Salivary cortisone reflects cortisol exposure under physiological conditions and after hydrocortisone
Author(s)
Type
Journal Article
Abstract
Context:
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.
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.
Date Issued
2016-04-01
Date Acceptance
2016-01-19
Citation
Journal of Clinical Endocrinology and Metabolism (JCEM), 2016, 101 (4), pp.1469-1477
ISSN
0021-972X
Publisher
Oxford University Press
Start Page
1469
End Page
1477
Journal / Book Title
Journal of Clinical Endocrinology and Metabolism (JCEM)
Volume
101
Issue
4
Copyright Statement
Copyright © 2016 by the Endocrine Society
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/26812690
Subjects
11-BETA-HYDROXYSTEROID DEHYDROGENASE
ADDISONS-DISEASE
CORTICOSTEROID-BINDING GLOBULIN
Endocrinology & Metabolism
GLUCOCORTICOIDS
HYPERTENSION
LC-MS/MS
Life Sciences & Biomedicine
REPLACEMENT
Science & Technology
SERUM
THERAPY
WHITEHALL II
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2016-04-01