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Abstract
Measuring serum cortisol to evaluate stress, adrenal disease, and monitor hydrocortisone replacement requires venepuncture. Conversely, salivary measurements are noninvasive.
Objective:This study aimed to investigate measurement of salivary cortisol and cortisone as alternatives to serum cortisol.
Design and Setting:This was a prospective cross-over study in a clinical research facility.
Patients and Methods:Over three periods (Period 1, 24-h physiological cortisol rhythm; Periods 2 and 3, after 20 mg oral and iv hydrocortisone) 14 male volunteers had serum and saliva cortisol and cortisone, serum albumin, cortisol-binding globulin, and free cortisol measured. Data were analyzed for rhythm parameters and correlations. Linear mixed-effects modelling was performed to determine the relationship between serum cortisol and salivary cortisone.
Results:Serum cortisol and cortisone showed similar circadian rhythms with large peak:trough ratios (cortisol median ratio, 11). Albumin and cortisol-binding globulin showed minor peak:trough ratios <1.2. When serum cortisol was <74 (SD, 29) nmol/L, salivary cortisol was not detectable but salivary cortisone was always detected. Salivary cortisol post-oral hydrocortisone produced spurious results due to contamination. Under physiological conditions, salivary cortisone correlated strongly with serum cortisol (ρ, 0.91; 95% confidence interval, 0.89–0.93; P < .001). Similarly, following iv or oral hydrocortisone, salivary cortisone correlated strongly with serum cortisol (ρ, 0.91; 95% confidence interval, 0.89–0.92; P < .001). A mixed-effects model showed that in this population 94% of the variation in salivary cortisone could be predicted from serum cortisol.
Conclusion:Salivary cortisol is frequently undetectable and contaminated by oral hydrocortisone. In contrast, salivary cortisone reflects serum cortisol and provides a noninvasive alternative to measuring serum cortisol levels.
Original language | English |
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Pages (from-to) | 1469-1477 |
Number of pages | 9 |
Journal | The Journal of clinical endocrinology and metabolism |
Volume | 101 |
Issue number | 4 |
Early online date | 26 Jan 2016 |
DOIs | |
Publication status | Published - Apr 2016 |
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Dive into the research topics of 'Salivary Cortisone Reflects Cortisol Exposure Under Physiological Conditions and After Hydrocortisone'. Together they form a unique fingerprint.Projects
- 2 Finished
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Steroid Profiling as a Biomarker Tool in the Diagnosis and Monitoring of Adrenal Tumours
Arlt, W. & Stewart, P.
2/03/09 → 29/02/12
Project: Research Councils
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Pre-Receptor Regulation of Dehydroepiandrosterone Synthesis, Metabolism and Action
1/08/04 → 31/10/09
Project: Research Councils