Salivary Cortisol as a Diagnostic Tool for Hyper- and Hypocortislism: Improved Screening by an Automated Immunoassay

Deutschbein, Timo; Broecker-Preuß, Martina; Flitsch, Joerg; Jaeger, Andrea; Althoff, Ricarda; Walz, Martin K.; Mann, Klaus; Petersenn, Stephan

doi:10.1210/endo-meetings.2011.part4.p7.p3-569

Cited by 2 publications

(3 citation statements)

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“…In patients with HPA-axis disease, testing saliva is patient-friendly and suitable for use with outpatients, as well as offering several analytical advantages because salivary F reflects the amount of serum free F 11 . In our cohort, morning unstimulated salivary F levels were not superior to serum F for diagnostic purposes, as also reported in another study 33 . A basal unstimulated salivary F 0 > 9.8 nmol/L presented SP 100% to predict both an intact HPA axis and a normal response to LDSST (serum F 30LDSST > 500 nmol/L or salivary F 30LDSST > 12.1 nmol/L), limiting the need for unnecessary LDSST in 69% of patients (11 out of 16 patients with basal serum F 0 83-415 nmol/L).…”

Section: Discussionsupporting

confidence: 90%

Low-dose short synacthen test with salivary cortisol in patients with suspected central adrenal insufficiency

Ceccato

Selmin

Antonelli

et al. 2021

Endocrine Connections

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Context: the low-dose short synacthen test (LDSST) is recommended for patients with suspected central adrenal insufficiency (AI) if their basal serum cortisol (F) levels are not indicative of an intact hypothalamic-pituitary-adrenal (HPA) axis. Objective: to evaluate diagnostic threshold for salivary F before and 30 minutes after administering 1 μg of synacthen, performed before 09:30 h. Design: a cross-sectional study from 2014 to 2020. Setting: a tertiary referral university hospital. Patients: 174 patients with suspected AI: 37 with central AI and 137 adrenal sufficient (AS). Main outcome measure: the diagnostic accuracy (sensitivity [SE], specificity [SP]) of serum and salivary F levels, measured respectively by chemiluminescence immunoassay and liquid chromatography-tandem mass spectrometry. Results: low basal serum or salivary F levels could predict AI. For the LDSST, the best ROC-calculated threshold for serum F to differentiate AI from AS was 427 nmol/L (SE 79%, SP 89%), serum F >500 nmol/L reached SP 100%. A salivary F peak >12.1 nmol/L after administering synacthen reached SE 95% and SP 84% for diagnosing central AI, indicating a conclusive reduction in the likelihood of AI. This ROC-calculated threshold for salivary F was similar to the 2.5th percentile of patients with a normal HPA axis, so it was considered sufficient to exclude AI. Considering AS those patients with salivary F >12.1 nmol/L after LDSST we could avoid unnecessary glucocorticoid treatment: 99/150 subjects (66%) had an inadequate serum F peak after synacthen, but salivary F was >12.1 nmol/L in 79 cases, who could therefore be considered AS. Conclusions: Salivary F levels >12.1 nmol/L after synacthen administration can indicate an intact HPA axis in patients with an incomplete serum F response, avoiding the need to start glucocorticoid replacement treatment.

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Section: Discussionsupporting

confidence: 90%

Low-dose short synacthen test with salivary cortisol in patients with suspected central adrenal insufficiency

Ceccato

Selmin

Antonelli

et al. 2021

Endocrine Connections

View full text Add to dashboard Cite

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“…Saliva samples were collected using Salivette® cotton swabs (Sarstedt, Nümbrecht, Germany) as previously described [13,15]. In brief, the subjects did not consume any food or drink except water within 15 min before sample collection.…”

Section: Sample Collectionmentioning

confidence: 99%

“…However, automated electrochemiluminescence immunoassays (ECLIAs) developed for measurement of serum cortisol concentration have been recently applied to saliva samples. The ECLIA-determined salivary cortisol concentrations were shown to be useful for the diagnosis of Cushing's syndrome and adrenal insufficiency [13,14]. Furthermore, salivary cortisol concentrations measured by second-generation ECLIAs showed better positive correlation with those measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) than those measured by first-generation ECLIAs [15].…”

Section: Introductionmentioning

confidence: 98%

Assessment of exercise-induced stress by automated measurement of salivary cortisol concentrations within the circadian rhythm in Japanese female long-distance runners

Ushiki

Tsunekawa

Shoho

et al. 2020

Preprint

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Background Overtraining syndrome, caused by prolonged excessive stress, results in reduced performance and cortisol responsiveness in athletes. It is necessary to collect saliva samples sequentially within circadian rhythm for assessing exercise stress by measuring cortisol concentrations, and automated cortisol measurements using electrochemiluminescence immunoassay (ECLIA) may be useful for measuring a large number of saliva samples. In this study, we evaluated the appropriate use of cortisol-based exercise stress assessment within the circadian rhythm, which may diagnose and prevent overtraining syndrome in athletes. Methods We collected saliva and sera from 54 healthy participants and analyzed the correlation between salivary cortisol concentrations measured by ECLIA and enzyme-linked immunosorbent assay (ELISA) or serum cortisol analysis. We also collected saliva continuously from 12 female long-distance runners on 2 consecutive days involving different intensities and types of exercise early in the morning and in the afternoon and measured salivary cortisol concentrations using ECLIA. Each exercise intensity of runners was measured by running velocities, Borg Scale score, and rate of change in the pulse rate by exercise. Results ECLIA-based salivary cortisol concentrations correlated positively with those detected by ELISA (ρ = 0.924, p < 0.001) and serum cortisol (ρ = 0.591, p = 0.001). In long-distance runners, circadian rhythm of salivary cortisol including peak after waking and decrease promptly thereafter were detected on both days by continuous saliva sampling. The rates of change in salivary cortisol concentrations were significantly lower after an early morning exercise than after an afternoon exercise on both days (day 1, p = 0.002 and day 2, p = 0.003). In the early morning exercise, the rate of change in salivary cortisol concentration was significantly higher on day 1 than on day 2 ( p = 0.034), similar to significant difference in running velocities ( p = 0.001). Conclusions Our results suggest that automated ECLIA-based salivary cortisol measurements are able to detect the athletes' circadian rhythm and compare the exercise stress intensities at the same times on different days, even in the early morning, possibly leading to prevention of overtraining syndrome.

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Salivary Cortisol as a Diagnostic Tool for Hyper- and Hypocortislism: Improved Screening by an Automated Immunoassay

Cited by 2 publications

References 0 publications

Low-dose short synacthen test with salivary cortisol in patients with suspected central adrenal insufficiency

Low-dose short synacthen test with salivary cortisol in patients with suspected central adrenal insufficiency

Assessment of exercise-induced stress by automated measurement of salivary cortisol concentrations within the circadian rhythm in Japanese female long-distance runners

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