Measurement of Salivary Cortisol Concentration in the Assessment of Adrenal Function in Critically Ill Subjects: A Surrogate Marker of the Circulating Free Cortisol

Arafah, Baha H; Nishiyama, Fumie J.; Tlaygeh, Haytham M.; Hejal, Rana

doi:10.1210/jc.2007-0181

Cited by 115 publications

(107 citation statements)

References 30 publications

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“…This finding is supported by previous studies showing a strongly positive correlation between salivary and serum cortisol levels measured by other methods 9,10 . Salivary cortisol reflects the biologically active free form of cortisol, thereby providing a more reliable measure than serum cortisol which is an inactive bound form 2 .…”

Section: Resultssupporting

confidence: 90%

Untitled

Saiyudthong¹,

Suwannarat²,

Trongwongsa³

et al. 2010

ScienceAsia

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Salivary cortisol has been increasingly used as a stress biomarker since saliva sampling induces less additional stress than blood sampling. Enzyme-linked immunosorbent assay (ELISA) has been commonly used to measure salivary cortisol in stress related research. Recently, electrochemiluminescence (ECL), a routine immunoassay analyser, has been suggested to measure salivary cortisol. Therefore, the aims of this study are: (1) to compare salivary cortisol level measured by ELISA and ECL and (2) to determine the relationship between salivary cortisol and serum cortisol measured by ECL. Both salivary and serum samples were collected from 83 volunteers for cortisol measurement by ECL analysis. The salivary cortisol value was 3% of that of the serum cortisol. For ECL, the positive correlation between salivary and serum cortisol levels was significant (r = 0.84; p < 0.001). The measurement by two different methods did not show any significant difference (p = 0.5497). The correlation of salivary cortisol values measured by both techniques was significant (r = 0.81; p < 0.001). The result suggests that ECL seems to be more practical and cheaper for salivary cortisol measurement.

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Section: Resultssupporting

confidence: 90%

Untitled

Saiyudthong¹,

Suwannarat²,

Trongwongsa³

et al. 2010

ScienceAsia

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“…Thus, patients responsive to such dose may not actually be able to increase adequately their cortisol levels when facing another stimulus, such as shock or hypoglycemia, decreasing the sensitivity of the test. Some researchers agree with this hypothesis, showing that the high dose test has high specificity and low sensitivity (5,29).…”

Section: High Dose Cortrosyn Test (250 μG)mentioning

confidence: 92%

“…Salivary and serum cortisol levels have a strong correlation, even in critically ill patients (29,31). Even so, more trials are necessary to validate levels of salivary cortisol for CIRCI diagnosis.…”

Section: Salivary Cortisolmentioning

confidence: 99%

Diagnosis of adrenal failure in critically ill patients

Moraes

Czepielewski

Friedman

et al. 2011

Arq Bras Endocrinol Metab

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SUMMARYIn the last two decades there was important evolution on the knowledge of the function of the hypothalamic-pituitary-adrenal axis. In the last decade, the expression "relative adrenal insufficiency" (RAI) was created, and more recently "critical illness-related corticosteroid insufficiency" (CIRCI) was used to designate those patients in which cortisol production was not sufficiently increased in stress situations. Patients with CIRCI have elevated hospital morbidity and mortality. Currently, there is a wide discussion about diagnostic criteria for this dysfunction. Besides basal cortisol, some publications now study the role of other tests, such as cortrosyn test − either in low (1 μg) or high doses (250 μg); free cortisol, salivary cortisol, metyrapone test and others. With this review, we aimed at summarizing the results of the most influent papers that intended to define diagnostic criteria for CIRCI. We also suggest an approach for CIRCI diagnosis and make it clear that the decision about steroid therapy in septic shock patients is matter apart from RAI. Arq Bras Endocrinol Metab. 2011;55(5):295-302 Keywords Adrenal insufficiency; sepsis; septic shock; cortrosyn; steroid therapy; CIRCI (critical illness-related corticosteroid insufficiency); RAI (relative adrenal insufficiency) SUMÁRIO Nas últimas décadas, houve uma importante evolução no conhecimento sobre a função do eixo hipotálamo-pituitária-adrenal. Na última década, foi cunhada a expressão "insuficiência adrenal relativa" (IAR) e, mais recentemente, a expressão "insuficiência adrenal relacionada à doença grave" (CIRCI) foi utilizada para designar aqueles pacientes nos quais a produção de cortisol não era suficientemente elevada em situações de estresse. Pacientes com CIRCI apresentam elevada morbidade e mortalidade em hospitais. Atualmente, há uma ampla discussão sobre os critérios de diagnóstico para essa desordem. Além do cortisol basal, algumas publicações analisaram o papel de outros testes, tais como o teste de estímulo com ACTH (cortrosina), com doses baixas (1 mg) ou altas (250 mg), cortisol livre, cortisol salivar, teste da metirapona e outros. O objetivo desta revisão foi resumir os resultados dos artigos mais importantes que buscaram definir os critérios de diagnóstico para a CIRCI. Também sugerimos uma abordagem para o diagnóstico da CIRCI e deixamos claro que a decisão sobre a terapia com esteroides em pacientes em choque séptico é uma questão separada da IAR. Arq Bras Endocrinol Metab. 2011;55(5):295-302 Descritores Insuficiência adrenal; sepse; choque séptico; cortrosina; terapia com esteroides; CIRCI (insuficiência adrenal relacionada à doença grave); IAR (insuficiência adrenal relativa)

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“…In serum, more than 90% of cortisol is bound to CBG and albumin (13). Because cirrhotic patients have low CBG levels, standard methods for measuring TC levels (including both free and protein bound fractions) may overestimate the AI rate in this population.…”

Section: Resultsmentioning

confidence: 99%

“…Salivary cortisol (SC) measurement has been suggested as an alternative method in the diagnosis of AI. It correlates well with FC and is not affected by serum protein levels (12)(13)(14)(15). In hemodynamically stable cirrhotic patients, the prevalence of AI has been reported to be 33% with TC measurements.…”

Section: Introductionmentioning

confidence: 82%