Skip to main content

Cosyntropin-stimulated salivary cortisol in hospitalized patients with hypoproteinemia

Endocrine volume 34, pages 68–74 (2008)Cite this article

Abstract

Analysis of adrenocortical function in acutely ill, hospitalized patients can be challenging due to changes in plasma binding proteins. This study used dynamic testing of salivary cortisol levels to evaluate adrenal function in hospitalized patients with low/low-normal plasma protein concentration in whom adrenal insufficiency was suspected. Twenty-eight patients with low serum albumin and proteins hospitalized for acute illness were evaluated for decreased adrenocortical function because of clinical presentations suspicious for adrenal insufficiency. Baseline and post cosyntropin-stimulated levels of serum total and salivary cortisol levels were assessed. Data were gathered by a retrospective analysis of medical records. Eight patients had normal peak serum total and salivary cortisol responses, consistent with intact adrenocortical function. Five patients had abnormal peak serum total and salivary cortisol responses indicating decreased adrenocortical function. Fifteen patients had subnormal peak serum total cortisol, but normal peak salivary cortisol responses indicating normal adrenal function. Salivary cortisol testing can identify hospitalized patients with apparently intact adrenal function in whom low serum protein confounded interpretation of serum total cortisol measurements. Salivary cortisol is a clinically useful surrogate for serum free cortisol in dynamic testing of adrenocortical function.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. D. Annane, V. Sebille, G. Troche, J.C. Raphael, P. Gajdos, E. Bellisant, JAMA 283, 1038–1045 (2000)

    CAS  Article  PubMed  Google Scholar 

  2. P. Bolufer, A. Gandia, A. Rodriguez, P. Antonio, Clin. Chim. Acta 183, 217–226 (1989)

    CAS  Article  PubMed  Google Scholar 

  3. A. Beishuizen, L.G. Thijs, I. Vermes, Intensive Care Med. 27, 1584–1591 (2001)

    CAS  Article  PubMed  Google Scholar 

  4. A.H. Hamrahian, T.S. Oseni, B.M. Arafah, N. Engl. J. Med. 350, 1629–1638 (2004)

    CAS  Article  PubMed  Google Scholar 

  5. M.S. Cooper, P.M. Stewart, N. Engl. J. Med. 348, 727–734 (2003)

    CAS  Article  PubMed  Google Scholar 

  6. M. Klose, M. Lange, A.K. Rasmussen, N.E. Skakkebaek, L. Hilsted, E. Haug, M. Andersen, U. Feldt-Rasmussen, J. Clin. Endocrinol. Metab. 92, 1326–1333 (2007)

    CAS  Article  PubMed  Google Scholar 

  7. L. Loriaux, N. Engl. J. Med. 350, 1601–1603 (2004)

    CAS  Article  PubMed  Google Scholar 

  8. T. Umeda, R. Kiramatsu, T. Iwaoka, T. Shimada, F. Miura, T. Sato, Clin. Chim. Acta 110, 245–253 (1981)

    CAS  Article  PubMed  Google Scholar 

  9. M.H. Laudat, S. Cerdas, C. Gournier, D. Guiban, B. Guilhaume, J.P. Luton, J. Clin. Endocrinol. Metab. 66, 343–348 (1988)

    CAS  Article  PubMed  Google Scholar 

  10. E. Aardal-Eriksson, B.E. Karlberg, A. Holm, Clin. Chem. Lab. Med. 36, 215–222 (1998)

    CAS  Article  PubMed  Google Scholar 

  11. J. Kahn, D.R. Rubinow, C.L. Davis, M. Kling, R.M. Post, Soc. Biol. Psychiatry 23, 335–349 (1988)

    CAS  Article  Google Scholar 

  12. H. Raff, Endocrinologist 10, 9–17 (2000)

    Article  Google Scholar 

  13. B.M. Arafah, F.J. Nishiyama, H. Tiaygeh, R. Hejal, J. Clin. Endocrinol. Metab. 92, 2965–2971 (2007)

    CAS  Article  PubMed  Google Scholar 

  14. E. Aardal, A.C. Holm, Cortisol in saliva—reference ranges and relation to cortisol in serum. Eur. J. Clin. Chem. Clin. Biochem. 33, 927–932 (1995)

    CAS  PubMed  Google Scholar 

  15. H. Raff, P.J. Homar, D.P. Skoner, Clin. Chem. 49, 203–204 (2003)

    CAS  Article  PubMed  Google Scholar 

  16. A.L. Arreger, E.M.L. Cardoso, O. Tumilaski, L.N. Contreras, Steroids 73, 77–82 (2008)

    Article  Google Scholar 

  17. L.N. Contreras, A.L. Arregger, O. Tumilaski, G. Persi, A. Zucchini, E.M. Cardoso, Endocrinologist 16, 30–35 (2006)

    CAS  Article  Google Scholar 

  18. E. Cardoso, G. Persi, N. Gonzalez, O. Tumilasci, A. Arreger, M. Burgos, V. Rodriquez, A. Molina, L.M. Contreras, Steroids 72, 328–334 (2007)

    CAS  Article  PubMed  Google Scholar 

  19. K. Lovas, T.E. Thorsen, E.S. Husebye, J. Endocrinol. Invest. 29, 727–731 (2006)

    CAS  PubMed  Google Scholar 

  20. E. Cardoso, G. Persi, A.L. Arregger, L.N. Contreras, Endocrinologist 12, 38–44 (2002)

    Google Scholar 

  21. D. Suri, J. Moran, J.U. Hibbard, K. Kasza, R.E. Weiss, J. Clin. Endocrinol. Metab. 91, 3866–3872 (2006)

    CAS  Article  PubMed  Google Scholar 

  22. Y. Marcus-Perlman, K. Tordjman, Y. Greenman, R. Limor, G. Shenkerman, E. Osher, N. Stern, Clin. Endocrinol. 64, 215–218 (2006)

    CAS  Article  Google Scholar 

  23. C. Kirschbaum, B.M. Kudielka, J. Gaab, N.C. Schommer, D. Hellhammer, Psychosom. Med. 61, 154–162 (1999)

    CAS  PubMed  Google Scholar 

  24. B.M. Arafah, J. Clin. Endocrinol. Metab. 91, 3725–3745 (2006)

    CAS  Article  PubMed  Google Scholar 

  25. M.J. Bolland, W.W. Chiu, J.S. Davidson, M.S. Croxson, J. Endocrinol. Invest. 28, 643–645 (2005)

    CAS  PubMed  Google Scholar 

  26. P. Dennesen, A. van der Ven, M. Vlasveld, L. Lokker, G. Ramsay, A. Kessels, P. van den Keijbus, A. Nieuw Amerongen, E. Veerman, Crit. Care Med. 31, 781–786 (2003)

    Article  PubMed  Google Scholar 

  27. M.S. Cooper, I. Bujalska, E. Rabbitt, E.A. Walker, R. Bland, M.C. Sheppard, M. Hewison, P.M. Stewart, J. Bone Miner. Res. 16, 1037–1044 (2001)

    CAS  Article  PubMed  Google Scholar 

  28. G. Dickstein, C. Shechner, W.E. Nicholson, I. Rosner, Z. Shen-Orr, F. Adawi, M. Lahav, J. Clin. Endocrinol. Metab. 72, 773–778 (1991)

    CAS  Article  PubMed  Google Scholar 

  29. J.G. Gonzalez-Gonzalez, N.E. De la Garza-Hernandez, L.G. Mancillas-Adame, J. Montes-Villarreal, J.Z. Villarreal-Perez, J. Endocrinol. 159, 275–280 (1998)

    CAS  Article  PubMed  Google Scholar 

  30. S.R. Bornstein, J. Licinio, R. Tauchnitz, L. Engelmann, A.B. Negrao, P. Gold, G.P. Chrousos, J. Clin. Endocrinol. Metab. 83, 280–283 (1998)

    CAS  Article  PubMed  Google Scholar 

  31. S.K. Grinspoon, B.M.K. Biller, J. Clin. Endocrinol. Metab. 79, 923–931 (1994)

    CAS  Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. Endocrine Research Laboratory, Endocrine-Diabetes Center, Aurora St. Luke’s Medical Center, 2801W KK River Pky Suite 245, Milwaukee, WI, 53215, USA

    Hershel Raff, Scott Brock & James W. Findling

  2. Division of Endocrinology, Metabolism and Clinical Nutrition, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226, USA

    Hershel Raff, Scott Brock & James W. Findling

Authors
  1. Hershel Raff
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Scott Brock
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. James W. Findling
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hershel Raff.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Raff, H., Brock, S. & Findling, J.W. Cosyntropin-stimulated salivary cortisol in hospitalized patients with hypoproteinemia. Endocr 34, 68–74 (2008). https://doi.org/10.1007/s12020-008-9101-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-008-9101-y

Keywords

  • Salivary cortisol
  • ACTH stimulation test
  • Adrenal insufficiency
  • Albumin
  • Adrenal