title: Assessment of glucocorticoid therapy with salivary cortisol in secondary adrenal insufficiency.
abstract: BACKGROUND
  Appropriate glucocorticoid replacement therapy in adrenal insufficiency (AI) is crucial, given the risks of chronic under- or overtreatment, particularly in patients on multiple medications. Salivary sampling allows for non-invasive, stress-free cortisol measurement.
  
  
  OBJECTIVE
  To determine whether salivary cortisol measurement is helpful in assessing the adequacy of glucocorticoid therapy with cortisone acetate (CA) in patients with secondary AI.
  
  
  METHODS
  A prospective cohort study at the Endocrinology Unit of Padua University Hospital.
  
  
  METHODS
  Six samples of salivary cortisol were collected from 28 patients with secondary AI on CA treatment and from 36 healthy volunteers at fixed times of the day, and used to calculate salivary cortisol levels at each time point and the area under the curve (AUC) across the different sampling times.
  
  
  RESULTS
  Salivary cortisol levels were lower in patients than in controls in the morning but no differences were found in the afternoon or at night before resting. Salivary cortisol levels were higher in patients immediately following CA administration. Ten patients showed an AUC above the 97.5th percentile of controls, without clinical signs of hypercortisolism, and salivary cortisol levels 90 min after each dose of CA predict the AUC. All patients had severe GH deficiency and there were no differences in salivary cortisol levels or AUC between patients treated or not with GH.
  
  
  CONCLUSIONS
  Two salivary cortisol determinations, able to predict the daily AUC, may allow for assessing the adequacy of glucocorticoid replacement therapy in secondary AI and for identifying cases of over- or undertreatment.
authors.affiliation: Endocrinology Unit, Department of Medicine DIMED, University of Padova, Via Ospedale Civile, 105, 35128 Padova, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Ceccato
authors.forename: Nora
authors.initials: N
authors.lastname: Albiger
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Reimondo
authors.forename: Anna Chiara
authors.initials: AC
authors.lastname: Frigo
authors.forename: Sergio
authors.initials: S
authors.lastname: Ferasin
authors.forename: Gianluca
authors.initials: G
authors.lastname: Occhi
authors.forename: Franco
authors.initials: F
authors.lastname: Mantero
authors.forename: Massimo
authors.initials: M
authors.lastname: Terzolo
authors.forename: Carla
authors.initials: C
authors.lastname: Scaroni
mesh_terms: D000309:Adrenal Insufficiency / Q000188:drug therapy* / Q000378:metabolism*; D000328:Adult; D000368:Aged; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012463:Saliva / Q000378:metabolism*
chemical_list: D005938:Glucocorticoids; D006854:Hydrocortisone