Diagnostic value of salivary cortisol in children with abnormal adrenal cortex functions.
ABSTRACT It has been shown that the free cortisol level in saliva may reflect plasma free cortisol. The measurement of cortisol in saliva is a simple method, and as such it is important in the pediatric age group. In this research, the diagnostic value of measurement of salivary cortisol (SC) measurement was examined in adrenal insufficiency (AI).
Fifty-one patients, mean age 10.8 +/- 4.29, who were investigated for possible AI, were included. Basal cortisol levels were below 18 microg/dl. Adrenal function was determined by low-dose ACTH test. During the test, samples for SC were obtained simultaneously with serum samples (at 0-10-20-30-40 min).
Mean basal serum cortisol level was 8.21 +/- 4.10 microg/dl (mean +/- SD). Basal SC was correlated to basal serum cortisol (r = 0.64, p < 0.001). A cut-off of 0.94 microg/dl for SC differentiated adrenal insufficient subjects from normals with a sensitivity and specificity of 80 and 77%, respectively. A peak SC less than 0.62 microg/dl defined AI with a specificity of 100%; however, sensitivity was 44%.
Measurement of SC may be used in the evaluation of AI. It is well-correlated to serum cortisol. Peak SC in low-dose ACTH test can be used to differentiate patients with AI in the initial evaluation of individuals with suspected AI.
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ABSTRACT: There is no consensus on adequate adrenal response to critical illness. We aimed to evaluate adrenal function in critically ill children and its association with clinical outcome. We hypothesized that salivary cortisol would be a more appropriate tool to evaluate adrenal function in critically ill children. This was a prospective cohort study. The concentrations of serum total and salivary cortisol were measured in 34 critically ill children before and after stimulation with 250 μg adrenocorticotropic hormone (ACTH) and values were compared to a control group of healthy children (n=15). Association between outcome and adrenal insufficiency defined by an increment in serum cortisol ≤250 nM (9 μg/dl) post-ACTH was assessed. Serum total and salivary cortisol concentrations pre- and post-ACTH were significantly higher in patients and they were correlated at baseline (r=0.67; p<0.0001) and after ACTH (r=0.41; p=0.02). The incidence of adrenal insufficiency was 32.3%. This group had higher Paediatric Risk of Mortality III score (p=0.04) but Paediatric Logistic Organ Dysfunction and vasoactive inotropic scores, duration of mechanical ventilation and length of paediatric intensive care unit and hospital stay were not significantly different compared to those with an increment >250 nM (9 μg/dl) post-ACTH. An inverse correlation between salivary cortisol post-ACTH and vasoactive inotropic score (r=-0.56; p=0.0008) was observed. A salivary cortisol concentration post-ACTH of ≤226 nM (8.2 μg/dl) had a sensitivity of 79% and a specificity of 62% to discriminate need for vasoactive or inotropic support (area under ROC curve 0.74). Adrenal insufficiency defined by the "delta criterion" was not associated with outcome. A post-ACTH salivary cortisol of ≤226 nM (8.2 μg/dl) may be suggestive of an insufficient adrenal response to critical illness. This article is protected by copyright. All rights reserved.Clinical Endocrinology 03/2014; · 3.35 Impact Factor
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ABSTRACT: The congress of the Endocrine Society 2008 approached the diagnostic, etiologic, prognostic and therapeutic novelties of adrenal insufficiency (AI). Diagnosis of AI often requires serum cortisol measurement during dynamic tests. Salivary cortisol measurement was reported to have an equivalent diagnostic performance to serum cortisol and that is even better when CBG levels are altered. Iatrogenic AI is much more frequent than Addison’s disease. Two studies have shown that patients with inhaled corticosteroid and opioid treatments should be tested for AI. A Norwegian study reported an increased mortality in the subgroup of young men that presented Addison’s disease before the age of 40. Plasma cortisol concentration in patients with current glucocorticoid replacement therapy differs notably from those observed in physiological condition. This imperfect replacement may be responsible for adverse physical condition and impaired quality of life. Two formulations of delayed hydrocortisone tablets with different pharmacokinetics from usual hydrocortisone (DuoCort™ and Chronocort™) are in development. The first study is promising and shows that these formulations better mimick the body’s natural cortisol release. Its use in the treatment of AI in patients with congenital adrenal hyperplasia has also been tested.Annales d Endocrinologie 09/2008; 69. · 0.66 Impact Factor
Article: Intra-articular glucocorticoid injections and their effect on hypothalamic-pituitary-adrenal (HPA) axis function Philip C Johnston, M.Cecilia Lansang, Soumya Chatterjee,Laurence Kennedy Department of Endocrinology, Diabetes and Metabolism, and Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195,Endocrine 08/2014; · 3.53 Impact Factor