{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T19:36:06Z","timestamp":1780688166349,"version":"3.54.1"},"reference-count":39,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,4,19]],"date-time":"2023-04-19T00:00:00Z","timestamp":1681862400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Context<\/jats:title><jats:p>Late\u2010night salivary cortisol (LNSC) is a simple and reliable screening test for Cushing syndrome (CS). With improved analytical performance of the current second\u2010generation electrochemiluminescence immunoassay (ECLIA; Elecsys Cortisol\u2010II; Roche Diagnostics), there is a need to revisit the LNSC cut\u2010offs, especially in a South\u2010Asian population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To derive LNSC cut\u2010offs for diagnosis of CS using second\u2010generation ECLIA kits.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Diagnostic accuracy study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We prospectively recruited 155 controls aged 18\u201360 years, including, normal\u2010weight (body mass index [BMI]\u2009&lt;\u200925\u2009kg\/m<jats:sup>2<\/jats:sup> and no hypertension or diabetes [<jats:italic>n<\/jats:italic>\u2009=\u200953]) and overweight\/obese (BMI 25\u201330\u2009kg\/m<jats:sup>2<\/jats:sup> and hypertension and\/or diabetes [<jats:italic>n<\/jats:italic>\u2009=\u200952] or BMI\u2009\u2265\u200930\u2009kg\/m<jats:sup>2<\/jats:sup> with\/without comorbidities [<jats:italic>n<\/jats:italic>\u2009=\u200950]) participants. All participants submitted LNSC samples collected at home; overweight\/obese controls additionally underwent dexamethasone suppression test to exclude CS. We also reviewed records of adults with endogenous CS (cases, <jats:italic>n<\/jats:italic>\u2009=\u200992) and a valid LNSC result using the same method.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The 95th percentile for LNSC in controls was 6.76\u2009nmol\/L. The mean\u2009\u00b1\u2009SD LNSC levels were 40.47\u2009\u00b1\u200949.63\u2009nmol\/L in cases and 3.37\u2009\u00b1\u20091.18\u2009nmol\/L in controls (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Receiver operating characteristic (ROC) analysis showed excellent diagnostic performance of LNSC for CS, with area under curves (AUCs) of 0.994 (cases vs. all controls) and 0.993 (cases vs. overweight\/obese controls), respectively. The best diagnostic performance was achieved at cut\u2010offs \u22656.73\u2009nmol\/L (sensitivity: 97.8%, specificity: 94.8%) and \u22657.26\u2009nmol\/L (sensitivity: 97.8%, specificity: 95.1%), respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>LNSC measured using second\u2010generation ECLIA demonstrated high diagnostic accuracy for CS. Based on this study, we propose a LNSC cutoff \u22656.73\u2009nmol\/L to diagnose CS.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.14920","type":"journal-article","created":{"date-parts":[[2023,4,13]],"date-time":"2023-04-13T12:51:30Z","timestamp":1681390290000},"page":"43-51","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Late\u2010night salivary cortisol cut\u2010offs for diagnosis of Cushing syndrome using second\u2010generation electrochemiluminescence immunoassay kits"],"prefix":"10.1111","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0922-5022","authenticated-orcid":false,"given":"Alpesh","family":"Goyal","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Metabolism All India Institute of Medical Sciences New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhawna","family":"Attri","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism All India Institute of Medical Sciences New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4345-717X","authenticated-orcid":false,"given":"Yashdeep","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism All India Institute of Medical Sciences New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mani","family":"Kalaivani","sequence":"additional","affiliation":[{"name":"Department of Biostatistics All India Institute of Medical Sciences New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viveka P.","family":"Jyotsna","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism All India Institute of Medical Sciences New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikhil","family":"Tandon","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism All India Institute of Medical Sciences New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,4,19]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2012.02.110227"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(21)00235-7"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2008-0125"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.12853"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-12-0685"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/0004563216687335"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cca.2009.11.033"},{"key":"e_1_2_8_9_1","unstructured":"Elecsys Cortisol\u2010II Assay Kit Insert. 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