Measurement of Salivary Cortisol Concentration in the Assessment of Adrenal Function in Critically Ill Subjects: A Surrogate Marker of the Circulating Free Cortisol

When sows are mixed into groups, hierarchies form and resulting aggression and stress can affect production and welfare. This study determined the effect of providing point-source materials on aggressive and play behaviors in gestating sows. Large white cross Landrace sows were mixed after insemination; six pens of 12 sows were housed in ‘standard’ pens, and six pens of 12 sows were housed in ‘enhanced’ pens. The ‘enhanced’ pens each contained two rubber mats, eight strands of 24 mm-thick sisal rope and two yellow plastic disks, suspended from the roof. The sows remained in these pens until pregnancy confirmation. Salivary cortisol concentration, injury counts, and sow behaviors were recorded the day before mixing (day 1), mixing (day 0) and post-mixing day 1, day 4, day 7 and day 20. At farrowing, reproductive outcomes were obtained. Play was observed (including locomotor and object play) in the ‘enhanced’ pen, and percentage of time spent playing was greater on d4 (1.48 ± 0.3 Square root transformed data (2.84% non-transformed adjusted mean)), d7 (1.43 ± 0.3 (2.97%)) and d20 (1.64 ± 0.3 (3.84%)), compared to d0 (0.56 ± 0.3 (0.70%)) and d1 (0.87 ± 0.3 (1.67%) (p < 0.05)). No play was observed in standard housing. Aggression, salivary free cortisol concentrations and injuries were unaffected (p > 0.05). The provision of materials had no impact on aggression, although their presence maintained sow interest and play behavior, suggesting a positive effect.

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Evaluation of Random Plasma Cortisol and the Low Dose Corticotropin Test as Indicators of Adrenal Secretory Capacity in Critically Ill Patients: A Prospective Study

Anaesthesia and Intensive Care ◽

10.1177/0310057x0503300208 ◽

2005 ◽

Vol 33 (2) ◽

pp. 201-209 ◽

Cited By ~ 69

Author(s):

B. Venkatesh ◽

R. H. Mortimer ◽

B. Couchman ◽

J. Hall

Keyword(s):

Critical Illness ◽

Critically Ill ◽

Plasma Cortisol ◽

Low Dose ◽

Single Point ◽

Urinary Free Cortisol ◽

Adrenal Function ◽

Free Cortisol ◽

Corticotropin Test ◽

Secretory Capacity

It is unclear whether a random plasma cortisol measurement and the corticotropin (ACTH) test adequately reflect glucocorticoid secretory capacity in critical illness. This study aimed to determine whether these tests provide information representative of the 24 hour period. Plasma cortisol was measured hourly for 24 hours in 21 critically ill septic patients followed by a corticotropin test with 1 μg dose administered intravenously. Serum and urine were analysed for ACTH and free cortisol respectively. Marked hourly variability in plasma cortisol was evident (coefficient of variation 8–30%) with no demonstrable circadian rhythm. The individual mean plasma cortisol concentrations ranged from 286±59 nmol/l to 796± 83 nmol/l. The 24 hour mean plasma cortisol was strongly correlated with both random plasma cortisol (r2 0.9, P<0.0001) and the cortisol response to corticotropin (r2 0.72, P<0.001). Only nine percent of patients increased their plasma cortisol by 250 nmol/l after corticotropin (euadrenal response). However, 35% of non-responders had spontaneous hourly rises >250 nmol/l thus highlighting the limitations of a single point corticotropin test. Urinary free cortisol was elevated (865±937 nmol) in both corticotropin responders and non-responders suggesting elevated plasma free cortisol. No significant relationship was demonstrable between plasma cortisol and ACTH. We conclude that although random cortisol measurements and the low dose corticotropin tests reliably reflect the 24 hour mean cortisol in critical illness, they do not take into account the pulsatile nature of cortisol secretion. Consequently, there is the potential for erroneous conclusions about adrenal function based on a single measurement. We suggest that caution be exercised when drawing conclusions on the adequacy of adrenal function based on a single random plasma cortisol or the corticotropin test.

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Correlation analysis of cortisol concentration in hair versus concentrations in serum, saliva and urine.

10.21203/rs.2.24006/v1 ◽

2020 ◽

Author(s):

Lukasz Cieszynski ◽

Jaroslaw Jendrzejewski ◽

Piotr Wisniewski ◽

Przemyslaw Klosowski ◽

Krzysztof Sworczak

Keyword(s):

Clinical Practice ◽

Salivary Cortisol ◽

Serum Cortisol ◽

Individual Characteristics ◽

Cortisol Concentration ◽

Reference Ranges ◽

Hair Cortisol ◽

Free Cortisol ◽

Hair Samples ◽

Cortisol Levels

Abstract Background: Cortisol concentration is measured in blood, urine, and saliva samples. It has been recently proven that cortisol could be also detected in hair samples. Cortisol measurements in different samples have their own individual characteristics and clinical utility. We aimed to investigate the correlation between hair cortisol concentration and standard cortisol measurements used in clinical practice. Methods: Fifty adult volunteers with a negative history of endocrine disorders were enrolled into the study. Morning serum cortisol (MSC), evening serum cortisol (ESC), evening free salivary cortisol (EFSC), urine free cortisol (UFC) and hair cortisol were analyzed in all participants. Eventually, 41 volunteers were included into the study, whose cortisol concentration in the 1 mg overnight dexamethason suppression test (1mgONDST) were <50 nmol/l, and cortisol levels in serum, saliva and urine were within reference ranges. Hair cortisol concentration (HCC) was performed for 20 mg of hair strands of the proximal 1 cm hair segments. Results: HCC ranged from 0.3036 to 2.65 nmol/l/mg, and the average value was 0.8125±0.4834 nmol/l/mg. No significant correlations were found between HCC and MSC (rho=0.04419, p=0.7838), HCC and ESC (rho=-0.2071, p=0.1938), HCC and EFSC (rho=0.1005, p=0.532), and HCC and UFC (rho = 0.1793, p = 0.262). Conclusions : This work is another step in the discussion on the application of HCC determinations in clinical practice. Our results have showed no correlations between HCC and single point cortisol assessment in blood, saliva and urine in patients with reference cortisol levels. Keywords: Hair cortisol, Serum cortisol, Salivary cortisol, Urine cortisol, Cortisol assessment, Cortisol correlation

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Usefulness of salivary cortisol as a marker of secondary adrenal insufficiency in paediatric patients

Annals of Clinical Endocrinology and Metabolism ◽

10.29328/journal.acem.1001020 ◽

2021 ◽

Vol 5 (1) ◽

pp. 024-028

Author(s):

Capdevila Laura ◽

Borràs Ariadna ◽

Berlanga Eugenio ◽

Sánchez-Manubens Judith ◽

Rivera Josefa ◽

...

Keyword(s):

Adrenal Insufficiency ◽

Salivary Cortisol ◽

Low Dose ◽

Adrenal Function ◽

Prolonged Treatment ◽

Acth Test ◽

Paediatric Patients ◽

Free Cortisol ◽

Adrenal Disease

Background: The main cause of adrenal insufficiency (AI) in paediatric patients is prolonged treatment with corticosteroids. Determination of plasma cortisol (PC) during ACTH test is the most used adrenal function indicator in clinical practice. However, determination of salivary cortisol (SC), a simple test especially useful in children in order to avoid invasive procedures, can be used as an alternative technique for the diagnosis of adrenal disease. Methods: A two-year prospective study (January 2014-January 2016) in paediatric patients (2-18 years of age) treated with corticosteroids for more than fifteen days, who were investigated for suspected AI. Low-dose ACTH test was used to determine adrenal function and samples for SC and PC were obtained simultaneously in basal situation and during the test (at 30, 60 and 90 minutes). Results: 230 samples (118 PC-112 SC) of 30 studies belonging to 20 patients (4 males), mean age 10.93 years ± 3.69 SD. Pearson’s correlation coefficient showed a positive correlation between PC and SC (r = 0.618, p < 0.001). All the studies with some determination of PC higher than 18 μg/dL (n = 8) had a SC peak higher than 0.61 μg/dL with a specificity of 66.67% and a sensitivity of 93.94% (ROC analysis). Conclusion: Measurement of SC is a less invasive, easier and quicker test than PC to measure plasma free cortisol levels. In our study, a SC peak in low-dose ACTH test higher than 0.61 μg/dL was able to discriminate patients without AI, and proved to be a useful tool in the initial evaluation of children with suspected AI.

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Hypothalamic Pituitary Adrenal Function during Critical Illness: Limitations of Current Assessment Methods

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2006-0674 ◽

2006 ◽

Vol 91 (10) ◽

pp. 3725-3745 ◽

Cited By ~ 218

Author(s):

Baha M. Arafah

Keyword(s):

Critical Illness ◽

Critically Ill ◽

Critically Ill Patients ◽

Serum Cortisol ◽

Adrenal Function ◽

Serum Free ◽

Total Cortisol ◽

Free Cortisol ◽

Alternative Approaches ◽

Hpa Function

Abstract Context: Activation of the hypothalamic-pituitary-adrenal (HPA) axis represents one of several important responses to stressful events and critical illnesses. Despite a large volume of published data, several controversies continue to be debated, such as the definition of normal adrenal response, the concept of relative adrenal insufficiency, and the use of glucocorticoids in the setting of critical illness. Objectives: The primary objective was to review some of the modulating factors and limitations of currently used methods of assessing HPA function during critical illness and provide alternative approaches in that setting. Design: This was a critical review of relevant data from the literature with inclusion of previously published as well as unpublished observations by the author. Data on HPA function during three different forms of critical illnesses were reviewed: experimental endotoxemia in healthy volunteers, the response to major surgical procedures in patients with normal HPA, and the spontaneous acute to subacute critical illnesses observed in patients treated in intensive care units. Setting: The study was conducted at an academic medical center. Patients/Participants: Participants were critically ill subjects. Intervention: There was no intervention. Main Outcome Measure: The main measure was to provide data on the superiority of measuring serum free cortisol during critical illness as contrasted to those of total cortisol measurements. Results: Serum free cortisol measurement is the most reliable method to assess adrenal function in critically ill, hypoproteinemic patients. A random serum free cortisol is expected to be 1.8 μg/dl or more in most critically ill patients, irrespective of their serum binding proteins. Because the free cortisol assay is not currently available for routine clinical use, alternative approaches to estimate serum free cortisol can be used. These include calculated free cortisol (Coolens’ method) and determining the free cortisol index (ratio of serum cortisol to transcortin concentrations). Preliminary data suggest that salivary cortisol measurements might be another alternative approach to estimating the free cortisol in the circulation. When serum binding proteins (albumin, transcortin) are near normal, measurements of total serum cortisol continue to provide reliable assessment of adrenal function in critically ill patients, in whom a random serum total cortisol would be expected to be 15 μg/dl or more in most patients. In hypoproteinemic critically ill subjects, a random serum total cortisol level is expected to be 9.5 μg/dl or more in most patients. Data on Cosyntropin-stimulated serum total and free cortisol levels should be interpreted with the understanding that the responses in critically ill subjects are higher than those of healthy ambulatory volunteers. The Cosyntropin-induced increment in serum total cortisol should not be used as a criterion for defining adrenal function, especially in critically ill patients. Conclusions: The routine use of glucocorticoids during critical illness is not justified except in patients in whom adrenal insufficiency was properly diagnosed or others who are hypotensive, septic, and unresponsive to standard therapy. When glucocorticoids are used, hydrocortisone should be the drug of choice and should be given at the lowest dose and for the shortest duration possible. The hydrocortisone dose (50 mg every 6 h) that is mistakenly labeled as low-dose hydrocortisone leads to excessive elevation in serum cortisol to values severalfold greater than those achieved in patients with documented normal adrenal function. The latter data should call into question the current practice of using such doses of hydrocortisone even in the adrenally insufficient subjects.

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Does Experience Make Hucul Horses More Resistant to Stress? A Pilot Study

Animals ◽

10.3390/ani11123345 ◽

2021 ◽

Vol 11 (12) ◽

pp. 3345

Author(s):

Jadwiga Topczewska ◽

Wanda Krupa ◽

Zofia Sokołowicz ◽

Jadwiga Lechowska

Keyword(s):

Pilot Study ◽

Genetic Resources ◽

Stress Level ◽

Salivary Cortisol ◽

Cortisol Concentration ◽

Conservation Program ◽

Evaluation Of Performance ◽

Free Cortisol ◽

Cortisol Levels ◽

Resources Conservation

The aim of the study was to determine whether experience related to horse age and number of starts in championships influences stress level, measured by salivary cortisol concentration. The study involved 18 clinically healthy Hucul mares who participated in the Polish Championships for Hucul Horses. Evaluation of performance value was carried out in accordance with the guidelines specified in the breeding and genetic resources conservation program for this breed. The championship lasted two days, consisting of conformation evaluation, endurance, and Hucul path. Saliva was collected at baseline (T1), after arena assessment (T2), after endurance (T3), and on the second day after the Hucul path (T4). Cortisol levels increased from an average of 2.73 ± 1.18 ng/mL (T1) to 10.46 ± 8.03 ng/mL after T3. Significantly lower levels of free cortisol were detected in the saliva of the younger mares, up to 9 years old, and mares who participated in only one qualifying path after each element of the championship. The highest levels of cortisol (T3) were found in mares competing repeatedly on the qualifying path. No correlation was found between cortisol levels and the championship results. Participation of mares in the championship was associated with stress, which was reflected in the increase in cortisol levels in saliva.

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Adrenal function/dysfunction in critically ill patients: a concise narrative review of recent novel insights

Journal of Anesthesia ◽

10.1007/s00540-021-02977-x ◽

2021 ◽

Author(s):

Greet Van den Berghe

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Narrative Review ◽

Adrenal Function

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Diurnal Salivary Cortisol in Sarcopenic Postmenopausal Women: The OsteoLaus Cohort

Calcified Tissue International ◽

10.1007/s00223-021-00863-y ◽

2021 ◽

Author(s):

Elena Gonzalez Rodriguez ◽

Pedro Marques-Vidal ◽

Bérengère Aubry-Rozier ◽

Georgios Papadakis ◽

Martin Preisig ◽

...

Keyword(s):

Postmenopausal Women ◽

Salivary Cortisol ◽

Population Based ◽

Cross Sectional Study ◽

Body Composition Assessment ◽

Cross Sectional ◽

X Ray ◽

Free Cortisol ◽

Cortisol Levels ◽

The Relationship

AbstractSarcopenia, similar to hypercortisolism, is characterized by loss of muscle mass and strength. Cortisol circadian rhythm changes with aging (blunted late-day nadir values) were suggested to contribute to this decline. We aimed to explore the relationship between diurnal salivary cortisol values and sarcopenia diagnosis and its components in postmenopausal women. This is a cross-sectional study within the OsteoLaus population-based cohort in Lausanne (Switzerland). Participants had a body composition assessment by dual X-ray absorptiometry (DXA), a grip strength (GS) measure, and salivary cortisol measures (at awakening, 30 min thereafter, 11 AM (sc-11AM) and 8 PM (sc-8PM)). Associations between salivary cortisol and sarcopenia diagnosed by six different criteria (based on appendicular lean mass (ALM) assessed by DXA, and muscle strength by GS), and its components, were analyzed. 471 women aged > 50 years (63.0 ± 7.5) were included. Various definitions identified different participants as sarcopenic, who consistently presented higher salivary cortisol at 11 AM and/or 8 PM. There were no associations between salivary cortisol levels and ALM measures, either absolute or after correction to height squared (ALM index) or body mass index. GS was inversely correlated to sc-11AM (r = − 0.153, p < 0.001) and sc-8PM (r = − 0.118, p = 0.002). Each 10 nmol/l increase of sc-11AM, respectively sc-8PM, was associated with a GS decrease of 1.758 (SE 0.472) kg, respectively 2.929 (SE 1.115) kg. In postmenopausal women, sarcopenia is associated with higher salivary cortisol levels at 11 AM and 8 PM. An increase of daily free cortisol levels in the physiological range could participate to sarcopenia development by decreasing muscle function in postmenopausal women.

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