Morning salivary cortisol versus short Synacthen test as a test of adrenal suppression.
BACKGROUND
The short Synacthen test (SST) is the most commonly used test for the assessment of adrenal suppression. We investigated the potential of a simpler and more cost-effective procedure [morning salivary cortisol (MSC)] as an outpatient screening tool to detect adrenal suppression in patients using topical intranasal corticosteroids for rhinosinusitis.


METHODS
Forty-eight patients who were using topical corticosteroids underwent adrenal function assessment by way of SST and MSC measurement.


RESULTS
Sixteen of the 48 patients had impaired MSCs. Of these 16 patients, 15 had an impaired SST (sensitivity 100%) and one had a normal SST. All patients with normal MSCs also had normal SSTs (specificity 97%).


CONCLUSIONS
The morning salivary cortisol measurement is a useful screening tool for adrenal suppression in this setting.
Patel
Rajan S
RS
Department of Otolaryngology, North Glasgow Hospitals University, NHS Trust, Glasgow, UK. dr_rajan_patel@hotmail.com
Shaw
Steve R
SR
McIntyre
Halena E
HE
McGarry
Gerald W
GW
Wallace
A Michael
AM
D000281:Administration, Intranasal; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects; D000311:Adrenal Glands / Q000187:drug effects / Q000378:metabolism*; D002940:Circadian Rhythm / Q000502:physiology; D003366:Cosyntropin / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis* / Q000097:blood; D010912:Pituitary-Adrenal Function Tests / Q000379:methods* / Q000706:statistics & numerical data; D010913:Pituitary-Adrenal System / Q000187:drug effects / Q000378:metabolism; D012463:Saliva / Q000737:chemistry*
D000305:Adrenal Cortex Hormones; D003366:Cosyntropin; C006418:adrenocorticotropin zinc; D006854:Hydrocortisone