Salivary steroid assays – research or routine?

Wood, Peter

doi:10.1258/acb.2008.008208

Cited by 147 publications

(150 citation statements)

References 113 publications

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“…The current findings support previous research suggesting that the free fraction of cortisol (salivary) may have a biphasic response, exponentially increasing once the CBG point has been saturated (3,9,27) . Previous research has shown that when the stress response is moderate and therefore concentrations remain below the CBG binding point, free cortisol appears to be representative of total cortisol (28)(29)(30) .…”

Section: *--------------------------------------Figures 4 5 and 6 Nesupporting

confidence: 90%

A Comparison of Capillary, Venous, and Salivary Cortisol Sampling after Intense Exercise

Fryer¹,

Dickson²,

Hillier³

et al. 2014

International Journal of Sports Physiology and Performance

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Venipuncture is expensive, invasive, and impractical for many sport-science and clinical-based settings. Salivary free cortisol is often cited as a noninvasive practical alternative. However, when cortisol concentrations exceed the corticosteroid-binding globulin (CBG) point of 500 nmol/L, a lack of agreement between salivary and venous blood cortisol has been found. Alternatively, capillary blood may present a minimally invasive, cost-effective, and practical surrogate for determining cortisol concentration.Purpose:The aim of this study was to determine whether cortisol concentrations sampled from capillary blood and saliva accurately reflect those found in venous blood across a large range of concentrations after intense exercise.Methods:Eleven healthy aerobically trained male subjects were recruited. Capillary, salivary, and venous blood samples were collected before and after (immediately and 5, 10, 15, and 20 min after) a treadmill VO2 max test.Results:Capillary and venous concentrations increased at a similar rate after exercise (Cohen d.14–.33), increasing up to 15 min postexercise before a decline was seen. Salivary cortisol values increased at a slower rate than venous and capillary cortisol but continued to increase 15 min postexercise (Cohen d .19–.47 and .09–.72, respectively).Conclusions:Capillary cortisol accurately reflects concentrations assayed from venous blood across a range of values below and above the CBG binding point. Capillary sampling provides a minimally invasive, cost-effective, practical surrogate for assessment of hypothalamic-pituitary-gland function.

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Section: *--------------------------------------Figures 4 5 and 6 Nesupporting

confidence: 90%

A Comparison of Capillary, Venous, and Salivary Cortisol Sampling after Intense Exercise

Fryer¹,

Dickson²,

Hillier³

et al. 2014

International Journal of Sports Physiology and Performance

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“…12 However, the use of salivary cortisol in the interpretation of SST needs to be validated in patients with liver impairment. In our study, we have demonstrated that 46% of patients may have a diagnosis of adrenal insufficiency due to low CBG when total cortisol alone is used to interpret SST results.…”

Section: Discussionmentioning

confidence: 99%

Serum total cortisol and free cortisol index give different information regarding the hypothalamus–pituitary–adrenal axis reserve in patients with liver impairment

Vincent¹,

Etogo-Asse

Dew³

et al. 2009

Ann Clin Biochem

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Background: The short synacthen test (SST) is used to investigate patients with suspected hypothalamus -pituitary-adrenal (HPA) axis pathology. A rise of serum total cortisol (total cortisol) above 550 nmol/L is accepted as sufficient adrenal reserve. In total, 80% of cortisol is bound to cortisol-binding globulin (CBG) and 10% to albumin. In the acute phase responses CBG concentrations decrease and can influence the interpretation of SST. The free cortisol index (FCI) is a surrogate marker for free cortisol and is defined as total cortisol (nmol/L)/CBG (mg/L) with an FCI . 12 representing sufficient adrenal reserve. The aim of this study was to compare total cortisol and FCI in the interpretation of SST in patients with liver impairment. Method: SST was done on 26 patients with liver impairment. Total cortisol was measured on Advia Centaur; serum CBG by radioimmunoassay and FCI calculated. Results: Eleven (42%) patients had a total cortisol .550 nmol/L (range 555 -2070) and FCI . 12 (12.0 -68.9) suggesting sufficient cortisol reserve. Three patients (13%) had total cortisol ,550 nmol/L (268 -413) and FCI , 12 (3.5-11.6) consistent with cortisol deficiency. Twelve patients (46%) had a total cortisol ,550 nmol/L (144 -529), but an FCI . 12 (12.0 -52.9). None of the patients had a total cortisol .550 nmol/L and FCI , 12. Conclusion: When total cortisol alone is used to interpret SST in patients with liver impairment, 46% may have been classified as having adrenal insufficiency because of low CBG. FCI may be better for the evaluation of HPA axis insufficiency in patients with liver impairment.

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“…Samples for SC are easy to obtain, they do not require hospitalization and are stable for up to seven days at room temperature, one month or more at 48C and three months or more at 2208C. 6 The high SC sensitivity and specificity in the diagnosis of CS have been confirmed by several studies, although cut-off values are different on the basis of the method assay used. 7 In view of this, it would be useful for each laboratory to generate its own reference range.…”

Section: Introductionmentioning

confidence: 95%

Clinical accuracy of midnight salivary cortisol measured by automated electrochemiluminescence immunoassay method in Cushing's syndrome

Carrozza¹,

Corsello

Paragliola

et al. 2010

Ann Clin Biochem

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Background: The diagnosis of Cushing's syndrome (CS) represents a challenge for endocrinologists. Several screening tests are used, but none of them seems to be the gold standard for the diagnosis. The aim of this study was to confirm the diagnostic value of salivary cortisol (SC) as a first-level screening test and to evaluate the clinical performance of a electrochemiluminescence immunoassay (ECLIA) method. Methods: In 33 patients with a strong clinical suspicion of CS, we evaluated urinary free cortisol, circadian rhythm plasma cortisol (PC) and morning PC after low-dose dexamethasone suppression test (LDDST). At the same sampling times, we evaluated SC analysed by the same automated method. Correlation studies were evaluated by Spearman index (significance P , 0.05). Results: On the basis of biochemical results CS was confirmed in 21/33. SC was significantly correlated to PC at 12:00 and 23:00. Thus, we chose 8.3 nmol/L as midnight SC cut-off value with 100% sensitivity and 97.4% specificity. The cut-off chosen after LDDST was 1.7 nmol/L (100% sensitivity and 72% specificity). Conclusion: SC assay showed a good clinical accuracy and the ECLIA method can be used in clinical routine to obtain fast results easily.

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Salivary steroid assays – research or routine?

Cited by 147 publications

References 113 publications

A Comparison of Capillary, Venous, and Salivary Cortisol Sampling after Intense Exercise

A Comparison of Capillary, Venous, and Salivary Cortisol Sampling after Intense Exercise

Serum total cortisol and free cortisol index give different information regarding the hypothalamus–pituitary–adrenal axis reserve in patients with liver impairment

Clinical accuracy of midnight salivary cortisol measured by automated electrochemiluminescence immunoassay method in Cushing's syndrome

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