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Cited by 114Adrenal Hormones and DisordersStress Responses and CortisolHormonal and reproductive studies

Plasma, salivary and urinary cortisol levels following physiological and stress doses of hydrocortisone in normal volunteers

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Jung, Caroline, Greco, Santo, Nguyen, Hanh HT, Ho, Jui T, Lewis, John G, Torpy, David J, Inder, Warrick J·2014·BMC Endocrine Disorders
DOI 10.1186/1472-6823-14-91PMC PMC4280712
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Abstract

BACKGROUND: Glucocorticoid replacement is essential in patients with primary and secondary adrenal insufficiency, but many patients remain on higher than recommended dose regimens. There is no uniformly accepted method to monitor the dose in individual patients. We have compared cortisol concentrations in plasma, saliva and urine achieved following "physiological" and "stress" doses of hydrocortisone as potential methods for monitoring glucocorticoid replacement. METHODS: Cortisol profiles were measured in plasma, saliva and urine following "physiological" (20 mg oral) or "stress" (50 mg intravenous) doses of hydrocortisone in dexamethasone-suppressed healthy subjects (8 in each group), compared to endogenous cortisol levels (12 subjects). Total plasma cortisol was measured half-hourly, and salivary cortisol and urinary cortisol:creatinine ratio were measured hourly from time 0 (between 0830 and 0900) to 5 h. Endogenous plasma corticosteroid-binding globulin (CBG) levels were measured at time 0 and 5 h, and hourly from time 0 to 5 h following administration of oral or intravenous hydrocortisone. Plasma free cortisol was calculated using Coolens' equation. RESULTS: Plasma, salivary and urine cortisol at 2 h after oral hydrocortisone gave a good indication of peak cortisol concentrations, which were uniformly supraphysiological. Intravenous hydrocortisone administration achieved very high 30 minute cortisol concentrations. Total plasma cortisol correlated significantly with both saliva and urine cortisol after oral and intravenous hydrocortisone (P <0.0001, correlation coefficient between 0.61 and 0.94). There was no difference in CBG levels across the sampling period. CONCLUSIONS: An oral dose of hydrocortisone 20 mg is supraphysiological for routine maintenance, while stress doses above 50 mg 6-hourly would rarely be necessary in managing acute illness. Salivary cortisol and urinary cortisol:creatinine ratio may provide useful alternatives to plasma cortisol measurements to monitor replacement doses in hypoadrenal patients.

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  • Jung et al. showed in healthy individuals, whose endogenous cortisol was suppressed by dexamethasone, that 50 mg of IV hydrocortisone achieved a mean 30 min total plasma cortisol of 2450 nmol/l.

    “Jung et al. showed in healthy individuals, whose endogenous cortisol was suppressed by dexamethasone, that 50 mg of IV hydrocortisone achieved a mean 30 min total plasma cortisol of 2450 nmol/l.54”

    From Adrenal crisis: prevention and management in adult patients (2019) · cites this paper as [54]

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Authors
Jung, C., Greco, S., Nguyen, H. H., Ho, J. T., Lewis, J. G., Torpy, D. J., & Inder, W. J.
Affiliations
  • The University of Melbourne (AU)
  • Royal Adelaide Hospital (AU)
  • Canterbury Health Laboratories (NZ)
  • The University of Queensland (AU)
Corresponding author
Inder, Warrick J
ORCID
Venue
BMC Endocrine Disorders
Publisher
Springer Science and Business Media LLC
Published
2014-11-26
Volume
14
Issue
1
Pages
91-91
ISSN
1472-6823 (ISSN-L)
DOI
10.1186/1472-6823-14-91
PMC
PMC4280712
OpenAlex
W2104596388
Cited by
114
References
8
Citations by year
2026: 7 · 2025: 7 · 2024: 12 · 2023: 9 · 2022: 13 · 2021: 11 · 2020: 14 · 2019: 7 · 2018: 8 · 2017: 14 · 2016: 12
FWCI
6.47
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Endocrine Disorders (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
Keywords
cortisol, glucocorticoid replacement therapy, adrenal insufficiency, salivary cortisol, plasma cortisol, dexamethasone suppression, corticosteroid-binding globulin, free cortisol, oral versus intravenous administration
MeSH terms
Administration, Oral, Adrenal Insufficiency, Adult, Creatinine, Dexamethasone, Drug Administration Schedule, Female, Glucocorticoids, Humans, Hydrocortisone, Injections, Intravenous, Male, Saliva, Stress, Physiological, Time Factors, Transcortin, Hormone Replacement Therapy, Healthy Volunteers

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