Salivary cortisone and cortisol following synacthen, a future replacement for serum cortisol? Commentary to: Use of Salivary Cortisol and cortisone in the high and low dose synacthen test.

2018 ◽  
Vol 88 (6) ◽  
pp. 770-771 ◽  
Author(s):  
Michael Conall Dennedy
Keyword(s):  
Salivary Cortisol ◽  
Low Dose ◽  
Serum Cortisol ◽  
Synacthen Test

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.

scholarly journals Diagnosis of secondary adrenal insufficiency in patients with hypothalamic–pituitary disease: comparison between serum and salivary cortisol during the high-dose short synacthen test

2009 ◽  
Vol 160 (1) ◽  
pp. 9-16 ◽  
Author(s):  
Timo Deutschbein ◽  
Nicole Unger ◽  
Klaus Mann ◽  
Stephan Petersenn
Keyword(s):  
Salivary Cortisol ◽  
Serum Cortisol ◽  
Early Morning ◽  
Diagnostic Value ◽  
Tolerance Test ◽  
High Dose ◽  
Characteristic Analysis ◽  
Synacthen Test ◽  
Short Synacthen Test

ObjectiveAccurate assessment of adrenal function is essential in patients with hypothalamic–pituitary–adrenal (HPA) disease. The measurement of salivary cortisol (SaC) instead of serum cortisol (SeC) offers several advantages, such as the determination of the free hormone. We evaluated the diagnostic value of SeC and SaC both unstimulated and during a high-dose short synacthen test (HDT) in comparison to the insulin tolerance test (ITT).DesignComparative study between 2005 and 2007.MethodsFifty-five patients with HPA impairment and 21 healthy controls were enrolled. Samples were collected in the early morning and over 120 min during the HDT. Receiver operating characteristic analysis revealed individual thresholds for four HDT periods (0–30, 0–60, 0–90, and 0–120 min).ResultsThe ITT identified 30 subjects as adrenal insufficient. With respect to the four HDT periods, sensitivity and specificity were 67–79% and 71–88% for SeC, compared with 63–72% and 72–86% for SaC. If upper and lower thresholds (with specificities >95%) were applied, patients were diagnosed in 40–45% by SeC and in 25–31% by SaC. The combination of basal cortisol and HDT allowed a diagnosis in 47–49% (SeC) and in 42–45% (SaC) respectively.ConclusionWe suggest the determination of basal SeC or SaC as first-line test. In comparison to the ITT, the HDT has only limited value in screening for alterations of the HPA axis. If the HDT is performed, sampling may be limited to 30 min post-synacthen, using either SeC or SaC. Due to the ease of collection and the independence of binding proteins, SaC may be preferable.

scholarly journals Can the Gold Standard Be Beaten? How Reliable Are Various Modifications of the Synacthen Test Compared to the Insulin Tolerance Test

2017 ◽  
pp. S387-S395 ◽  
Author(s):  
M. KOSAK ◽  
M. DUSKOVA ◽  
L. STARKA ◽  
H. JANDIKOVA ◽  
H. POSPISILOVA ◽  
...  
Keyword(s):  
Salivary Cortisol ◽  
Serum Cortisol ◽  
Tolerance Test ◽  
Insulin Tolerance Test ◽  
Maximum Response ◽  
Similar Response ◽  
Good Reliability ◽  
Maximum Serum ◽  
Insulin Tolerance ◽  
Synacthen Test

Criteria for the evaluation of the insulin tolerance test (ITT) and Synacthen test are still a matter of debate. The objective of the study was to make a comparison of serum and salivary cortisol during four stimulation tests. Sixty four healthy volunteers underwent the ITT, the Synacthen test with 1 (LDST), 10 (MDST) and 250 (HDST) μg dose of ACTH. Maximum serum cortisol response was observed at the 90 min of the ITT (49 %), HDST (89 %) and MDST (56 %) and at the 40 min of the LDST (44 %). Results expressed as 95 % confidence intervals: 408.0-843.6 and 289.5-868.1 nmol/l in the IIT at 60 and 90 min. In the HDST and the MDST serum cortisol reached the maximum at 90 min 542.6-1245.5 and 444.2-871.3 nmol/l. Levels of salivary cortisol followed the same pattern as serum cortisol. Salivary cortisol reached the maximum response in the HDST and the MDST at 90 min and at 40 min in the LDST. We confirmed good reliability of all tests with respect to timing of response and maximum response compared to the ITT. We proved that the MDST test can provide the similar response in serum cortisol to the HDST. Measuring either salivary cortisol or ACTH levels did not provide any additional benefit then measuring serum cortisol by itself.

Early morning salivary cortisol and cortisone, and adrenal responses to a simplified low-dose short Synacthen test in children with asthma

2013 ◽  
Vol 80 (3) ◽  
pp. 376-383 ◽  
Author(s):  
Joanne Blair ◽  
Gillian Lancaster ◽  
Andrew Titman ◽  
Matthew Peak ◽  
Paul Newlands ◽  
...  
Keyword(s):  
Salivary Cortisol ◽  
Low Dose ◽  
Early Morning ◽  
Children With Asthma ◽  
Synacthen Test ◽  
Short Synacthen Test

scholarly journals Salivary cortisol in low dose (1 µg) ACTH test in healthy women: comparison with serum cortisol

2007 ◽  
pp. 449-454 ◽  
Author(s):  
K Šimůnková ◽  
R Hampl ◽  
M Hill ◽  
J Doucha ◽  
L Stárka ◽  
...  
Keyword(s):  
Salivary Cortisol ◽  
Low Dose ◽  
Serum Cortisol ◽  
Hormonal Contraceptives ◽  
Physiological Data ◽  
Total Serum ◽  
Acth Test ◽  
Acth Stimulation ◽  
Healthy Women ◽  
Normal Body Weight

To date, a single report has appeared on the use of salivary cortisol for adrenal function testing with a low dose ACTH, although 1 microg has become preferred as a more physiological stimulus than the commonly used 250 microg ACTH test. Our present study was aimed to obtain physiological data on changes of free salivary cortisol after 1 microg ACTH stimulation. This approach was compared with the common method based on the changes of total serum cortisol. Intravenous, low-dose ACTH test was performed in 15 healthy women (aged 22-40 years) with normal body weight, not using hormonal contraceptives, in the follicular phase of the menstrual cycle. Blood and saliva for determination of cortisol were collected before ACTH administration and 30 and 60 min after ACTH administration. Basal concentration of salivary cortisol (mean +/- S.E.M., 15.9+/-1.96 nmol/l) increased after 1 microg ACTH to 29.1+/-2.01 nmol/l after 30 min, and to 27.4+/-2.15 nmol/l after 60 min. The differences between basal and stimulated values were highly significant (p<0.0001). The values of salivary cortisol displayed very little interindividual variability (p<0.04) in contrast to total serum cortisol values (p<0.0001) A comparison of areas under the curve (AUC) related to initial values indicated significantly higher AUC values for salivary cortisol than for total serum cortisol (1.89+/-0.88 vs. 1.22+/-0.19, p<0.01). Correlation analysis of serum and salivary cortisol levels showed a borderline relationship between basal levels (r=0.5183, p=0.0525); correlations after stimulation were not significant. Low-dose ACTH administration appeared as a sufficient stimulus for increasing salivary cortisol to a range considered as a normal adrenal functional reserve.

Hypothalamic–pituitary–adrenal axis suppression – The value of salivary cortisol and cortisone in assessing hypothalamic–pituitary–adrenal recovery

2020 ◽  
Vol 57 (6) ◽  
pp. 456-460 ◽  
Author(s):  
Tejas Kalaria ◽  
Mayuri Agarwal ◽  
Sukhbir Kaur ◽  
Lauren Hughes ◽  
Hayley Sharrod-Cole ◽  
...  
Keyword(s):  
Salivary Cortisol ◽  
Serum Cortisol ◽  
Hypothalamic Pituitary Adrenal Axis ◽  
Adrenal Suppression ◽  
Baseline Serum ◽  
Hypothalamic Pituitary Adrenal ◽  
Adrenal Axis ◽  
Synacthen Test ◽  
Short Synacthen Test ◽  
Pituitary Adrenal Axis

Background The 0.25 mg short synacthen test is used to assess recovery from hypothalamic–pituitary–adrenal suppression due to chronic glucocorticoid administration. We assessed the potential role of salivary cortisol and cortisone in predicting hypothalamic–pituitary–adrenal function using the short synacthen test as the gold standard test. Method Between 09:00 and 10:30, salivary and blood samples were collected just prior to a short synacthen test to assess hypothalamic–pituitary–adrenal axis recovery in patients previously treated with oral glucocorticoids. The cut-off for a normal short synacthen test was a 30-min cortisol ≥450 nmol/L. Results Fifty-six short synacthen tests were performed on 47 patients. Of these, 15 were normal. The area under receiver operating characteristic curves for serum cortisol, salivary cortisone and salivary cortisol were 0.772, 0.785 and 0.770, respectively. From the receiver operating characteristic analysis, the cut-offs for baseline serum cortisol (≥365 nmol/L) and salivary cortisone (≥37.2 nmol) predicted hypothalamic–pituitary–adrenal axis recovery with 100% specificity in 26.7% of pass short synacthen tests, whereas salivary cortisol predicted none. Baseline serum cortisol (≤170 nmol/L), salivary cortisone (≤9.42 nmol/L) and salivary cortisol (≤1.92 nmol/L) predicted hypothalamic–pituitary–adrenal suppression with 100% sensitivity in 58.5%, 53.7% and 51.2% of failed short synacthen tests, respectively. Using these cut-offs, baseline serum cortisol, salivary cortisone and salivary cortisol could reduce the need for short synacthen tests by 50%, 46% and 37%, respectively. Conclusion Although marginally inferior to early morning serum cortisol, early morning salivary cortisone may be used as a first-line test for assessing hypothalamic–pituitary–adrenal function. We plan to incorporate salivary cortisone into a home-based patient pathway to identify patients with hypothalamic–pituitary–adrenal recovery, continuing hypothalamic–pituitary–adrenal suppression and those who require a short synacthen test.

scholarly journals Use of salivary cortisol and cortisone in the high- and low-dose synacthen test

2017 ◽  
Vol 88 (6) ◽  
pp. 772-778 ◽  
Author(s):  
Charlotte J. Elder ◽  
Robert F. Harrison ◽  
Alexandra S. Cross ◽  
Ruben Vilela ◽  
Brian G. Keevil ◽  
...  
Keyword(s):  
Salivary Cortisol ◽  
Low Dose ◽  
Synacthen Test

The correlation of salivary cortisol values with serum cortisol values

2017 ◽  
Author(s):  
Blertina Dyrmishi ◽  
Taulant Olldashi ◽  
Ema Lumi ◽  
Entela Puca ◽  
Emirvina Kolici ◽  
...  
Keyword(s):  
Salivary Cortisol ◽  
Serum Cortisol

scholarly journals A high-sensitivity test in the assessment of adrenocortical insufficiency: 10 microg vs 250 microg cosyntropin dose assessment of adrenocortical insufficiency

1998 ◽  
Vol 159 (2) ◽  
pp. 275-280 ◽  
Author(s):  
JG Gonzalez-Gonzalez ◽  
NE De la Garza-Hernandez ◽  
LG Mancillas-Adame ◽  
J Montes-Villarreal ◽  
JZ Villarreal-Perez
Keyword(s):  
Healthy Subjects ◽  
Low Dose ◽  
Standard Dose ◽  
Addison’S Disease ◽  
High Sensitivity ◽  
Serum Cortisol ◽  
Dose Assessment ◽  
Addison's Disease ◽  
Acth Test ◽  
Adrenocortical Insufficiency

The short cosyntropin (synthetic ACTH) test is recognized as the best screening manoeuvre in the assessment of adrenocortical insufficiency. Recent data, however, suggest that i.v. administration of 250 microg cosyntropin could be a pharmacological rather than a physiological stimulus, losing sensitivity for detecting adrenocortical failure. Our objective was to compare 10 vs 250 microg cosyntropin in order to find differences in serum cortisol peaks in healthy individuals, the adrenocortical response in a variety of hypothalamic-pituitary-adrenal axis disorders and the highest sensitivity and specificity serum cortisol cut-off point values. The subjects were 83 healthy people and 37 patients, the latter having Addison's disease (11), pituitary adenomas (7), Sheehan's syndrome (9) and recent use of glucocorticoid therapy (10). Forty-six healthy subjects and all patients underwent low- and standard-dose cosyntropin testing. In addition, 37 controls underwent the low-dose test. On comparing low- and standard-dose cosyntropin testing in healthy subjects there were no statistical differences in baseline and peaks of serum cortisol. In the group of patients, 2 out of 11 cases of Addison's disease showed normal cortisol criterion values during the standard test but abnormal during the low-dose test. In our group of patients and controls, the statistical analysis displayed a better sensitivity of the low-dose vs standard-dose ACTH test at 30 and 60 min. In conclusion, these results suggest that the use of 10 microg rather than 250 microg cosyntropin i.v. in the assessment of suspicious adrenocortical dysfunction gives better results.

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