Use of salivary cortisol and cortisone in the high- and low-dose synacthen test
Abstract
CONTEXT: Salivary cortisone reflects serum cortisol levels, is more sensitive than salivary cortisol at lower values of serum cortisol and is noninvasive. OBJECTIVE: To investigate the relationship between serum cortisol and salivary cortisol and cortisone following low- and high-dose synacthen. DESIGN AND SETTING: Prospective pharmacodynamic studies in clinical research facilities. PARTICIPANTS AND INTERVENTION: Thirty-five dexamethasone-suppressed, healthy adult males underwent an intravenous synacthen test: N = 23 low-dose (1 mcg), N = 12 high-dose (250 mcg). Paired serum and salivary samples were taken at 15 sampling points over 120 minutes. MAIN OUTCOME MEASURE: Serum cortisol and salivary cortisol and cortisone were analysed for correlations and by a mixed-effects model. RESULTS: At baseline, the correlation between serum cortisol and salivary cortisol was weak with many samples undetectable (r = .45, NS), but there was a strong correlation with salivary cortisone (r = .94, P < .001). Up to 50 minutes following synacthen, the correlation coefficient between serum cortisol and salivary cortisol and cortisone was <0.8, but both had a stronger correlation at 60 minutes (salivary cortisol r = .89, P < .001, salivary cortisone r = .85, P < .001). The relationship was examined excluding samples in the dynamic phase (baseline to 60 minutes). Salivary cortisol and cortisone showed a close relationship to serum cortisol. Salivary cortisone showed the stronger correlation: salivary cortisol r = .82, P < .001, salivary cortisone r = .96, P < .001. CONCLUSION: Following synacthen, both salivary cortisol and cortisone reflect serum cortisol levels, but there is a lag in their rise up to 60 minutes. The results support further research for possible future use of a 60-minute salivary cortisone measurement during the synacthen test.
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- Authors
- Elder, C. J., Harrison, R. F., Cross, A. S., Vilela, R., Keevil, B. G., Wright, N. P., & Ross, R. J.
- Affiliations
- University of Sheffield (GB)
- Department of Clinical Biochemistry University Hospital of South Manchester NHS Trust Manchester UK
- Sheffield Children's NHS Foundation Trust (GB)
- Corresponding author
- Ross, Richard J.
- ORCID
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2017-11-29
- Volume
- 88
- Issue
- 6
- Pages
- 772-778
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- OpenAlex
- W2767762237
- Cited by
- 21
- References
- 28
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 4 · 2020: 4 · 2019: 5 · 2018: 3
- FWCI
- 2.60
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Funders
- Medical Research Council
- Glasgow Children's Hospital Charity
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Keywords
- salivary cortisol, salivary cortisone, serum cortisol, ACTH stimulation test, dexamethasone suppression
- MeSH terms
- Adult, Cortisone, Cosyntropin, Humans, Hydrocortisone, Male, Middle Aged, Prospective Studies, Saliva, Young Adult
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