Low‐dose ACTH (1 µg) salivary test: a potential alternative to the classical blood test
- 9 January 2006
- journal article
- Published by Wiley in Clinical Endocrinology
- Vol. 64 (2), 215-218
- https://doi.org/10.1111/j.1365-2265.2006.02451.x
Abstract
Objectives 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 µg) ACTH test in subjects with presumed normal and elevated levels of CBG. Patients/methods We measured serum and salivary cortisol responses to intravenous administration of 1 µg 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 ≥ 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.Keywords
This publication has 17 references indexed in Scilit:
- A new less-invasive and more informative low-dose ACTH test: salivary steroids in response to intramuscular corticotrophinClinical Endocrinology, 2004
- Salivary cortisol and short and long-term memory for emotional faces in healthy young womenPsychoneuroendocrinology, 2004
- A dose–response study of salivary cortisol after dexamethasone suppression test in Cushing's disease and its potential use in the differential diagnosis of Cushing's syndromeClinical Endocrinology, 2003
- Salivary Cortisol Response During Exposure Treatment in Driving PhobicsPsychosomatic Medicine, 2003
- Low‐dose (1 μg) adrenocorticotrophin (ACTH) stimulation as a screening test for impaired hypothalamo–pituitary–adrenal axis function: sensitivity, specificity and accuracy in comparison with the high‐dose (250 μg) testClinical Endocrinology, 2000
- Out-Patient Screening for Cushing's Syndrome: The Sensitivity of the Combination of Circadian Rhythm and Overnight Dexamethasone Suppression Salivary Cortisol TestsJournal of Clinical Endocrinology & Metabolism, 1999
- Late-Night Salivary Cortisol as a Screening Test for Cushing's SyndromeJournal of Clinical Endocrinology & Metabolism, 1998
- The role of the low dose (1 microgram) adrenocorticotropin test in the evaluation of patients with pituitary diseasesJournal of Clinical Endocrinology & Metabolism, 1995
- The effect of oral contraceptives on plasma-free and salivary cortisol and cortisoneClinica Chimica Acta; International Journal of Clinical Chemistry, 1987
- Salivary cortisol for the evaluation of Cushing's syndromeClinica Chimica Acta; International Journal of Clinical Chemistry, 1985