Monitoring adrenal insufficiency through salivary steroids: a pilot study

Author:

Tucci Lorenzo12ORCID,Fanelli Flaminia23,Improta Ilaria12,Bissi Valentina23,Lena Claudia2,Galante Greta23,Mezzullo Marco23,Magagnoli Matteo23,Lalumera Anna Bianca12,Colombin Giacomo12,Coscia Kimberly12,Rotolo Laura12,Vicennati Valentina12,Pagotto Uberto123ORCID,Di Dalmazi Guido12ORCID

Affiliation:

1. Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna , 40138 Bologna , Italy

2. Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna , 40138 Bologna , Italy

3. Center for Applied Biomedical Research, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna , 40138 Bologna , Italy

Abstract

Abstract Background Various glucocorticoid replacement therapies (GRTs) are available for adrenal insufficiency (AI). However, their effectiveness in restoring glucocorticoid rhythm and exposure lacks adequate biochemical markers. We described the diurnal salivary cortisol (SalF) and cortisone (SalE) rhythm among different GRTs and analysed the associations between saliva-derived parameters and life quality questionnaires. Methods Control subjects (CSs, n = 28) and AI patients receiving hydrocortisone (HC, n = 9), cortisone acetate (CA, n = 23), and dual-release hydrocortisone once (DRHC-od, n = 10) and twice a day (DRHC-td, n = 6) collected 9 saliva samples from 07:00 to 23:00. Patients compiled Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale, and Addison disease-specific quality-of-life questionnaires. SalE and SalF were measured by liquid chromatography-mass spectrometry. Exposure was monitored using SalE for HC and DRHC and SalF for CA. Area under the curve (AUC) was computed. Different GRTs were compared by Z-scores calculated from saliva-derived parameters. Questionnaire results predictors were evaluated with multiple regression analysis. Results Compared with controls, all GRTs resulted in glucocorticoid overexposure in the morning. Hydrocortisone, CA, and DRHC-td caused overexposure also in afternoon and evening. Compared with other treatments, CA determined increased Z-score-07:00 (P < .001), DRHC-td determined increased Z-score-AUC07:00→14:00 (P = .007), and DRHC-od induced lower Z-score-AUC14:00→23:00 (P = .015). Z-scores-AUC14:00→16:00 ≥ .619 best predicted questionnaire scores. Conclusions None of the GRTs mimics normal glucocorticoid rhythmicity and exposure. SalE, SalF, and Z-score may be useful markers for monitoring and comparing different GRTs. Excess glucocorticoid in early afternoon best associated with depressive symptoms and worse life and sleep quality.

Funder

Emilia-Romagna Region

Ministry of University and Research

Projects of Relevant National Interest

Publisher

Oxford University Press (OUP)

Cited by 1 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Utility of Salivary Cortisol and Cortisone in the Diagnostics of Adrenal Insufficiency;The Journal of Clinical Endocrinology & Metabolism;2024-07-12

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