Monday, November 26, 2012

Europe Continues to Lead Research on Cyclical Cushing's

It is my strong belief that European endocrinologists and research will pave the way for cyclical patients in the United States, who continue to struggle.

Don't believe me?

Well, I point you to many articles that consistently come out of Ireland, Italy, Germany, France, England, Serbia, Spain, and others I can't remember now. When I get a chance, I'll try to post a link with all of these articles in one place. Until then, please, I beg you. Trust me on this.

I have read many articles on cyclical Cushing's -- after searching high and low for them. These articles come primarily from our European friends. 

Common knowledge about cyclical Cushing's must be racing around the continent on those bullet trains (which I adore, by the way!).


1.    U. M. Graham,
2.    S. J. Hunter,
3.    M. McDonnell,
4.    K. R. Mullan and
5.    A. B. Atkinson
1.   Regional Centre for Endocrinology and Diabetes (U.M.G., S.J.H., K.R.M., A.B.A.) and Regional Endocrine Laboratory (M.McD.), Royal Victoria Hospital, Belfast BT12 6BA, United Kingdom
1.    Address all correspondence and requests for reprints to: Dr. Una Graham, Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, United Kingdom. E-mail:
Context: Cyclical Cushing's syndrome is detected in our center by collecting sequential early morning urine (EMU)* samples for cortisol to creatinine ratio over 28 d. The Endocrine Society suggests that nocturnal salivary cortisol (NSC)* may be used to assess patients for cyclical Cushing's. However, there is only very limited evidence that it correlates with early morning urine testing or that it demonstrates cycling over 28 d.

Objective: We sought to correlate nocturnal salivary cortisol with early morning urine results collected the following morning and to determine whether nocturnal salivary cortisol could be used to detect cyclical Cushing's.

Design and Setting: An observation study of 28-d collections for nocturnal salivary cortisol and early morning urine was performed in a tertiary referral center over 1 yr.

Patients: A 28-d collection of nocturnal salivary cortisol and early morning urine was performed in 10 patients with confirmed or suspected Cushing's syndrome.

Main Outcome Measure: The main outcome of the study was the correlation of salivary and urinary cortisol with graphical assessment of results for cycling.

Results: Eleven collections were performed. One patient with cyclical Cushing's completed the collection before and after cabergoline therapy. Two hundred seventy matched salivary and urinary results were correlated (r = 0.79; P < 0.001). In two patients with cyclical Cushing's, early morning urine and nocturnal salivary cortisol followed a similar cyclical pattern. In one patient with recurrent cyclical Cushing's, cortisol was elevated in both saliva and urine but with more prominent cycles in saliva.

Conclusion: Nocturnal salivary cortisol correlated well with early morning urine (EMU). Nocturnal salivary cortisol detected all cases of cyclical Cushing's. Therefore, nocturnal salivary cortisol may prove to be an additional option or replacement for early morning urine in detecting cyclical Cushing's syndrome.

* For ease of reading, blogger changed all EMU to early morning urines and all NSC to nocturnal salivary cortisol. A Cushie brain is far too foggy to keep even these simple conventions straight even when reading a brief article.