الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 187 |  |  |
| | | from | 187 | | |
Abstract
Background: Cushing’s syndrome is a clinical problem that sometimes very difficult to be diagnosed. Midnight salivary and hair cortisol are promising investigations for diagnosis of Cushing’s syndrome. Aim of the work: to establish a proper diagnostic workup for the diagnosis of Cushing’s syndrome, establish the cut off value of midnight salivary and urinary cortisol creatinine ratio in African-Egyptian and evaluate its usefulness in the diagnosis of Cushing ’s syndrome and finally, try to measure cortisol in hair as a biomarker of long-term systemic exposure. Subjects and methods: The study population consisted of 40 subjects. Investigations in the form of 24hours UFC, MSC at 11 pm, Midnight serum cortisol at 11 pm, LDDST, ACTH, Hair cortisol, UCCR to all patients and 8-mg dexamethasone suppression test for those with high ACTH level. In-addition to Radio-diagnostic techniques including CT abdomen for all patients, dynamic MRI pituitary for those with high ACTH levels and CT chest for those with high ACTH levels and normal MRI pituitary. Results: Our results show serum cortisol levels different in patients with Cushing’s syndrome compared with controls and these differences are reproduced in saliva. Both serum and saliva cortisol levels are higher in Patients with Cushing ’s syndrome compared with healthy subjects suggesting that saliva measurements are appropriate in diagnosis of this disease. One important and relevant finding of the present study for the clinical practice is that salivary cortisol levels at 23:00 h allows distinguishing patients with Cushing ’s syndrome from patients with cushingoid features or healthy control subjects. Based on our data, healthy controls present suppressed values of salivary and serum cortisol at midnight.The results of hair cortisol measurement was not significant, Conclusion: In conclusion, we found that midnight salivary cortisol was significantly correlated with serum cortisol sampled at the same time. We established the cutoff value of MSC 4.2 ng/dL in the Egyptian-African population measured by competitive immunoenzymatic assay to distinguish patients with CS with 93.75 % sensitivity and 94.7% specificity. Bedtime salivary cortisol levels, due to their accuracy and convenience are a valuable alternative to help in the diagnosis of patients with Cushing’s syndrome, these results need to be replicated in other centers in Egypt to include more patients. Segmental hair analysis may provide a more objective tool for assessment of cortisol levels during the past months to years, however unfortunately our results shows no significant differences between patients with Cushing’s syndrome and those who don’t have