Document Detail


Assessment of glucocorticoid therapy with salivary cortisol in secondary adrenal insufficiency.
MedLine Citation:
PMID:  23034783     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
CONTEXT: Appropriate glucocorticoid replacement therapy in adrenal insufficiency (AI) is crucial, given to the risks of chronic under- or over treatment, particularly in patients on multiple medications. Salivary sampling allows non-invasive, stress-free cortisol measurement. OBJECTIVE: To determine whether salivary cortisol measurement is helpful in assessing the adequacy of glucocorticoid therapy with cortisone acetate (CA) in patients with secondary AI. DESIGN: A prospective cohort study at the Endocrinology Unit of Padua University-Hospital. METHODS: Six samples of salivary cortisol were collected from 28 patients with secondary AI on CA treatment and from 36 healthy volunteers at fixed times of the day, and used to calculate salivary cortisol levels at each time-point and the Area Under Curve (AUC) across the different sampling times. RESULTS: Salivary cortisol levels were lower in patients than controls in the morning but no differences were found in the afternoon or at night before resting. Salivary cortisol levels were higher in patients immediately following CA administration. Ten patients showed an AUC above the 97.5th percentile of controls, without clinical signs of hypercortisolism, and salivary cortisol levels 90 minutes after each dose of CA predict the AUC. All patients had severe GH-deficiency: there were no differences in salivary cortisol levels or AUC between patients treated or not with GH. CONCLUSIONS: Two salivary cortisol determinations, able to predict the daily AUC, may allow assessment of the adequacy of glucocorticoid replacement therapy in secondary AI and for identifying cases of over- or under-treatment.
Authors:
Filippo Ceccato; Nora Albiger; Giuseppe Reimondo; Annachiara Frigo; Sergio Ferasin; Gianluca Occhi; Franco Mantero; Massimo Terzolo; Carla Scaroni
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-3
Journal Detail:
Title:  European journal of endocrinology / European Federation of Endocrine Societies     Volume:  -     ISSN:  1479-683X     ISO Abbreviation:  Eur. J. Endocrinol.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-4     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9423848     Medline TA:  Eur J Endocrinol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
F Ceccato, Department of Medicine, DIMED, Endocrinology Unit, University of Padova, Padova, Italy.
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