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Stimulated Salivary Cortisol as a Noninvasive Diagnostic Tool for Adrenal Insufficiency

Endocrinology and Metabolism 2020년 35권 3호 p.628 ~ 635
김윤지, 김정희, 홍아람, 박경선, 김상완, 신찬수, 김성연,
소속 상세정보
김윤지 ( Kim Yoon-Ji ) - Seoul National University College of Medicine Seoul National University Hospital Department of Internal Medicine
김정희 ( Kim Jung-Hee ) - Seoul National University College of Medicine Seoul National University Hospital Department of Internal Medicine
홍아람 ( Hong A-Ram ) - Seoul National University College of Medicine Seoul National University Hospital Department of Internal Medicine
박경선 ( Park Kyeong-Seon ) - Seoul National University College of Medicine Seoul National University Hospital Department of Internal Medicine
김상완 ( Kim Sang-Wan ) - Seoul National University College of Medicine Seoul National University Hospital Department of Internal Medicine
신찬수 ( Shin Chan-Soo ) - Seoul National University College of Medicine Seoul National University Hospital Department of Internal Medicine
김성연 ( Kim Seong-Yeon ) - Seoul National University College of Medicine Seoul National University Hospital Department of Internal Medicine

Abstract


Background: Salivary cortisol is routinely used as a diagnostic test for Cushing syndrome. The diagnostic use of salivary cortisol for adrenal insufficiency (AI), however, is less established. We aimed to investigate the utility of morning basal and adrenocorticotropic hormone-stimulated salivary cortisol in diagnosing AI in Korean adults.

Methods: We prospectively included 120 subjects (female, n=70) from Seoul National University Hospital. AI was defined as a stimulated serum cortisol level of <496.8 nmol/L during the short Synacthen test (SST). Serum and saliva samples were drawn between 8:00 AM and 10:00 AM. Salivary cortisol levels were measured using an enzyme immunoassay kit.

Results: Thirty-four patients were diagnosed with AI according to the SST results. Age, sex, body mass index, serum albumin levels, and serum creatinine levels did not significantly differ between the normal and AI groups. Basal and stimulated salivary cortisol levels were positively correlated with basal (r=0.538) and stimulated serum cortisol levels (r=0.750), respectively (all P<0.001). Receiver operating characteristic curve analysis yielded a cutoff level of morning basal salivary cortisol of 3.2 nmol/L (sensitivity, 84.9%; specificity, 73.5%; area under the curve [AUC]=0.822). The optimal cutoff value of stimulated salivary cortisol was 13.2 nmol/L (sensitivity, 90.7%; specificity, 94.1%; AUC=0.959). Subjects with a stimulated salivary cortisol level above 13.2 nmol/L but a stimulated serum cortisol level below 496.8 nmol/L (n=2) had lower serum albumin levels than those showing a concordant response.

Conclusion: The diagnostic performance of stimulated salivary cortisol measurements after the SST was comparable to serum cortisol measurements for diagnosing AI.

키워드

Saliva; Adrenal insufficiency; Hydrocortisone

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