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

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.

scholarly journals Comparison of Total and Salivary Cortisol in a Low-Dose ACTH (Synacthen) Test: Influence of Three-Month Oral Contraceptives Administration to Healthy Women

2008 ◽  
pp. S193-S199
Author(s):  
K Šimůnková ◽  
L Stárka ◽  
M Hill ◽  
L Kříž ◽  
R Hampl ◽  
...  
Keyword(s):  
Salivary Cortisol ◽  
Adrenocorticotropic Hormone ◽  
Low Dose ◽  
Serum Cortisol ◽  
Acth Test ◽  
Basal Serum ◽  
Free Cortisol ◽  
Synacthen Test ◽  
Significant Change ◽  
Calculated Free Cortisol

The objective of this study was to evaluate the influence of low-dose combined oral contraception (COC) on basal and stimulated (1 microg ACTH test) levels of serum and salivary cortisol (F), cortisone and on basal serum cortisol binding globulin (CBG), adrenocorticotropic hormone (ACTH), dehydroepiadrosterone (DHEA) and calculated free cortisol in healthy young women. Three-month administration of COC resulted in 1) significant increase of basal (454.0+/-125.0 to 860.9+/-179.7 nmol/l) and ACTH-stimulated serum cortisol in 30th min (652.3+/-60.5 to 1374.1+/-240.6 nmol/l); 2) no significant change of basal (15.4+/-7.3 to 18.9+/-8.5 nmol/l) and ACTH-stimulated salivary cortisol at the 30th min (32.4+/-8.8 to 32.9+/-9.0 nmol/l); 3) no significant change of basal serum cortisone (38,8+/-7.68 to 45.2+/-24.2 nmol/l) and ACTH-stimulated cortisone at the 30th (34.8+/-10.9 to 47.0+/-35.7 nmol/l); 4) significant increase of basal ACTH (17.2+/-9.0 to 38.2+/-29.4 ng/l), CBG (991.0+/-161.0 to 2332.0+/-428.0 nmol/l), and 5) no significant change of basal DHEA (24.6+/-15.7 to 22.6+/-11.7 micromol/l) and calculated basal value for free cortisol (22.8+/-14.9 to 19.2+/-6.9 nmol/l). In conclusions, higher basal and ACTH-stimulated serum cortisol were found after three-month administration of COC, while basal and stimulated salivary cortisol were not significantly affected. Therefore, salivary cortisol can be used for assessment of adrenal function in women regularly using COC.

Serum free cortisol as an ancillary tool in the interpretation of the low-dose 1-μg ACTH test

2011 ◽  
Vol 75 (3) ◽  
pp. 294-300 ◽  
Author(s):  
Rona Limor ◽  
Karen Tordjman ◽  
Yonit Marcus ◽  
Yona Greenman ◽  
Etty Osher ◽  
...  
Keyword(s):  
Low Dose ◽  
Acth Test ◽  
Serum Free ◽  
Free Cortisol

The 1-μg `low dose' ACTH test for assessment of adrenal function in geriatric patients

1998 ◽  
Vol 27 (2) ◽  
pp. 99-104
Author(s):  
Jacob Feldman ◽  
Menachem S Shapiro ◽  
Marrk Niven ◽  
Eli Weiss ◽  
Abraham Yaretsky
Keyword(s):  
Geriatric Patients ◽  
Low Dose ◽  
Adrenal Function ◽  
Acth Test

scholarly journals Salivary Cortisol Determination in ACTH Stimulation Test to Diagnose Adrenal Insufficiency in Patients with Liver Cirrhosis

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Lara Albert ◽  
Joaquím Profitós ◽  
Jordi Sánchez-Delgado ◽  
Ismael Capel ◽  
José Miguel González-Clemente ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Adrenal Insufficiency ◽  
Salivary Cortisol ◽  
Serum Cortisol ◽  
Stimulation Test ◽  
Decompensated Cirrhosis ◽  
Acth Test ◽  
Acth Stimulation Test ◽  
Acth Stimulation ◽  
Cirrhotic Patients

Purpose. The prevalence of adrenal insufficiency (AI) in patients with decompensated liver cirrhosis is unknown. Because these patients have lower levels of cortisol-binding carrier proteins, their total serum cortisol (TSC) correlates poorly with free serum cortisol (FC). Salivary cortisol (SaC) correlates better with FC. We aimed to establish SaC thresholds for AI for the 250 μg intravenous ACTH test and to estimate the prevalence of AI in noncritically ill cirrhotic patients. Methods. We included 39 patients with decompensated cirrhosis, 39 patients with known AI, and 45 healthy volunteers. After subjects fasted ≥8 hours, serum and saliva samples were collected for determinations of TSC and SaC at baseline 0’(T0) and at 30-minute intervals after intravenous administration of 250 μg ACTH [30’(T30), 60’(T60), and 90’(T90)]. Results. Based on the findings in healthy subjects and patients with known AI, we defined AI in cirrhotic patients as SaC-T0< 0.08 μg/dL (2.2 nmol/L), SaC-T60 < 1.43 μg/dl (39.5 nmol/L), or ΔSaC<1 μg/dl (27.6 nmol/L). We compared AI determination in cirrhotic patients with the ACTH test using these SaC thresholds versus established TSC thresholds (TSC-T0< 9 μg/dl [248 nmol/L], TSC-T60 < 18 μg/dl [497 nmol/L], or ΔTSC<9 μg/dl [248 nmol/L]). SaC correlated well with TSC. The prevalence of AI in cirrhotic patients was higher when determined by TSC (48.7%) than by SaC (30.8%); however, this difference did not reach statistical significance. AI was associated with sex, cirrhosis etiology, and Child-Pugh classification. Conclusions. Measuring SaC was more accurate than TSC in the ACTH stimulation test. Measuring TSC overestimated the prevalence of AI in noncritically ill cirrhotic patients.

scholarly journals Evaluation of adrenal function in patients with growth hormone deficiency and hypothalamic–pituitary disorders: comparison between insulin-induced hypoglycemia, low-dose ACTH, standard ACTH and CRH stimulation tests

2005 ◽  
Vol 152 (5) ◽  
pp. 735-741 ◽  
Author(s):  
M Maghnie ◽  
E Uga ◽  
F Temporini ◽  
N Di Iorgi ◽  
A Secco ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Growth Hormone Deficiency ◽  
Adrenal Insufficiency ◽  
Low Dose ◽  
Clinical Symptoms ◽  
Adrenal Function ◽  
Hormone Deficiency ◽  
Cortisol Response ◽  
Normal Response ◽  
Morning Cortisol

Objectives: Patients with organic growth hormone deficiency (GHD) or with structural hypothalamic–pituitary abnormalities may have additional anterior pituitary hormone deficits, and are at risk of developing complete or partial corticotropin (ACTH) deficiency. Evaluation of the integrity of the hypothalamic–pituitary–adrenal axis (HPA) is essential in these patients because, although clinically asymptomatic, their HPA cannot appropriately react to stressful stimuli with potentially life-threatening consequences. Design and methods: In this study we evaluated the integrity of the HPA in 24 patients (age 4.2–31 years at the time of the study) with an established diagnosis of GHD and compared the reliability of the insulin tolerance test (ITT), short synacthen test (SST), low-dose SST (LDSST), and corticotropin releasing hormone (CRH) test in the diagnosis of adrenal insufficiency. Results: At a cortisol cut-off for a normal response of 550 nmol/l (20 μg/dl), the response to ITT was subnormal in 11 subjects, 6 with congenital and 5 with acquired GHD. Four patients had overt adrenal insufficiency, with morning cortisol concentrations ranging between 66.2–135.2 nmol/l (2.4–4.9 μg/dl) and typical clinical symptoms and laboratory findings. In all these patients, a subnormal cortisol response to ITT was confirmed by LDSST and by CRH tests. SST failed to identify one of the patients as adrenal insufficient. In the seven asymptomatic patients with a subnormal cortisol response to ITT, the diagnosis of adrenal insufficiency was confirmed in one by LDSST, in none by SST, and in five by CRH tests. The five patients with a normal cortisol response to ITT exhibited a normal response also after LDSST and SST. Only two of them had a normal response after a CRH test. In the seven patients with asymptomatic adrenal insufficiency mean morning cortisol concentration was significantly higher than in the patients with overt adrenal insufficiency. ITT was contraindicated in eight patients, and none of them had clinical symptoms of overt adrenal insufficiency. One of these patients had a subnormal cortisol response to LDSST, SST, and CRH, and three exhibited a subnormal response to CRH but normal responses to LDSST and to SST. Conclusion: We conclude that none of these tests can be considered completely reliable for establishing or excluding the presence of secondary or tertiary adrenal insufficiency. Consequently, clinical judgment remains one of the most important issues for deciding which patients need assessment or re–assessment of adrenal function.

scholarly journals Determination of the source of androgen excess in functionally atypical polycystic ovary syndrome by a short dexamethasone androgen-suppression test and a low-dose ACTH test

2011 ◽  
Vol 26 (11) ◽  
pp. 3138-3146 ◽  
Author(s):  
Robert L. Rosenfield ◽  
Monica Mortensen ◽  
Kristen Wroblewski ◽  
Elizabeth Littlejohn ◽  
David A. Ehrmann
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Low Dose ◽  
Polycystic Ovary ◽  
Acth Test ◽  
Androgen Excess ◽  
Ovary Syndrome ◽  
Suppression Test ◽  
Androgen Suppression

scholarly journals Relative Adrenal Insufficiency in Cirrhotic Patients

2015 ◽  
Vol 8 ◽  
pp. CGast.S18127 ◽  
Author(s):  
Sotirios N. Anastasiadis ◽  
Olga I. Giouleme ◽  
Georgios S. Germanidis ◽  
Themistoklis G. Vasiliadis
Keyword(s):  
Liver Disease ◽  
Liver Failure ◽  
High Density Lipoprotein ◽  
Adrenal Insufficiency ◽  
Salivary Cortisol ◽  
Density Lipoprotein ◽  
Relative Adrenal Insufficiency ◽  
Total Cortisol ◽  
Free Cortisol ◽  
Cirrhotic Patients

Relative adrenal insufficiency (RAI) was demonstrated in patients with cirrhosis and liver failure. A relationship appears to exist between the severity of the liver disease and the presence of RAI. Neither the mechanism nor the exact prevalence of RAI is fully understood. There is though a hypothesis that low high-density lipoprotein (HDL) levels in this group of patients may be responsible for the insufficiency of cortisol. Several questions also arise about the way and the kind of cortisol (total cortisol, free cortisol, or even salivary cortisol) that should be measured. The presence of RAI in patients with cirrhosis is unquestionable, but still several studies should come up in order to properly define it and fully understand it.

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