title: Low-dose ACTH (1 microg) salivary test: a potential alternative to the classical blood test.
abstract: OBJECTIVE
  Salivary cortisol is unaffected by cortisol binding globulin (CBG) and hence allows CBG-related variations in serum total cortisol to be bypassed. We assessed whether or not salivary cortisol can be used for the low-dose (1 microg) ACTH test in subjects with presumed normal and elevated levels of CBG.
  
  
  METHODS
  We measured serum and salivary cortisol responses to intravenous administration of 1 microg ACTH in 14 healthy volunteers, 14 'hyperoestrogenic' women [in their first or early second trimester of pregnancy, using oral contraceptives (OC) or on hormone replacement therapy (HRT)] and 10 patients with secondary hypoadrenalism. Cortisol levels were recorded before as well as 30 and 60 min (+30; +60 min) after ACTH administration.
  
  
  RESULTS
  Baseline salivary cortisol did not differ significantly between the hypoadrenal and healthy patients (7.11+/-1.4 and 12.13+/-1.59 nmol/l; P=0.48) but there was a significant difference between hypoadrenal and hyperoestrogenic patients (18.94+/- 3.44 nmol/l; P=0.01). The largest difference between hypoadrenal patients and healthy individuals was observed at+30 min (9.16+/-2.8, 52.65+/-8.78 and 48.81+/- 6.9 nmol/l, in the hypoadrenal, healthy and hyperoestrogenic patients, respectively; P< 0.05). At this time-point values< 24.28 nmol/l were found in all hypoadrenal patients and cortisol levels >or= 27.6 nmol/l were found in 26 out of 28 healthy volunteers. ACTH-stimulated serum cortisol but not salivary cortisol was significantly higher in hyperoestrogenic women than in the healthy volunteers at either+30 or+60 min.
  
  
  CONCLUSIONS
  The salivary low-dose ACTH test yields results that parallel the response of circulating cortisol to ACTH and may provide an alternative to the blood test, particularly in situations where increased CBG levels complicate the changes in serum cortisol levels.
authors.affiliation: Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Centre, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Marcus-Perlman
authors.forename: K
authors.initials: K
authors.lastname: Tordjman
authors.forename: Y
authors.initials: Y
authors.lastname: Greenman
authors.forename: R
authors.initials: R
authors.lastname: Limor
authors.forename: G
authors.initials: G
authors.lastname: Shenkerman
authors.forename: E
authors.initials: E
authors.lastname: Osher
authors.forename: N
authors.initials: N
authors.lastname: Stern
mesh_terms: D000309:Adrenal Insufficiency / Q000378:metabolism*; D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage*; D000328:Adult; D002352:Carrier Proteins / Q000097:blood*; D003276:Contraceptives, Oral / Q000627:therapeutic use; D003480:Cushing Syndrome / Q000097:blood / Q000175:diagnosis; D003955:Diagnostic Tests, Routine / Q000379:methods; D004967:Estrogens / Q000097:blood*; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis* / Q000097:blood; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D012463:Saliva / Q000737:chemistry*
chemical_list: D002352:Carrier Proteins; D003276:Contraceptives, Oral; D004967:Estrogens; C027091:cortisol binding globulin; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone