Prague Med. Rep. 2016, 117, 18-33

https://doi.org/10.14712/23362936.2016.2

A Comparison of Salivary Steroid Levels during Diagnostic Tests for Adrenal Insufficiency

Michaela Dušková1, Kateřina Šimůnková2, Jana Vítků1, Lucie Sosvorová1, Hana Jandíková1, Hana Pospíšilová1, Monika Šrámková1, Mikuláš Kosák2, Michal Kršek2, Václav Hána2, Magdaléna Žánová3, Drahomíra Springer3, Luboslav Stárka1

1Institute of Endocrinology, Prague, Czech Republic
23rd Department of Medicine – Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
3Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic

Received December 2, 2015
Accepted February 24, 2016

References

1. Agha, A., Tomlinson, J. W., Clark, P. M., Holder, G., Stewart, P. M. (2006) The long-term predictive accuracy of the short synacthen (corticotrophin) stimulation test for assessment of the hypothalamic-pituitary-adrenal axis. J. Clin. Endocrinol. Metab. 91(1), 43–47. <https://doi.org/10.1210/jc.2005-1131>
2. Artl, W. (2009) The approach to the adult with newly diagnosed adrenal insufficiency. J. Clin. Endocrinol. Metab. 94, 1059–1067.
3. Borm, K., Slawik, M., Beuschlein, F., Seiler, L., Flohr, F., Berg, A., Koenig, A., Reincke, M. (2005) Low-dose glucose infusion after achieving critical hypoglycemia during insulin tolerance testing: Effects on time of hypoglycemia, neuroendocrine stress response and patient’s discomfort in a pilot study. Eur. J. Endocrinol. 153(4), 521–526. <https://doi.org/10.1530/eje.1.01992>
4. Chatha, K. K., Middle, J. G., Kilpatrick, E. S. (2010) National UK audit of the short synacthen test. Ann. Clin. Biochem. 47(Pt 2), 158–164. <https://doi.org/10.1258/acb.2009.009209>
5. Christ-Crain, M., Jutla, S., Widmer, I., Couppis, O., König, C., Pargger, H., Puder, J., Edwards, R., Müller, B., Grossman, A. B. (2007) Masurement of serum free cortisol shows discordant responsivity to stress and dynamic evaluation. J. Clin. Endocrinol. Metab. 92, 1729–1735. <https://doi.org/10.1210/jc.2006-2361>
6. Cornes, M. P., Ashby, H. L., Khalid, Y., Buch, H. N., Ford, C., Gama, R. (2015) Salivary cortisol and cortisone responses to tetracosactrin (synacthen). Ann. Clin. Biochem. 52(Pt 5), 606–610. <https://doi.org/10.1177/0004563215577838>
7. Crowley, S., Hindmarsh, P. C., Holownia, P., Honour, J. W., Brook, C. G. (1991) The use of low doses of ACTH in the investigation of adrenal function in man. J. Endocrinol. 130, 475–479. <https://doi.org/10.1677/joe.0.1300475>
8. Deutschbein, T., Unger, N., Mann, K., Petersenn, S. (2009a) Diagnosis of secondary adrenal insufficiency: Unstimulated early morning cortisol in saliva and serum in comparison with the insulin tolerance test. Horm. Metab. Res. 41(11), 834–839. <https://doi.org/10.1055/s-0029-1225630>
9. Deutschbein, T., Unger, N., Mann, K., Petersenn, S. (2009b) Diagnosis of secondary adrenal insufficiency in patients with hypothalamic-pituitary disease: Comparison between serum and salivary cortisol during the high-dose short synacthen test. Eur. J. Endocrinol. 160, 9–16. <https://doi.org/10.1530/EJE-08-0600>
10. Dickstein, G. (1998) The low dose (1 microgram) ACTH test – When and how to use it. Clin. Endocrinol. (Oxf.) 49(1), 135. <https://doi.org/10.1046/j.1365-2265.1998.00526.x>
11. Dickstein, G., Shechner, C., Nicholson, W. E., Rosner, I., Shen-Orr, Z., Adawi, F., Lahav, M. (1991) Adrenocorticotropin stimulation test: Effects of basal cortisol level, time of day, and suggested new sensitive low dose test. J. Clin. Endocrinol. Metab. 72(4), 773–778. <https://doi.org/10.1210/jcem-72-4-773>
12. Dickstein, G., Spigel, D., Arad, E., Shechner, C. (1997) One microgram is the lowest ACTH dose to cause a maximal cortisol response. There is no diurnal variation of cortisol response to submaximal ACTH stimulation. Eur. J. Endocrinol. 137, 172–175. <https://doi.org/10.1530/eje.0.1370172>
13. Dušková, M., Sosvorová, L., Vítků, J., Jandíková, H., Rácz, B., Chlupáčová, T., De Cordeiro, J., Stárka, L. (2015) Changes in the concentrations of corticoid metabolites – The effect of stress, diet and analytical method. Prague Med. Rep. 116(4), 268–278. <https://doi.org/10.14712/23362936.2015.66>
14. Ekström, J. (1989) Autonomic control of salivary secretion. Proc. Finn. Dent. Soc. 85, 323–331.
15. Ho, J. T., Al-Musalhi, H., Chapman, M. J., Quach, T., Thomas, P. D., Bagley, C. J., Lewis, J. G., Torpy, D. J. (2006) Septic shock and sepsis: A comparison of total and free plasma cortisol levels. J. Clin. Endocrinol. Metab. 91, 105–114. <https://doi.org/10.1210/jc.2005-0265>
16. Kazlauskaite, R., Evans, A. T., Villabona, C. V., Abdu, T. A., Ambrosi, B., Atkinson, A. B., Choi, C. H., Clayton, R. N., Courtney, C. H., Gonc, E. N., Maghnie, M., Rose, S. R., Soule, S. G., Tordjman, K.; Consortium for Evaluation of Corticotropin Test in Hypothalamic-Pituitary Adrenal Insufficiency (2008) Corticotropin tests for hypothalamic-pituitary-adrenal insufficiency: a metaanalysis. J. Clin. Endocrinol. Metab. 93(11), 4245–4253. <https://doi.org/10.1210/jc.2008-0710>
17. Klose, M., Lange, M., Rasmussen, A. K., Skakkebæk, N. E., Hilsted, L., Haug, E., Andersen, M., Feldt-Rasmussen, U. (2007) Factors influencing the adrenocorticotropin test: Role of contemporary cortisol assays, body composition, and oral contraceptive agents. J. Clin. Endocrinol. Metab. 92, 1326–1333. <https://doi.org/10.1210/jc.2006-1791>
18. Landon, J., Smith, D. C., Perry, L. A. (1984) The assay of salivary cortisol. In: Immunoassays of Steroids in Saliva; Proceedings of the Ninth Tenovus Workshop, Cardiff, UK, 1982. Read, G. F., Editor, pp. 300–307, Alpha Omega Publishing Ltd., Cardiff.
19. Laureti, S., Aubourg, P., Calcinaro, F., Rocchiccioli, F., Casucci, G., Angeletti, G., Bruneti, P., Falorni, A. (1998) Etiological diagnosis of primary adrenal insufficiency using an original flowchart of immune and biochemical markers. J. Clin. Endocrinol. Metab. 83, 3163–3168.
20. Laureti, S., Arvat, E., Candeloro, P., Di Vito, L., Ghigo, E., Santeusanio, F., Falorni, A. (2000) Low dose (1 microg) ACTH test in the evaluation of adrenal dysfunction in pre-clinical Addison’s disease. Clin. Endocrinol. (Oxf.) 53(1), 107–115. <https://doi.org/10.1046/j.1365-2265.2000.01050.x>
21. Laureti, S., Candeloro, P., Aglietti, M. C., Giordano, R., Arvat, E., Ghigo, E., Santeusanio, F., Falorni, A. (2002) Dehydroepiandrosterone, 17alpha-hydroxyprogesterone and aldosterone responses to the low-dose (1 micro g) ACTH test in subjects with preclinical adrenal autoimmunity. Clin. Endocrinol. (Oxf.) 57(5), 677–683. <https://doi.org/10.1046/j.1365-2265.2002.01651.x>
22. Mishra, S. K., Gusta, N., Goswami, R. (2007) Plasma adrenocorticotropin (ACTH) values and cortisol response to 250 and 1 µg ACTH stimulation in patients with hyperthyroidism before and after carbimazole therapy: case-control comparative study. J. Clin. Endocrinol. Metab. 92, 1693–1696. <https://doi.org/10.1210/jc.2006-2090>
23. Murphy, H., Livesey, J., Espiner, E. A., Donald, R. A. (1998) The low dose ACTH test – a further test. Ann. Clin. Biochem. 47(Pt 2), 158–164.
24. Oelkers, W. (1996) Dose-response aspects in the clinical assessment of the hypothalamo-pituitary-adrenal axis, and the low-dose adrenocorticotropin test. Eur. J. Endocrinol. 135, 27–33. <https://doi.org/10.1530/eje.0.1350027>
25. Patel, L., Clayton, P. E. (1999) Clinical usefulness of the low dose ACTH test. J. Endocrinol. Invest. 2(5), 401–404. <https://doi.org/10.1007/BF03343580>
26. Perogamvros, I., Keevin, B. G., Ray, D. W., Trainer, P. J. (2010) Salivary cortisone is potential biomarker for serum free cortisol. J. Clin. Endocrinol. Metab. 95, 4951–4958. <https://doi.org/10.1210/jc.2010-1215>
27. Poršová, I., Stárka, L., Blahoš, J., Putz, Z. (1987) Graduated intrasmuscular ACTH test with measurement of salivary cortisol. Vnitr. Lek. 33, 356–360. (in Czech)
28. Qureshi, A. C., Bahri, A., Breen, L. A., Barnes, S. C., Powrie, J. K., Thomas, S. M., Carroll, P. V. (2007) The influence of the route of oestrogen administration on serum levels of cortisol-binding globulin and total cortisol. Clin. Endocrinol. (Oxf.) 66, 632–635. <https://doi.org/10.1111/j.1365-2265.2007.02784.x>
29. Rasmuson, S., Olsson, T., Hagg, E. (1996) A low dose ACTH test to assess the function of the hypothalamic-pituitary-adrenal axis. Clin. Endocrinol. (Oxf.) 44(2), 151–156. <https://doi.org/10.1046/j.1365-2265.1996.600482.x>
30. Sandström, A., Peterson, J., Sandström, E., Lundberg, M., Nystrom, I. L., Nyberg, L., Olsson, T. (2011) Cognitive deficits in relation to personality type and hypothalamic-pituitary-adrenal (HPA) axis dysfunction in women with stress-related exhaustion. Scand. J. Psychol. 52(1), 71–82. <https://doi.org/10.1111/j.1467-9450.2010.00844.x>
31. Šimůnková, K., Hampl, R., Hill, M., Doucha, J., Stárka, L., Vondra, K. (2007) Salivary cortisol in low dose (1 microg) ACTH test in healthy women: comparison with serum cortisol. Physiol. Res. 56(4), 449–453.
32. Šimůnková, K., Stárka, L., Hill, M., Kříž, L., Hampl, R., Vondra, K. (2008) Comparison of total and salivary cortisol in a low-dose ACTH (Synacthen) test: Influence of three-month oral contraceptives administration to healthy women. Physiol. Res. 57, S193–S199 (Suppl. 1).
33. Sosvorova, L., Vitku, J., Chlupacova, T., Mohapl, M., Hampl, R. (2015) Determination of seven selected neuro- and immunomodulatory steroids in human cerebrospinal fluid and plasma using LC-MS/MS. Steroids 98, 1–8. <https://doi.org/10.1016/j.steroids.2015.01.019>
34. Taylor, A. E., Keevil, B., Huhtaniemi, I. T. (2015) Mass spectrometry and immunoassay: How to measure steroid hormones today and tomorrow. Eur. J. Endocrinol. 173(2), D1–D12. <https://doi.org/10.1530/EJE-15-0338>
35. Torpy, J. T., Ho, D. J. (2007) Corticosteroid-binding globulin gene polymorphisms: Clinical implications and links to idiopathic chronic fatigue disorders. Clin. Endocrinol. (Oxf.) 67, 161–167. <https://doi.org/10.1111/j.1365-2265.2007.02890.x>
36. van Uum, S. H., Walker, B. R., Hermus, A. R., Sweep, C. G., Smits, P., de Leeuw, P. W., Lenders, J. W. (2002) Effect of glycyrrhetinic acid on 11β-hydroxysteroid dehydrogenase activity in normotensive and hypertensive subjects. Clin. Sci. (Lond.) 102, 203–211. <https://doi.org/10.1042/cs1020203>
37. Vieira, J. G., Nakamura, O. H., Carvalho, V. M. (2014) Determination of cortisol and cortisone in human saliva by a liquid chromatography-tandem mass spectrometry method. Arq. Bras. Endocrinol. Metabol. 58(8), 844–850. <https://doi.org/10.1590/0004-2730000003347>
38. Vining, R. F., McGinley, R. A., Maksvytis, J. J., Ho, K. Y. (1983) Salivary cortisol: A better measure of adrenal cortical function than serum cortisol. Ann. Clin. Biochem. 20(Pt 6), 329–335. <https://doi.org/10.1177/000456328302000601>
39. Wallace, I., Cunningham, S., Lindsay, J. (2009) The diagnosis and investigation of adrenal word of caution. J. Clin. Endocrinol. Metab. 83(2), 712–713.
front cover

ISSN 1214-6994 (Print) ISSN 2336-2936 (Online)

Archive