Hypothalamic–pituitary–adrenal axis suppression – The value of salivary cortisol and cortisone in assessing hypothalamic–pituitary–adrenal recovery

2020 ◽  
Vol 57 (6) ◽  
pp. 456-460 ◽  
Author(s):  
Tejas Kalaria ◽  
Mayuri Agarwal ◽  
Sukhbir Kaur ◽  
Lauren Hughes ◽  
Hayley Sharrod-Cole ◽  
...  
Keyword(s):  
Salivary Cortisol ◽  
Serum Cortisol ◽  
Hypothalamic Pituitary Adrenal Axis ◽  
Adrenal Suppression ◽  
Baseline Serum ◽  
Hypothalamic Pituitary Adrenal ◽  
Adrenal Axis ◽  
Synacthen Test ◽  
Short Synacthen Test ◽  
Pituitary Adrenal Axis

Background The 0.25 mg short synacthen test is used to assess recovery from hypothalamic–pituitary–adrenal suppression due to chronic glucocorticoid administration. We assessed the potential role of salivary cortisol and cortisone in predicting hypothalamic–pituitary–adrenal function using the short synacthen test as the gold standard test. Method Between 09:00 and 10:30, salivary and blood samples were collected just prior to a short synacthen test to assess hypothalamic–pituitary–adrenal axis recovery in patients previously treated with oral glucocorticoids. The cut-off for a normal short synacthen test was a 30-min cortisol ≥450 nmol/L. Results Fifty-six short synacthen tests were performed on 47 patients. Of these, 15 were normal. The area under receiver operating characteristic curves for serum cortisol, salivary cortisone and salivary cortisol were 0.772, 0.785 and 0.770, respectively. From the receiver operating characteristic analysis, the cut-offs for baseline serum cortisol (≥365 nmol/L) and salivary cortisone (≥37.2 nmol) predicted hypothalamic–pituitary–adrenal axis recovery with 100% specificity in 26.7% of pass short synacthen tests, whereas salivary cortisol predicted none. Baseline serum cortisol (≤170 nmol/L), salivary cortisone (≤9.42 nmol/L) and salivary cortisol (≤1.92 nmol/L) predicted hypothalamic–pituitary–adrenal suppression with 100% sensitivity in 58.5%, 53.7% and 51.2% of failed short synacthen tests, respectively. Using these cut-offs, baseline serum cortisol, salivary cortisone and salivary cortisol could reduce the need for short synacthen tests by 50%, 46% and 37%, respectively. Conclusion Although marginally inferior to early morning serum cortisol, early morning salivary cortisone may be used as a first-line test for assessing hypothalamic–pituitary–adrenal function. We plan to incorporate salivary cortisone into a home-based patient pathway to identify patients with hypothalamic–pituitary–adrenal recovery, continuing hypothalamic–pituitary–adrenal suppression and those who require a short synacthen test.

Baseline Serum Total Cortisol During the Primary Corona Virus Infection in the Beginning of the Pandemic in Cameroon

2020 ◽  
Author(s):  
Martine Claude Etoa Etoga ◽  
Astasselbe Hadja Inna ◽  
Magellan Guewo-Fokeng ◽  
Mesmin Dehayem ◽  
Anne Ongmeb Boli ◽  
...  
Keyword(s):  
Serum Cortisol ◽  
Severe Form ◽  
Hypothalamic Pituitary Adrenal Axis ◽  
Marked Rise ◽  
Cross Sectional ◽  
Baseline Serum ◽  
Significance Level ◽  
Hypothalamic Pituitary Adrenal ◽  
Adrenal Axis ◽  
Pituitary Adrenal Axis

Abstract Introduction: Improvement of critically ill patients Covid 19 positive placed on glucocorticoids may suggest impairment of the adrenal function. Our objective was to evaluate baseline serum cortisol in covid+ patients.Methods: This was a descriptive and analytical cross-sectional study conducted in a population of patients infected with 2019-nCoV in Cameroon. Patients receiving corticosteroids irrespective of the route of administration within 3 months prior to recruitment and those with any hypothalamic-pituitary-adrenal axis disease were excluded. We reviewed the medical records of patients to collect socio-demographic and clinical data. Patients were then sampled at 8 am for serum cortisol assay by the competitive ELISA method. Statistical analyses were performed using the Student's test to compare means. The significance level was set at p<0.05. Results: We included 80 covid+ patients, predominantly males (45, 56.3%) with a mean age of 43±13 years. The co-morbidities found were hypertension (9, 11.3%), diabetes mellitus (7, 8.8%), cardiovascular disease (8, 10%) and obesity (4, 5%). The most common symptoms were asthenia (44, 55%), fever (36, 45%) and respiratory symptoms (75, 93.7%). The non-severe form was the most common (70, 87.5%). Only 12.5% (10) of patients received oxygen therapy within our study. The mean baseline serum cortisol in the series was 279.55 nmol/l±128.68 (min 96.1332 nmol/l; max 665.0521 nmol/l). Sixty-nine patients (86.3%) had baseline cortisol ≤413.79nmol/l, suggesting an insufficient response to stress. No statistically significant association was found between serum cortisol and disease severity.Conclusion: The absence of a marked rise of cortisol during COVID-19 suggests possible involvement of the hypothalamic-pituitary-adrenal axis in this infection.

scholarly journals The Midnight to Morning Urinary Cortisol Increment Is an Accurate, Noninvasive Method for Assessment of the Hypothalamic-Pituitary-Adrenal Axis

1999 ◽  
Vol 84 (9) ◽  
pp. 3093-3098 ◽  
Author(s):  
W. M. Kong ◽  
J. Alaghband-Zadeh ◽  
J. Jones ◽  
G. Carter ◽  
D. O’Shea
Keyword(s):  
Tolerance Test ◽  
Hypothalamic Pituitary Adrenal Axis ◽  
Urinary Cortisol ◽  
Optimal Method ◽  
Hypothalamic Pituitary Adrenal ◽  
Adrenal Axis ◽  
Insulin Tolerance ◽  
Synacthen Test ◽  
Short Synacthen Test ◽  
Pituitary Adrenal Axis

The optimal method for assessing the hypothalamic-pituitary-adrenal axis (HPA) remains controversial. The insulin tolerance test (ITT) is considered the gold standard, but is invasive and potentially dangerous. The short Synacthen test (SST) is the most commonly used alternative, but its concordance with the ITT is poor. Using sleep as a reliable stimulus to ACTH release, we proposed that the increment in urinary cortisol levels between midnight and waking could provide a noninvasive, physiological means for the assessment of the HPA axis. Double voided urine samples were collected at home at midnight and waking in 40 patients with pituitary disease and 40 controls. Cortisol and creatinine levels were measured, and the cortisol/creatinine (Cort/Cr) ratio was calculated. The Cort/Cr increment was defined as the morning Cort/Cr ratio minus the midnight Cort/Cr ratio. The Cort/Cr increment of the patients was compared to the results of their ITT or SST. Using the results from the 40 controls, a normal Cort/Cr increment was defined as greater then 9. The positive predictive value of a Cort/Cr increment for the diagnosis of HPA insufficiency was 95%. These findings suggest that the midnight to morning Cort/Cr increment is a reliable, noninvasive alternative to the ITT/SST for assessment of the HPA.

Overt Glucocorticoid Excess Due to Inhaled Corticosteroid Therapy

PEDIATRICS ◽  
1988 ◽  
Vol 81 (3) ◽  
pp. 452-455
Author(s):  
Gregory A. Hollman ◽  
David B. Allen
Keyword(s):  
Triamcinolone Acetonide ◽  
Inhaled Corticosteroids ◽  
Therapeutic Option ◽  
Serum Cortisol ◽  
Hypothalamic Pituitary Adrenal Axis ◽  
Systemic Absorption ◽  
Hypothalamic Pituitary Adrenal ◽  
Adrenal Axis ◽  
Cortisol Levels ◽  
Pituitary Adrenal Axis

Inhaled corticosteroids have become an important therapeutic option in the treatment of childhood asthma. The preparations currently available for pediatric use (beclomethasone dipropionate and triamcinolone acetonide) do not, in general, cause significant hypothalamic-pituitary-adrenal axis suppression and physical signs of glucocorticoid excess have not been described with their use. We report an 8-year-old girl with asthma in whom obesity, hirsutism, and growth retardation developed during treatment with inhaled triamcinolone acetonide alone. Laboratory studies showed suppression of endogenous cortisol production but did not demonstrate suppression of the hypothalamic-pituitary-adrenal axis. Cessation of inhaled triamcinolone acetonide therapy resulted in resolution of obesity and hirsutism, resumption of normal growth, and a return to normal of serum cortisol levels and urinary 17-hydroxycorticosteroid excretion. Careful monitoring of growth velocity and (if clinically indicated) morning serum cortisol levels in asthmatic children using inhaled corticorsteroids will detect the rare instance of glucocorticoid excess resulting from systemic absorption of these drugs.

scholarly journals Changes in different salivary biomarkers related to physiologic stress in elite handball players: the case of females

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Gonzalo Mariscal ◽  
Pablo Vera ◽  
José Luis Platero ◽  
Fernando Bodí ◽  
Jose Enrique de la Rubia Ortí ◽  
...  
Keyword(s):  
Salivary Cortisol ◽  
Immunoglobulin A ◽  
Cortisol Concentration ◽  
Hypothalamic Pituitary Adrenal Axis ◽  
Alpha Amylase ◽  
Adrenergic System ◽  
Hypothalamic Pituitary Adrenal ◽  
Adrenal Axis ◽  
Playing Time ◽  
Pituitary Adrenal Axis

AbstractThis study evaluates pre- and post-match concentrations of salivary cortisol, alpha-amylase (AA) and immunoglobulin A (lgA) in a group of 21 elite female handball players in the Spanish national women’s league. The players’ mean age was 23.0 ± 5.4 years. The concentration of the biomarkers was determined using ELISA. Mean playing time was 25.2 min. The players’ cortisol concentration increased significantly (p < 0.05) whereas the IgA concentration fell significantly (p < 0.01) at the end of the match. There were no significant changes in the concentrations of AA between pre and post-match timepoints. The changes observed in the study also depended on the position played; defenders exhibited the highest cortisol and lowest IgA concentrations after the match. Larger changes in cortisol and IgA were seen in those who played for more than 30 min. The present study shows that a competitive handball match increases physiologic stress in females, with activation of the hypothalamic-pituitary-adrenal axis and the adrenergic system, resulting in decreased immunocompetence.

scholarly journals Accuracy of several parameters of hypothalamic–pituitary–adrenal axis activity in predicting before surgery the metabolic effects of the removal of an adrenal incidentaloma

2010 ◽  
Vol 163 (6) ◽  
pp. 925-935 ◽  
Author(s):  
Cristina Eller-Vainicher ◽  
Valentina Morelli ◽  
Antonio Stefano Salcuni ◽  
Claudia Battista ◽  
Massimo Torlontano ◽  
...  
Keyword(s):  
Adrenal Incidentaloma ◽  
Serum Cortisol ◽  
Urinary Free Cortisol ◽  
Hypothalamic Pituitary Adrenal Axis ◽  
Metabolic Effects ◽  
Hypothalamic Pituitary Adrenal ◽  
Adrenal Axis ◽  
Free Cortisol ◽  
Metabolic Outcome ◽  
Pituitary Adrenal Axis

ContextIt is unknown whether the metabolic effects of the removal of an adrenal incidentaloma (AI) can be predicted by the assessment of cortisol hypersecretion before surgery.ObjectiveTo evaluate the accuracy of several criteria of hypothalamic–pituitary–adrenal axis activity in predicting the metabolic outcome after adrenalectomy.DesignRetrospective longitudinal study.PatientsIn 55 surgically treated AI patients (Group 1) before surgery and in 53 nontreated AI patients (Group 2) at the baseline, urinary free cortisol (UFC), cortisol after 1 mg overnight dexamethasone-suppression test (1 mg-DST), ACTH, and midnight serum cortisol (MSC) were measured. In Groups 1 and 2, metabolic parameters were evaluated before and 29.6±13.8 months after surgery and at the baseline and after 35.2±10.9 months respectively.Main outcome measuresThe improvement/worsening of weight, blood pressure, glucose, and cholesterol levels (endpoints) was defined by the presence of a >5% weight decrease/increase and following the European Society of Cardiology or the ATP III criteria respectively. The accuracy of UFC, 1 mg-DST, ACTH, and MSC, singularly taken or in combination, in predicting the improvement/worsening of ≥2 endpoints was calculated.ResultsThe presence of ≥2 among UFC>70 μg/24 h (193 nmol/l), ACTH<10 pg/ml (2.2 pmol/l), 1 mg-DST>3.0 μg/dl (83 nmol/l) (UFC–ACTH–DST criterion) had the best accuracy in predicting the endpoints' improvement (sensitivity (SN) 65.2%, specificity (SP) 68.8%) after surgery. In the nontreated AI patients, this criterion predicted the worsening of ≥2 endpoints (SN 55.6%, SP 82.9%).ConclusionsThe UFC–ACTH–DST criterion seems to be the best for predicting the metabolic outcome in surgically treated AI patients.

Effect of Inhaled Beclomethasone Dipropionate on Hypothalamic-Pituitary-Adrenal Axis Function in Children with Asthma

PEDIATRICS ◽  
1983 ◽  
Vol 72 (1) ◽  
pp. 60-64
Author(s):  
David E. Goldstein ◽  
Peter König
Keyword(s):  
Beclomethasone Dipropionate ◽  
Serum Cortisol ◽  
Urinary Free Cortisol ◽  
Hypothalamic Pituitary Adrenal Axis ◽  
Hypothalamic Pituitary Adrenal ◽  
Adrenal Axis ◽  
Normal Limits ◽  
Free Cortisol ◽  
Significant Difference ◽  
Pituitary Adrenal Axis

The hypothalamic-pituitary-adrenal axis was investigated in 15 asthmatic children treated with inhaled beclomethasone dipropionate (mean 490 µg/day) and 11 asthmatic control subjects receiving no corticosteroid therapy. Measurements of 24-h urinary free cortisol and 17 hydroxy corticosteroids, serum cortisol, response to ACTH, and the oral metyrapone test showed no significant difference between the two groups. All the patients' results were within normal limits, and carbohydrate metabolism, as shown by blood glucose and hemoglobin A1c, was not affected by beclomethasone therapy. Thus, in the above dose, inhaled beclomethasone does not cause suppression of the hypothalamic--pituitary-adrenal axis.

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