ECE2016 Guided Posters Adrenal (1) (10 abstracts)
ACTH stimulation test (250 μg): is salivary cortisol an alternative to serum cortisol?
Lara Albert 1 , Olga Giménez-Palop 1 , Ismael Capel 1 , Jose Miguel González-Clemente 1 , David Subías 1 , Jorge Sánchez-Delgado 2, , Joaquim Profitós 2 , Eugenio Berlanga 4 , Laia Casamitjana 1 & Mercedes Rigla 1
1Endocrinology Department, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí, UAB, Sabadell, Catalunya, Spain; 2Hepatology Department, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí, UAB, Sabadell, Catalunya, Spain; 3Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Sabadell, Catalunya, Spain; 4Laboratory Department, UDIAT, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Insitut Universitari Parc Taulí., Sabadell, Catalunya, Spain.
Introduction: Most serum cortisol (SeC) is linked to cortisol binding globulin and albumin. When the synthesis of proteins is reduced or increased, SeC does not reflect the actual free cortisol (FC) (active fraction). Methods for FC analysis are very laborious and expensive, which makes difficult to use them as a routine laboratory tests. Salivary cortisol (SaC) mirrors the FC in serum, being its measurement easier and cheaper. The determination of SaC, instead of total cortisol after stimulation with ACTH, has been proposed as an alternative for adrenal insufficiency diagnosis, but this test has not been standardized yet. The goal of this study is to determinate the reference values for SaC after stimulation with 250 μg of ACTH i.v. and their correlation with those for SeC.
Methods and design: Forty-five healthy volunteers and 39 patients with known adrenal insufficiency (primary or secondary) were included. After at least 8 h fast, serum and saliva samples were collected before and after the administration of 250 μg of ACTH i.v. for the determination of cortisol in times: 0′, 30′, 60′ and 90′. Patients received their last dosage of hidrocortisone at 0900 h the day before.
Results: All healthy volunteers had a SeC peak at 30 min ≥18 μg/dl. Healthy volunteers SaC [mean±SD (range), μg/dl] was: 0′:0.56±0.31(0.08–1.37); 30′;1.58±0.45(0.83–2.72); 60′:2.35±0.63(1.43–4.24); 90′:2.91±0.82(1.63–5.42). Patients SaC [mean±SD (range), μg/dl] was: 0′:0.33±0.30(0.05–1.53); 30′:0.32±0.24(0.05–1.17) 60′:0.32±0.24(0.05–0.90); 90′:0.37±0.50(0.05–3.13). The SaC correlated with SeC at all times, except in time 0′ for the group of patients. Healthy volunteers lower limit value SaC at 60′ was 1.43 μg/dl. This cut-off classified all patients correctly.
Conclusion: Measurement of SaC offers an alternative to SeC ACTH stimulation test (250 μg). We suggest that adrenal insufficiency can be excluded when SaC at 60′ is ≥1.43 μg/dl.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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