Utility of salivary cortisol measurements in Cushing's syndrome and adrenal insufficiency.

Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin 53215, USA.
The Journal of Clinical Endocrinology and Metabolism (Impact Factor: 6.31). 07/2009; 94(10):3647-55. DOI: 10.1210/jc.2009-1166
Source: PubMed

ABSTRACT The measurement of cortisol in saliva is a simple, reproducible, and reliable test to evaluate the normal and disordered control of the hypothalamic-pituitary-adrenal (HPA) axis. There are a variety of simple methods to obtain saliva samples without stress, making this a robust test applicable to many different experimental and clinical situations.
Ovid Medline and PubMed from 1950 to present were searched using the following strategies: [ and and<Cushing or Cushing's>] and [ and and<adrenal insufficiency or hypoadrenalism or hypopituitarism or Addison's disease>]. The bibliographies of all relevant citations were evaluated for any additional appropriate citations.
Measurement of an elevated late-night (2300 to 2400 h) salivary cortisol has a greater than 90% sensitivity and specificity for the diagnosis of endogenous Cushing's syndrome. Late-night salivary cortisol measurements are also useful to monitor patients for remission and/or recurrence after pituitary surgery for Cushing's disease. Because it is a surrogate for plasma free cortisol, the measurement of salivary cortisol may be useful during an ACTH stimulation test in patients with increased plasma binding protein concentrations due to increased estrogen, or decreased plasma binding protein concentrations during critical illness. Most reference laboratories now offer salivary cortisol testing.
It is expected that the use of the measurement of salivary cortisol will become routine in the evaluation of patients with disorders of the HPA axis.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Human saliva is not just the fluid in our mouth, but it mirrors our body's health and well being. Biomolecules that are circulating in the blood are also found in human saliva. It consists of approximately about 2,000 proteins, and most significantly, 26% of these proteins are also found in blood, therefore emphasizes the saliva's importance as an added biological resource for disease diagnosis and monitoring, as well as an ultimate diagnostic medium to establish a person's response to treatment. The field of saliva diagnostics (SDs) began in the early 60s when salivary calcium levels were found to be elevated in cystic fibrosis patients, and 50 years on now how the field has unmitigated to an unpredicted distance due to the development of increasingly sensitive detection techniques. Hence, today in the era of nanotechnology and genomics, field of salivary diagnostics is promising a dramatic change in disease diagnosis and clinical monitoring. It has expanded into detection of cancer, heart and infectious diseases. Today we are using human saliva to detect illicit drugs, alcohol, to measure hormone levels, especially estrogen levels in women suffering from hormone imbalance, endometriosis, and to diagnose HIV virus in patients suspected of having AIDS. In addition, there are home-based saliva tests that one can order over the Internet to test one's own cholesterol levels and also can verify the risk of developing prostate cancer. With the development of novel, more sensitive detection technology platforms, and the innovation of standardized analytical tools, establishment of reference intervals will make saliva diagnostic a reality in the near future. Especially in the areas of population-based screening programs, confirmatory diagnostics, risk stratification, forensic and therapy response monitoring. So, it represents a progressively more valuable complementary means of diagnosis.
    Journal of Scientific and Innovative Research 2014. 03/2014; 2014(3(3)):372-387.
  • Source
    Endocrine 08/2014; · 3.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The hypothalamic-pituitary-adrenal (HPA) axis is a classic neuroendocrine system. One of the best ways to understand the HPA axis is to appreciate its dynamics in the variety of diseases and syndromes that affect it. Excess glucocorticoid activity can be due to endogenous cortisol overproduction (spontaneous Cushing's syndrome) or exogenous glucocorticoid therapy (iatrogenic Cushing's syndrome). Endogenous Cushing's syndrome can be subdivided into ACTH-dependent and ACTH-independent, the latter of which is usually due to autonomous adrenal overproduction. The former can be due to a pituitary corticotroph tumor (usually benign) or ectopic ACTH production from tumors outside the pituitary; both of these tumor types overexpress the proopiomelanocortin gene. The converse of Cushing's syndrome is the lack of normal cortisol secretion and is usually due to adrenal destruction (primary adrenal insufficiency) or hypopituitarism (secondary adrenal insufficiency). Secondary adrenal insufficiency can also result from a rapid discontinuation of long-term, pharmacological glucocorticoid therapy because of HPA axis suppression and adrenal atrophy. Finally, mutations in the steroidogenic enzymes of the adrenal cortex can lead to congenital adrenal hyperplasia and an increase in precursor steroids, particularly androgens. When present in utero, this can lead to masculinization of a female fetus. An understanding of the dynamics of the HPA axis is necessary to master the diagnosis and differential diagnosis of pituitary-adrenal diseases. Furthermore, understanding the pathophysiology of the HPA axis gives great insight into its normal control. © 2014 American Physiological Society. Compr Physiol 4:739-769, 2014.
    Comprehensive Physiology. 04/2014; 4(2):739-69.