Cosyntropin-stimulated salivary cortisol in hospitalized patients with hypoproteinemia. Endocrine 2008;34(1-3):68-74
Date
10/24/2008Pubmed ID
18946745DOI
10.1007/s12020-008-9101-yScopus ID
2-s2.0-65449141396 (requires institutional sign-in at Scopus site) 21 CitationsAbstract
Analysis of adrenocortical function in acutely ill, hospitalized patients can be challenging due to changes in plasma binding proteins. This study used dynamic testing of salivary cortisol levels to evaluate adrenal function in hospitalized patients with low/low-normal plasma protein concentration in whom adrenal insufficiency was suspected. Twenty-eight patients with low serum albumin and proteins hospitalized for acute illness were evaluated for decreased adrenocortical function because of clinical presentations suspicious for adrenal insufficiency. Baseline and post cosyntropin-stimulated levels of serum total and salivary cortisol levels were assessed. Data were gathered by a retrospective analysis of medical records. Eight patients had normal peak serum total and salivary cortisol responses, consistent with intact adrenocortical function. Five patients had abnormal peak serum total and salivary cortisol responses indicating decreased adrenocortical function. Fifteen patients had subnormal peak serum total cortisol, but normal peak salivary cortisol responses indicating normal adrenal function. Salivary cortisol testing can identify hospitalized patients with apparently intact adrenal function in whom low serum protein confounded interpretation of serum total cortisol measurements. Salivary cortisol is a clinically useful surrogate for serum free cortisol in dynamic testing of adrenocortical function.
Author List
Raff H, Brock S, Findling JWAuthors
James W. Findling MD Professor in the Medicine department at Medical College of WisconsinHershel Raff PhD Professor in the Academic Affairs department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Adrenal InsufficiencyAdult
Aged
Aged, 80 and over
Cosyntropin
Critical Illness
Female
Hospitalization
Humans
Hydrocortisone
Hypoproteinemia
Inpatients
Male
Middle Aged
Pituitary-Adrenal Function Tests
Reproducibility of Results
Retrospective Studies
Saliva