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!).
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Authors
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: qublbc8@hotmail.com.
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.
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* 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.
