Cushing’s syndrome diagnosis accuracy highest with urinary free cortisol test

By: Mohan Garikiparithi | General Health | Thursday, February 11, 2016 - 12:00 PM

cushings-syndrome-diagnosis-accuracy-highest-with-urinary-free-cortisol-testDiagnosis accuracy of Cushing’s syndrome is highest with urinary cortisol test. A study published in The Journal of Clinical Endocrinology and Metabolism found a 24-hour urinary free cortisol test can most accurately diagnose Cushing’s syndrome.

The researchers analyzed data from 137 adults, all with hypercortisolism, between 2012 and 2014. Thirty-eight of the participants had a confirmed diagnosis of Cushing’s syndrome, and 99 did not. Researchers measured 24-hour urinary free cortisol with liquid chromatography-tandem mass spectrometry (LC-MS/MS), late-night salivary cortisol with a radio-immunometric method, and serum cortisol with a 1-mg dexamethasone suppression test. The three tests were performed on patients within two weeks.

LC-MS/MS test – used to measure 24-hour urinary free cortisol – was found to reveal higher positive ratio and lower likelihood ratio among the three tests.

The researchers wrote, “This result is rather surprising, because some authors have recently advocated replacing [the urinary free cortisol] assay with other tests. Our findings go against such a hypothesis, probably because we used LC-MS/MS in our routine clinical practice for all patients, meaning that high [urinary free cortisol] concentrations pointed to a high likelihood of [Cushing’s syndrome].”

Higher urinary free cortisol was found among men with Cushing’s syndrome, as well as greater cortisol suppression in the 1-mg dexamethasone suppression test in women, but gender did not affect test accuracy.

The researchers concluded, “Choosing between valid tests for ruling out [Cushing’s syndrome] in high-risk populations requires an understanding of their diagnostic performance in different clinical settings. We recommend measuring [urinary free cortisol] with LC-MS/MS as the first-line screening test for the diagnosis of [Cushing’s syndrome], and then confirming hypercortisolism with the 1-mg [dexamethasone suppression test] or late-night salivary cortisol assay.”

Know all about cortisol urine test

A cortisol urine test measures the amount of cortisol in the urine. Cortisol is produced by the adrenal gland and is released into the body during times of stress – physical or emotional. Aside from being the stress hormone, cortisol performs other important functions in the body, like controlling blood sugar, regulating blood pressure, fighting infection, regulating mood, and playing a role in metabolism of carbohydrates, fats, and proteins.

If you are showing symptoms of a medical condition that causes cortisol to fluctuate, your doctor will perform a cortisol urine test to help diagnosis.

Common symptoms for high cortisol include:

  • Frequent urination
  • Increase in thirst
  • Fatty tissue deposits, especially around the abdomen and upper back
  • Pink or purple stretch marks
  • Weight gain
  • Fatigue
  • Muscle weakness
  • Thinning skin that bruises easily

Symptoms of low cortisol are:

  • Weight loss
  • Fatigue
  • Dizziness
  • Fainting
  • Muscle weakness
  • Abdominal pain
  • Diarrhea
  • Constipation

Based on your test results, your doctor will provide you with a diagnosis and be able to begin treatment for whatever the condition may be.

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Addison’s disease and low cortisol hormone levels

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