Abstract
Background: Salivary cortisol is unaffected by cortisol binding globulin and reflects free serum cortisol as compared to total serum cortisol. Aim: The aim of the present study was to compare the salivary cortisol response with the serum cortisol response in a low-dose (1-μg) ACTH test in a clinical setting and to determine the optimal cut-off value of salivary cortisol as an alternative to serum cortisol. Material/subjects and methods: We measured serum and salivary cortisol responses to iv administration of 1-μg ACTH in 51 patients (17 males) referred to the Department of Clinical Chemistry for ACTH-testing. Serum cortisol was assessed before, 20, and 30 min after ACTH-administration, and salivary cortisol was assessed before and 30 min after ACTH administration. Results: Mean cortisol at baseline, 20, and 30 min were 0.44 μmol/l (SD: 0.22), 0.64 μmol/l (SD: 0.24), and 0.70 μmol/l (SD: 0.25), respectively. Median basal salivary cortisol was 8.4 nmol/l [interquartile range (IQR): 3.8–14.2]. Salivary cortisol at 30 min equaled 35.9 nmol/l (IQR: 21.1–46.2). Basal salivary cortisol was significantly correlated with salivary cortisol at 30 min (r=0.53; p<0.001). Salivary cortisol at 30 min of 23.5 nmol/l had a sensitivity and specificity of 78.1% and 70.0%, respectively as compared to the serum cortisol cut-off values of >0.50 μmol/l. Conclusions: The salivary low-dose ACTH-test yields more dynamic responses than serum sortisol. However, the sensitivity and specificity of salivary cortisol are too low to be adequate as an alternative to the serum cortisol measurements. In women on estrogen therapy, however, the use of salivary cortisol might be superior to serum cortisol.
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Tordjman K, Jaffe A, Grazas N, Apter C, Stern N. The role of the low dose (1 microgram) adrenocorticotropin test in the evaluation of patients with pituitary diseases. J Clin Endocrinol Metab 1995, 80: 1301–5.
Rasmuson S, Olsson T, Hagg E. A low dose ACTH test to assess the function of the hypothalamic-pituitary-adrenal axis. Clin Endocrinol (Oxf) 1996, 44: 151–6.
Dökmetas HS, Colak R, Kelestimur F, Selçuklu A, Unlühizarci K, Bayram F. A comparison between the 1-microg adrenocorticotropin (ACTH) test, the short ACTH (250 microg) test, and the insulin tolerance test in the assessment of hypothalamo-pituitary-adrenal axis immediately after pituitary surgery. J Clin Endocrinol Metab 2000, 85: 3713–9 [Erratum in: J Clin Endocrinol Metab 2001, 86: 3085].
Kazlauskaite R, Evans AT, Villabona CV, et al; Consortium for Evaluation of Corticotropin Test in Hypothalamic-Pituitary Adrenal Insufficiency. Corticotropin tests for hypothalamic-pituitary-adrenal insufficiency: a metaanalysis. J Clin Endocrinol Metab 2008, 93: 4245–53.
Dhillo WS, Kong WM, Le Roux CW, et al. Cortisol-binding globulin is important in the interpretation of dynamic tests of the hypothalamic—pituitary—adrenal axis. Eur J Endocrinol 2002, 146: 231–5.
Qureshi AC, Bahri A, Breen LA, et al. The influence of the route of oestrogen administration on serum levels of cortisol-binding globulin and total cortisol. Clin Endocrinol (Oxf) 2007, 66: 632–5.
Kirschbaum C, Hellhammer DH. Salivary cortisol in psychoneuroendocrine research: recent developments and applications. Psychoneuroendocrinology 1994, 19: 313–33.
Marcus-Perlman Y, Tordjman K, Greenman Y, et al. Low-dose ACTH (1 microg) salivary test: a potential alternative to the classical blood test. Clin Endocrinol (Oxf) 2006, 64: 215–8.
Simunková K, Hampl R, Hill M, Doucha J, Stárka L, Vondra K. Salivary cortisol in low dose (1 microg) ACTH test in healthy women: comparison with serum cortisol. Physiol Res 2007, 56: 449–53.
Moisey R, Wright D, Aye M, Murphy E, Peacey SR. Interpretation of the short Synacthen test in the presence of low cortisol-binding globulin: two case reports. Ann Clin Biochem 2006, 43: 416–9.
Vining RF, McGinley RA, Maksvytis JJ, Ho KY. Salivary cortisol: a better measure of adrenal cortical function than serum cortisol. Ann Clin Biochem 1983, 20: 329–35.
Simunková K, Stárka L, Hill M, Kríz L, Hampl R, Vondra K. Comparison of total and salivarycortisol in a low-dose ACTH (Synacthen) test: influence of three-month oral contraceptives administration to healthy women. Physiol Res 2008, 57 (Suppl 1): S193–9.
Dickstein G, Shechner C, Nicholson WE, et al. Adrenocorticotropin stimulation test: effects of basal cortisol level, time of day, and suggested new sensitive low dose test. J Clin Endocrinol Metab 1991, 72: 773–8.
Bewick V, Cheek L, Ball J. Statistics review 13: receiver operating characteristic curves. Crit Care 2004, 8: 508–12.
Obuchowski NA, Lieber ML, Wians FH Jr. ROC curves in clinical chemistry: uses, misuses, and possible solutions. Clin Chem 2004, 50: 1118–25.
Edwards KM, Mills PJ. Effect of estrogen versus estrogen and progesterone on cortisol and interleukin-6. Maturitas 2008, 61: 330–3.
Ahn RS, Lee YJ, Choi JY, Kwon HB, Chun SI. Salivary cortisol and DHEAlevels in the Korean population: age-related differences, diurnal rhythm, and correlations with serum levels. Yonsei Med J 2007, 48: 379–88.
Rotman-Pikielny P, Roash V, Chen O, Limor R, Stern N, Gur HG. Serum cortisol levels in patients admitted to the department of medicine: Prognostic correlations and effects of age, infection, and comorbidity. Am J Med Sc 2006, 332: 61–7.
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Schindhelm, R.K., van de Leur, J.J.C.M. & Rondeel, J.M.M. Salivary Cortisol as an alternative for serum Cortisol in the low-dose adrenocorticotropic hormone stimulation test?. J Endocrinol Invest 33, 92–95 (2010). https://doi.org/10.1007/BF03346560
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DOI: https://doi.org/10.1007/BF03346560