BSPED2015 e-Posters Adrenal (12 abstracts)
Between patient and inter-time point variability in salivary cortisone: cortisol ratios
J Park 1 , G Lancaster 2 , A Titman 2 , M Peak 3 , P Newlands 4 , C Collingwood 4 , C Chesters 4 , T Moorcroft 5 , D Hawcutt 6 , M Didi 1 , J Couriel 7 & J Blair 1
1Department of Endocrinology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK; 2Postgraduate Statistics Centre, Lancaster University, Lancaster, UK; 3Department of research, Alder Hey Children’s NHS Foundation Trsust, Liverpool, UK; 4Department of Biochemistry, Alder Hey CHildren’s NHS Foundation Trsut, Liverpool, UK; 5NIHR Clinical Research Network: Children, North West Coast, UK; 6Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK; 7Department of Respiratory Medicine, Alder Hey CHildren’s NHS Foundation Trust, Liverpool, UK.
Background: Salivary biomarkers are attractive diagnostic tools for paediatric practice, enabling non-invasive sampling at home. Salivary cortisol (SCl) and cortisone (SCn) are sensitive markers of adrenal insufficiency during inhaled corticosteroid treatment(1). SCn is reported to be the best correlate of plasma cortisol. Measurements of SCl may not be necessary, reducing cost and sample volumes.
Eleven beta hydroxysteroid dehydrogenase type 2 (11BHSD2) regulates conversion of cortisol to cortisone. It is subject to genetic variability, and may become saturated at high cortisol concentrations. These factors could be important if only SCn is used as a biomarker of plasma cortisol for clinical decision making.
Patients and methods: We examined inter and intra-individual variability in SCl:SCn in 756 early morning saliva samples collected on 3 consecutive days (D1, D2, D3 ) from 269 (160 M) children with asthma, age 10 yrs (5–15), as reported previously(1).
Box-Cox transformations were applied to yield normally distributed data. Pearson correlation and variance component models were used to investigate intra and inter-individual variability.
Results: Mean SCl:SCn ratio for all samples was 0.177 (range 0.0274–3.57). There was a weak correlation between SCl:SCn on D1 vs D2, D1 vs D3 and D2 vs D3: 0.512, 0.580 and 0.585 respectively. 56% of overall variation was explained by between patient variation and 44% by inter-time point measurement error.
Conclusions: Statistically significant relationships are observed between measurements obtained from the same individual over time, and between individuals. However, the observed level of variability could influence clinical decision making for individual patients. These observations may indicate genetic heterogeneity in our population and /or saturation of 11BHSD2 at higher levels of SCl. We continue to measure both biomarkers on serial samples to mitigate these effects.
1. Early morning salivary cortisol and cortisone, and adrenal responses to a simplified low-dose short Synacthen test in children with asthma. Clin Endocrinol. 2014, 80, 376–83.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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