subject><subject>area under the curve</subject><subject>Chemical Sciences</subject><subject>chemistry</subject><subject>Circadian Rhythm</subject><subject>Clinical Study</subject><subject>Cortisol</subject><subject>cortisone</subject><subject>Cortisone - analysis</subject><subject>Cushing syndrome</subject><subject>Cushing Syndrome - diagnosis</subject><subject>Dexamethasone</subject><subject>Endocrinology and Diabetes</subject><subject>Endokrinologi och diabetes</subject><subject>Female</subject><subject>Hormones</subject><subject>human</subject><subject>Humans</subject><subject>hydrocortisone</subject><subject>Hydrocortisone - analysis</subject><subject>Kemi</subject><subject>Liquid chromatography</subject><subject>Male</subject><subject>mass screening</subject><subject>Mass Screening - methods</subject><subject>Mass Screening - statistics & numerical data</subject><subject>Mass spectroscopy</subject><subject>Middle Aged</subject><subject>Natural Sciences</subject><subject>Naturvetenskap</subject><subject>Nervous system diseases</subject><subject>Pituitary</subject><subject>procedures</subject><subject>receiver operating characteristic</subject><subject>reference value</subject><subject>Reference Values</subject><subject>ROC Curve</subject><subject>Saliva</subject><subject>Saliva - chemistry</subject><subject>Sensitivity and Specificity</subject><subject>Tandem Mass Spectrometry</subject><subject>time factor</subject><subject>Time Factors</subject><subject>very elderly</subject><subject>Young Adult</subject><issn>0804-4643</issn><issn>1479-683X</issn><issn>1479-683X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkstu1DAUhiMEotPCij2KxJIGfIsTL6thuGkkJASIneXYJ1OXTDy1k6LZ8Rq8Hk_CSWcGVh11Yfmiz5_t4z_LnlHyipacvF58XBRUFaSu2INsRkWlClnz7w-zGamJKIQU_CQ7TemKEIpj8jg74YxRLstqlnWfoYUIvYXc9wPEG9OlPLR5Mp2_MXGb2xAHn0KXm94dJj3czoZL8DF33qz6kAZvc2PtGI3doiqfj-nS96s_v36nPG17F8ManmSPWvTD031_ln19u_gyf18sP737ML9YFo1UbChc5aBWUtbECccUky3UTpbEsbZplKS2AlZRQ4G3smytKq0pHWecVSUw3MfPsmLnTT9hMzZ6E_0a36KD8Xq_9ANHoEXFhCLIL-_ku3GDrcE2bWgaAMlrrmXLhBYOnG6YEFoKwUtJhZLCHT1-hTpcWt3a8LK0pMif38m_8d8udIgrPY5aCEoJP6r_j69HTWuCJbkfHyLyBO9T34_vPPIVpmmq9osdv4nheoQ06Kswxh4_WDOuFMZSsanGL3eUjSGlCO0_LyV6yrHGHGuq9JRjpJ_vnWOzxiIf2ENwEaA7oPEhWQ_94FtvzVHpX7JAAP4</recordid><startdate>20200601</startdate><enddate>20200601</enddate><creator>Bäcklund, Nils</creator><creator>Brattsand, Göran</creator><creator>Israelsson, Marlen</creator><creator>Ragnarsson, Oskar</creator><creator>Burman, Pia</creator><creator>Edén Engström, Britt</creator><creator>Høybye, Charlotte</creator><creator>Berinder, Katarina</creator><creator>Wahlberg, Jeanette</creator><creator>Olsson, Tommy</creator><creator>Dahlqvist, Per</creator><general>Bioscientifica Ltd</general><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>DG8</scope><scope>D91</scope><scope>D93</scope><scope>DF2</scope><scope>F1U</scope><scope>D95</scope></search><sort><creationdate>20200601</creationdate><title>Reference intervals of salivary cortisol and cortisone and their diagnostic accuracy in Cushing’s syndrome</title><author>Bäcklund, Nils ; Brattsand, Göran ; Israelsson, Marlen ; Ragnarsson, Oskar ; Burman, Pia ; Edén Engström, Britt ; Høybye, Charlotte ; Berinder, Katarina ; Wahlberg, Jeanette ; Olsson, Tommy ; Dahlqvist, Per</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b692t-d7de896680d4d2926fe8d650d2fbb961c7e271a1e3f65fc95ca5d323275e29663</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>80 and over</topic><topic>Accuracy</topic><topic>Adrenocorticotropic hormone</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analytical Chemistry</topic><topic>Analytisk kemi</topic><topic>Area Under Curve</topic><topic>area under the curve</topic><topic>Chemical Sciences</topic><topic>chemistry</topic><topic>Circadian Rhythm</topic><topic>Clinical Study</topic><topic>Cortisol</topic><topic>cortisone</topic><topic>Cortisone - analysis</topic><topic>Cushing syndrome</topic><topic>Cushing Syndrome - diagnosis</topic><topic>Dexamethasone</topic><topic>Endocrinology and Diabetes</topic><topic>Endokrinologi och diabetes</topic><topic>Female</topic><topic>Hormones</topic><topic>human</topic><topic>Humans</topic><topic>hydrocortisone</topic><topic>Hydrocortisone - analysis</topic><topic>Kemi</topic><topic>Liquid chromatography</topic><topic>Male</topic><topic>mass screening</topic><topic>Mass Screening - methods</topic><topic>Mass Screening - statistics & numerical data</topic><topic>Mass spectroscopy</topic><topic>Middle Aged</topic><topic>Natural Sciences</topic><topic>Naturvetenskap</topic><topic>Nervous system diseases</topic><topic>Pituitary</topic><topic>procedures</topic><topic>receiver operating characteristic</topic><topic>reference value</topic><topic>Reference Values</topic><topic>ROC Curve</topic><topic>Saliva</topic><topic>Saliva - chemistry</topic><topic>Sensitivity and Specificity</topic><topic>Tandem Mass Spectrometry</topic><topic>time factor</topic><topic>Time Factors</topic><topic>very elderly</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bäcklund, Nils</creatorcontrib><creatorcontrib>Brattsand, Göran</creatorcontrib><creatorcontrib>Israelsson, Marlen</creatorcontrib><creatorcontrib>Ragnarsson, Oskar</creatorcontrib><creatorcontrib>Burman, Pia</creatorcontrib><creatorcontrib>Edén Engström, Britt</creatorcontrib><creatorcontrib>Høybye, Charlotte</creatorcontrib><creatorcontrib>Berinder, Katarina</creatorcontrib><creatorcontrib>Wahlberg, Jeanette</creatorcontrib><creatorcontrib>Olsson, Tommy</creatorcontrib><creatorcontrib>Dahlqvist, Per</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Linköpings universitet</collection><collection>SWEPUB Örebro universitet</collection><collection>SWEPUB Umeå universitet</collection><collection>SWEPUB Uppsala universitet</collection><collection>SWEPUB Göteborgs universitet</collection><collection>SWEPUB Lunds universitet</collection><jtitle>European journal of endocrinology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bäcklund, Nils</au><au>Brattsand, Göran</au><au>Israelsson, Marlen</au><au>Ragnarsson, Oskar</au><au>Burman, Pia</au><au>Edén Engström, Britt</au><au>Høybye, Charlotte</au><au>Berinder, Katarina</au><au>Wahlberg, Jeanette</au><au>Olsson, Tommy</au><au>Dahlqvist, Per</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Reference intervals of salivary cortisol and cortisone and their diagnostic accuracy in Cushing’s syndrome</atitle><jtitle>European journal of endocrinology</jtitle><addtitle>Eur J Endocrinol</addtitle><date>2020-06-01</date><risdate>2020</risdate><volume>182</volume><issue>6</issue><spage>569</spage><epage>582</epage><pages>569-582</pages><issn>0804-4643</issn><issn>1479-683X</issn><eissn>1479-683X</eissn><abstract>Objective The challenge of diagnosing Cushing’s syndrome (CS) calls for high precision biochemical screening. This study aimed to establish robust reference intervals for, and compare the diagnostic accuracy of, salivary cortisol and cortisone in late-night samples and after a low-dose (1 mg) dexamethasone suppression test (DST). Design and methods Saliva samples were collected at 08:00 and 23:00 h, and at 08:00 h, after a DST, from 22 patients with CS and from 155 adult reference subjects. We also collected samples at 20:00 and 22:00 h from 78 of the reference subjects. Salivary cortisol and cortisone were analysed with liquid chromatography-tandem mass spectrometry. The reference intervals were calculated as the 2.5th and 97.5th percentiles of the reference population measurements. Diagnostic accuracies of different tests were compared, based on areas under the receiver-operating characteristic curves. Results The upper reference limits of salivary cortisol and cortisone at 23:00 h were 3.6 nmol/L and 13.5 nmol/L, respectively. Using these reference limits, CS was detected with a sensitivity (95% CI) of 90% (70–99%) and specificity of 96% (91–98%) for cortisol, and a 100% (84–100%) sensitivity and 95% (90–98%) specificity for cortisone. After DST, cortisol and cortisone upper reference limits were 0.79 nmol/L and 3.5 nmol/L, respectively. CS was detected with 95% (75–100%) sensitivity and 96% (92–99%) specificity with cortisol, and 100% (83–100%) sensitivity and 94% (89–97%) specificity with cortisone. No differences in salivary cortisol or cortisone levels were found between samples collected at 22:00 and 23:00 h. Conclusion Salivary cortisol and cortisone in late-night samples and after DST showed high accuracy for diagnosing CS, salivary cortisone being slightly, but significantly better.</abstract><cop>England</cop><pub>Bioscientifica Ltd</pub><pmid>32213657</pmid><doi>10.1530/EJE-19-0872</doi><tpages>14</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | 80 and over Accuracy Adrenocorticotropic hormone Adult Aged Aged, 80 and over Analytical Chemistry Analytisk kemi Area Under Curve area under the curve Chemical Sciences chemistry Circadian Rhythm Clinical Study Cortisol cortisone Cortisone - analysis Cushing syndrome Cushing Syndrome - diagnosis Dexamethasone Endocrinology and Diabetes Endokrinologi och diabetes Female Hormones human Humans hydrocortisone Hydrocortisone - analysis Kemi Liquid chromatography Male mass screening Mass Screening - methods Mass Screening - statistics & numerical data Mass spectroscopy Middle Aged Natural Sciences Naturvetenskap Nervous system diseases Pituitary procedures receiver operating characteristic reference value Reference Values ROC Curve Saliva Saliva - chemistry Sensitivity and Specificity Tandem Mass Spectrometry time factor Time Factors very elderly Young Adult |
| title | Reference intervals of salivary cortisol and cortisone and their diagnostic accuracy in Cushing’s syndrome |
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