Comparison of Salivary Cortisol, Serum Cortisol, Plasma ACTH and Urinary Free Cortisol Levels in Thyrotoxic and Hypothyroid Patients

2012 ◽  
Vol 32 (1) ◽  
pp. 54-58
Author(s):  
Mustafa Sait GÖNEN ◽  
Emin ÖZKAYA ◽  
Sevil KURBAN ◽  
Süleyman Hilmi İPEKCİ ◽  
Cevdet DURAN ◽  
...  
Keyword(s):  
Salivary Cortisol ◽  
Serum Cortisol ◽  
Urinary Free Cortisol ◽  
Plasma Acth ◽  
Free Cortisol ◽  
Cortisol Levels ◽  
Hypothyroid Patients

scholarly journals Spontaneous remission of hypercortisolism presumed due to asymptomatic tumor apoplexy in ACTH-producing pituitary macroadenoma

2013 ◽  
Vol 57 (6) ◽  
pp. 486-489 ◽  
Author(s):  
Marcio Carlos Machado ◽  
Patricia Sampaio Gadelha ◽  
Marcello Delano Bronstein ◽  
Maria Candida Barisson Vilares Fragoso
Keyword(s):  
Salivary Cortisol ◽  
Signs And Symptoms ◽  
Spontaneous Remission ◽  
Pituitary Surgery ◽  
Serum Cortisol ◽  
Urinary Free Cortisol ◽  
High Plasma ◽  
Imaging Data ◽  
Cystic Component ◽  
Free Cortisol

Cushing's disease (CD) is usually caused by secretion of ACTH by a pituitary corticotroph microadenoma. Nevertheless, 7%-20% of patients present with ACTH-secreting macroadenomas. Our aim is to report a 36-year-old female patient with CD due to solid-cystic ACTH-macroadenoma followed up during 34 months. The patient presented spontaneous remission due to presumed asymptomatic tumor apoplexy. She showed typical signs and symptoms of Cushing's syndrome (CS). Initial tests were consistent with ACTH-dependent CS: elevated urinary free cortisol, abnormal serum cortisol after low dose dexamethasone suppression test, and elevated midnight salivary cortisol, associated with high plasma ACTH levels. Pituitary magnetic resonance imaging (MRI) showed a sellar mass of 1.2 x 0.8 x 0.8 cm of diameter with supra-sellar extension leading to slight chiasmatic impingement, and showing hyperintensity on T2-weighted imaging, suggesting a cystic component. She had no visual impairment. After two months, while waiting for pituitary surgery, she presented spontaneous resolution of CS. Tests were consistent with remission of hypercortisolism: normal 24-h total urinary cortisol and normal midnight salivary cortisol. Pituitary MRI showed shrinkage of the tumor with disappearance of the chiasmatic compression. She has been free from the disease for 28 months (without hypercortisolism or hypopituitarism). The hormonal and imaging data suggested that silent apoplexy of pituitary tumor led to spontaneous remission of CS. However, recurrence of CS was described in cases following pituitary apoplexy. Therefore, careful long-term follow-up is required.

scholarly journals Decreased pituitary sensitivity to glucocorticoids in endurance-trained men

2001 ◽  
pp. 363-368 ◽  
Author(s):  
M Duclos ◽  
JB Corcuff ◽  
F Pehourcq ◽  
A Tabarin
Keyword(s):  
Hpa Axis ◽  
Low Dose ◽  
Urinary Free Cortisol ◽  
Test Results ◽  
O2 Uptake ◽  
Plasma Acth ◽  
Free Cortisol ◽  
Suppression Test ◽  
Cortisol Levels ◽  
Dexamethasone Suppression

OBJECTIVE: Muscular exercise induces hypothalamo-pituitary-adrenal (HPA) axis activation and when regularly repeated, as in endurance training, leads to HPA axis adaptation. To assess whether non-professional endurance-trained (ET) men with a substantial training load and no clinical or biological features of HPA axis overactivity can present subtle alterations of HPA axis sensitivity to glucocorticoid negative feedback, nine ET men were subjected to HPA axis testing using the dexamethasone-corticotrophin-releasing hormone (CRH) test. DESIGN: Nine endurance-trained men and eight healthy age-matched sedentary men were studied. Morning plasma cortisol and 24 h urinary free cortisol (UFC) were determined and a low dose dexamethasone suppression test (LDDST) was performed followed by CRH stimulation (dexamethasone-CRH test). RESULTS: After a day without physical exercise, at 0800 h, plasma ACTH and cortisol concentrations, and the 24 h UFC and UFC/urinary creatinine (UC) ratio were similar in ET and sedentary men. By contrast, clear differences between the groups were seen in cortisol and ACTH responses to the dexamethasone-CRH test. In eight ET subjects, after LDDST, basal ACTH and cortisol levels were similar to those of sedentary men, whereas one ET subject displayed a poor suppression of cortisol level (131 nmol/l). After injection of CRH, however, three of nine ET men's cortisol levels were not suppressed by dexamethasone but instead displayed significant CRH-induced increase (peak cortisol: 88, 125 and 362 nmol/l). No sedentary subject exhibited any increase in cortisol levels. CONCLUSION: Three of nine ET men with a mean maximum rate of O2 uptake (VO2, max) of 61 ml/kg per min, running 50-70 km per week, were resistant to glucocorticoid suppression during the combined dexamethasone-CRH test.

scholarly journals Bilateral and unilateral adrenal incidentalomas: biochemical and clinical characteristics

2013 ◽  
Vol 168 (2) ◽  
pp. 235-241 ◽  
Author(s):  
V Morelli ◽  
S Palmieri ◽  
A S Salcuni ◽  
C Eller-Vainicher ◽  
E Cairoli ◽  
...  
Keyword(s):  
Serum Cortisol ◽  
Urinary Free Cortisol ◽  
Adrenal Incidentalomas ◽  
Mineral Density ◽  
Femoral Bone Mineral Density ◽  
Free Cortisol ◽  
Suppression Test ◽  
Cortisol Levels ◽  
Dexamethasone Suppression

ObjectiveThe possible different prevalence of arterial hypertension (AH), type 2 diabetes mellitus (T2DM), dyslipidaemia (DL) and vertebral fractures (FX) between patients with bilateral and unilateral adrenal incidentalomas (BAI and UAI, respectively) with and without subclinical hypercortisolism (SH) is unknown. In this study we compared the prevalence of AH, T2DM, DL and FX in BAI and UAI patients in relation to SH.DesignProspective study.MethodsIn 175 UAI and 38 BAI patients, we evaluated BMI, spinal and femoral bone mineral density (LS and FN BMD, respectively) and the presence of AH, T2DM, DL and FX. SH was diagnosed in the presence of ≥2 of the following: urinary free cortisol levels >193 nmol/24 h, serum cortisol levels after 1 mg dexamethasone suppression test >83 nmol/l or ACTH levels <2.2 pmol/l.ResultsAge, BMI and cortisol secretion were comparable, while FN BMD was lower in BAI than in UAI patients (−0.45±0.86 vs 0.09±1.07, P=0.004). The prevalence of SH, AH, T2DM, and DL was comparable, while the prevalence of FX was higher in BAI than in UAI (52.6 vs 28%, P=0.007). The presence of FX was associated with BAI (odds ratio (OR) 2.6, 95% confidence interval (95% CI) 1.2–5.6, P=0.016), after adjusting for SH (OR 1.77, 95% CI 0.85–3.7, P=0.12), BMI (OR 1.06, 95% CI 0.98–1.13, P=0.1), age (OR 1.07, 95% CI 1.04–1.11, P=0.0001) and LS BMD (OR 1.31, 95% CI 1.03–1.67, P=0.03).ConclusionBAI patients have an increased FX risk than UAI ones. Further studies should investigate the causes of bone involvement in BAI patients.

Is the Correlation between Salivary Cortisol and Serum Cortisol Reliable Enough to Enable Use of Salivary Cortisol Levels in Preterm Infants?

2017 ◽  
Vol 34 (13) ◽  
pp. 1302-1305
Author(s):  
Katherine Wynne-Edwards ◽  
Parthiv Amin ◽  
Ruokun Zhou ◽  
Arun Sundaram ◽  
Tania Martinez-Soto ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Preterm Infants ◽  
Salivary Cortisol ◽  
Saliva Sample ◽  
Serum Cortisol ◽  
Relative Adrenal Insufficiency ◽  
Free Cortisol ◽  
Cortisol Levels ◽  
Paired Serum ◽  
Gestational Age At Birth

Background Newborn premature infants are susceptible to development of relative adrenal insufficiency following transition from fetal to extrauterine life. However, the best diagnostic test for adrenal insufficiency in neonates has yet to be developed. Objectives and Methods The aim of this study was (1) to assess the feasibility of obtaining sufficient saliva sample to allow measurement of cortisol by liquid chromatography coupled to tandem mass spectrometry and (2) to assess the correlation, if any, between salivary and serum cortisol in preterm infants of ≤32 weeks' gestational age at birth. Results Samples for 230 paired serum and saliva cortisol levels from 90 preterm infants were analyzed. 87.5% of samples collected had sufficient salivary volumes for measurement. Despite being statistically significant (p < 0.0001), the correlation (Spearman r = 0.674) between serum and salivary cortisol was not strong. Conclusion Salivary free cortisol measurement is feasible but cannot be used to accurately reflect serum total cortisol. Further studies comparing salivary free cortisol to serum free cortisol and establishing normative data are needed before salivary cortisol can be used for diagnostic purposes.

scholarly journals Is There Value in Routine Screening for Cushing’s Syndrome in Patients with Diabetes?

2010 ◽  
Vol 95 (5) ◽  
pp. 2262-2265 ◽  
Author(s):  
K. Mullan ◽  
N. Black ◽  
A. Thiraviaraj ◽  
P. M. Bell ◽  
C. Burgess ◽  
...  
Keyword(s):  
Clinical Features ◽  
Cushing’S Syndrome ◽  
Salivary Cortisol ◽  
Serum Cortisol ◽  
Cushing's Syndrome ◽  
Diabetic Patients ◽  
Diabetes Clinic ◽  
Free Cortisol ◽  
Cortisol Levels ◽  
Dexamethasone Test

Abstract Context: Subclinical Cushing’s syndrome has been described among diabetic populations in recent years, but no consensus has emerged about the value of screening. Methods: We enrolled 201 consecutive patients attending our diabetes clinic and 79 controls. Patients with at least two of the following three criteria were offered screening using a 2300 h salivary cortisol test: glycosylated hemoglobin of at least 7%, body mass index of at least 25 kg/m2, and a history of hypertension or blood pressure of at least 140/90 mm Hg. Results are expressed as mean ± sem. Results: Mean nighttime salivary cortisol levels were similar in the two groups (8.5 ± 1.0 nmol/liter for diabetic patients vs. 5.8 ± 1.0 nmol/liter for controls). Forty-seven patients (23%) had a value of at least 10 nmol/liter, which was set as a conservative threshold above which further investigation would be performed. Thirty-five (75%) agreed to further testing with a 1-mg overnight dexamethasone test. Of the remaining 12 patients, 10 were followed up clinically for at least 1 yr, and no evidence was found of the syndrome evolving. In 28 patients, serum cortisol suppressed to 60 nmol/liter or less. Of the seven patients who failed this test, four agreed to a 2 mg/d 48-h dexamethasone test, with serum cortisol suppressing to 60 nmol/liter or less in all four. Three declined this test but had normal 24-h urinary free cortisol levels. No patient had clinical features of hypercortisolism. Conclusions: The 1–3% detection rates of three recently published series have not been realized at our center where we studied a group using criteria making patients more likely to have hypercortisolism. Our results do not support the validity of screening patients without clinical features of Cushing’s syndrome in the diabetes clinic.

scholarly journals Limited value of cabergoline in Cushing's disease: a prospective study of a 6-week treatment in 20 patients

2016 ◽  
Vol 174 (1) ◽  
pp. 17-24 ◽  
Author(s):  
Pia Burman ◽  
Britt Edén-Engström ◽  
Bertil Ekman ◽  
F Anders Karlsson ◽  
Erik Schwarcz ◽  
...  
Keyword(s):  
Prospective Study ◽  
Cushing’S Disease ◽  
Salivary Cortisol ◽  
Case Reports ◽  
Serum Cortisol ◽  
Urinary Free Cortisol ◽  
Cushing's Disease ◽  
Morning Cortisol ◽  
Free Cortisol ◽  
A Prospective Study

Context and objectiveThe role of cabergoline in Cushing's disease (CD) remains controversial. The experience is limited to case reports and few open studies that report the effects determined after ≥1 month of treatment. In prolactinomas and dopamine-responsive GH-secreting tumours, effects of cabergoline are seen within days or weeks. Here, we searched for short-term effects of cabergoline in CD.DesignTwenty patients (19 naïve and one recurrent) were included in a prospective study. Cabergoline was administered in increasing doses of 0.5–5 mg/week over 6 weeks.MethodsUrinary free cortisol (UFC) 24 h, morning cortisol and ACTH, and salivary cortisol at 0800, 1600 and 2300 h were determined once weekly throughout. Diurnal curves (six samples) of serum cortisol were measured at start and end.ResultsAt study end, the median cabergoline dose was 5 mg, range 2.5–5 mg/week. The prolactin levels, markers of compliance, were suppressed in all patients. During the treatment, hypercortisolism varied, gradual and dose-dependent reductions were not seen. Five patients had a >50% decrease of UFC, three had a >50% rise of UFC. Salivary cortisol at 2300 h showed a congruent >50% change with UFC in two of the five cases with decreased UFC, and in one of the three cases with increased UFC. One patient with decreases in both UFC and 2300 h salivary cortisol also had a reduction in diurnal serum cortisol during the course of the study.ConclusionsCabergoline seems to be of little value in the management of CD. Only one patient had a response-like pattern. Given the known variability of disease activity in CD, this might represent a chance finding.

Relationship between 24-hour urinary-free cortisol excretion and salivary cortisol levels sampled from awakening to bedtime in healthy subjects

Life Sciences ◽  
2003 ◽  
Vol 73 (3) ◽  
pp. 349-358 ◽  
Author(s):  
Rachel Yehuda ◽  
Sarah L. Halligan ◽  
Ren Kui Yang ◽  
Ling Song Guo ◽  
Iouri Makotkine ◽  
...  
Keyword(s):  
Salivary Cortisol ◽  
Healthy Subjects ◽  
Urinary Free Cortisol ◽  
Free Cortisol ◽  
Cortisol Excretion ◽  
Cortisol Levels

scholarly journals The pituitary–adrenal axis in adult thalassaemic patients

2010 ◽  
Vol 162 (1) ◽  
pp. 43-48 ◽  
Author(s):  
Massimo Scacchi ◽  
Leila Danesi ◽  
Agnese Cattaneo ◽  
Elena Valassi ◽  
Francesca Pecori Giraldi ◽  
...  
Keyword(s):  
Serum Cortisol ◽  
Urinary Free Cortisol ◽  
Stressful Events ◽  
Adrenocortical Function ◽  
High Dose ◽  
Plasma Acth ◽  
Mean Values ◽  
Free Cortisol ◽  
Basal Plasma ◽  
The Mean

ObjectiveWe previously described in young thalassaemic patients an altered cortisol and ACTH responsiveness suggesting an impaired adrenocortical reserve. Owing to iron overload, a worsening of adrenal function should be expected in adult patients.DesignIn 124 adults with β-thalassaemia, urinary free cortisol (UFC) and plasma ACTH levels were determined and compared with those measured in 150 controls. In 45 patients, cortisol was measured in response to: i) tetracosactide 1 μg as an i.v. bolus (low-dose test, LDT) and ii) tetracosactide 250 μg infused i.v. over 8 h (high-dose test, HDT).ResultsUFC and serum cortisol were within the reference range in all patients. Conversely, basal plasma ACTH values were above the upper limit of the normal range in 19 patients. There were no statistically significant differences in the mean values of UFC, basal serum cortisol and plasma ACTH between patients and controls. A subnormal cortisol response to the LDT was registered in 18 out of 56 patients. Three of these patients also displayed a subnormal response to the HDT, together with elevated baseline plasma ACTH levels. In the LDT, a positive correlation was found between basal and peak cortisol values (P<0.0001). The latter were negatively correlated with basal ACTH values in both LDT (P<0.0001) and HDT (P<0.0001).ConclusionsAdult thalassaemic patients often present a subtle impairment of adrenocortical function. This may become clinically relevant in case of major stressful events. Thus, we recommend an assessment of adrenocortical function in all adult thalassaemic patients.

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

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

scholarly journals The Occurrence of Subclinical Hypercortisolism and Osteoporosis in Patients with Incidentally Discovered Unilateral and Bilateral Adrenal Tumors

2016 ◽  
Vol 35 (4) ◽  
pp. 401-409
Author(s):  
Sanja Ognjanović ◽  
Djuro Macut ◽  
Milan Petakov ◽  
Valentina Elezović Kovačević ◽  
Tatjana Isailović ◽  
...  
Keyword(s):  
Serum Cortisol ◽  
Urinary Free Cortisol ◽  
Adrenal Tumors ◽  
Mineral Density ◽  
Subclinical Hypercortisolism ◽  
Similar Frequency ◽  
Free Cortisol ◽  
Adrenal Masses ◽  
Suppression Test ◽  
Cortisol Levels

SummaryBackground:Adrenal incidentalomas (AI) are clinically silent adrenal masses that are detected incidentally during imaging procedures performed for unrelated diseases. The aim of this study was to investigate the prevalence of subclinical hypercortisolism (SH) and associated co-morbidities in patients with unilateral AI (UAI) and bilateral AI (BAI).Methods:We evaluated 152 patients, 105 (69.1%) with UAI and 47 (30.9%) with BAI. SH was diagnosed in the presence of serum cortisol levels after 1 mg dexamethasone suppression test (DST) or after 2-day low-dose DST (LDDST) > 50 nmol/L with at least one of the following parameters: midnight serum cortisol > 208 nmol/L, 24-h urinary free cortisol > 245 nmol/24 h, or ACTH < 10 ng/L. Bone mineral density (BMD) was measured at lumbar spine (LS) and femoral neck (FN).Results:Age, BMI, and waist circumference were comparable, and diabetes, hypertension and dyslipidemia occurred with similar frequency in both groups. The overall prevalence of SH was 20.5% based on post-1 mg DST, and 20.0% based on post-LDDST cortisol levels, and it was more prevalent in BAI than UAI patients (31.1%vs15.2%, respectively, p=0.026). LS BMD was lower in BAI than in UAI patients (0.96±0.14vs0.87±0.15, p=0.002). There were no differences in FN BMD. The prevalence of osteoporosis was higher in BAI compared to UAI patients (37.1%vs15.9%, respectively, p=0.011).Conclusions:Patients with BAI had higher prevalence of SH and osteoporosis than those with UAI. Frequency of other co-morbidities was similar. This may be due to the higher degree of autonomous cortisol secretion or different tissue-specific sensitivity to glucocorticoids.

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