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In the alcoholic patient with pseudo-Cushing's, admission to hospital (and avoidance of alcohol) will result in normal midnight cortisol levels within five days, excluding Cushing's [6] Another cause for Cushing's syndrome is adrenocortical carcinoma. This is a rare form of cancer with an incidence of 1-2 per million people annually.
In 2010 Sakihara, et al., evaluated the usefulness and accuracy of salivary, plasma, and urinary cortisol levels and determined salivary cortisol to be the "method of choice" for Cushing's syndrome screening. [23] In 2008 Restituto, et al., found early morning salivary cortisol to be "as good as serum" as an Addison's disease screening ...
The late-night or midnight salivary cortisol test has been gaining support due to its ease of collection and stability at room temperature, therefore it can be assigned to outpatients. [8] The test measures free circulating cortisol and have both a sensitivity and specificity of 95–98%. [8] [11] This test is especially useful for diagnosing ...
Low-dose and high-dose variations of the test exist. [4] The test is given at low (usually 1–2 mg) and high (8 mg) doses of dexamethasone, and the levels of cortisol are measured to obtain the results. [5] A low dose of dexamethasone suppresses cortisol in individuals with no pathology in endogenous cortisol production.
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The timing of these changes also varies by substance. Levels of serum cortisol, prolactin, and ACTH peak immediately after the end of stress induction, but salivary cortisol peaks 10 minutes later and hGH peaks 40 minutes later. These effects were found in more than 70% of the participants. [1] Heart rate is also an indicator of stress.
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