Characterization of the serum and salivary cortisol response to the intravenous 250 Aμg ACTH1-24 stimulation test
Characterization of the serum and salivary cortisol response to the intravenous 250 Aμg ACTH1-24 stimulation test
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DOI：
10.1007/s12020-017-1505-0
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发表时间：
2018-03-01
期刊：
影响因子：
3.7
通讯作者：
Inder, Warrick J.
中科院分区：
文献类型：
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作者：
Nolan, Brendan J.;Sorbello, Jane;Inder, Warrick J.
ACTH（1-24）刺激试验通常用于评估下丘脑-垂体-肾上腺（HPA）轴。考虑到CBG浓度和结合亲和力的变化，血清总皮质醇可能会对一些患者进行错误的分类。唾液皮质醇与血清游离皮质醇相关性很好，但更容易测量，并在商业实验室广泛使用。本研究的目的是探讨在ACTH（1-24）刺激试验中测量唾液皮质醇的效用。临床研究机构的病例对照研究。87例疑似皮质醇缺乏的患者、24例健康对照者和10例口服避孕药（OC）的健康女性进行了静脉注射250 μ g ACTH（1-24）刺激试验。评估ACTH（1-24）刺激的血清和唾液皮质醇的一致性。健康志愿者与OC组女性血清皮质醇差异有统计学意义（P < 0.001），而唾液皮质醇差异无统计学意义。60 min时唾液皮质醇参考区间下限为26 nmol/L。27/89（30%）疑似HPA轴障碍的试验未能达到60分钟血清皮质醇切断值500 nmol/L。其中，24/27（89%）唾液皮质醇< 26 nmol/L。而60 min血清皮质醇值为500 ~ 599 nmol/L的12/19（63%）和60 min血清皮质醇值为ae600 nmol/L的5/43（12%）试验唾液皮质醇值< 26 nmol/L。对于已证实或怀疑CBG改变的患者，以及可能60分钟血清皮质醇值为500-599 nmol/L的患者，唾液皮质醇在250 A μ g ACTH（1-24）刺激试验中提供了额外的诊断价值。
The ACTH(1-24) stimulation test is commonly used to assess the hypothalamic-pituitary-adrenal (HPA) axis. Given variations in CBG concentration and binding affinity, serum total cortisol may misclassify some patients. Salivary cortisol correlates well with serum free cortisol but is easier to measure and widely available in commercial laboratories. The aim of this study was to investigate the utility of measuring salivary cortisol during the ACTH(1-24) stimulation test.Case-control study in a clinical research facility. Eighty-seven patients with suspected cortisol deficiency, twenty-four healthy controls, and ten healthy women on the oral contraceptive (OC) underwent an intravenous 250 A mu g ACTH(1-24) stimulation test. Concordance of ACTH(1-24) stimulated serum and salivary cortisol was evaluated.There was a significant difference in serum cortisol between the healthy volunteers and the women on the OC (P < 0.001) but no difference in salivary cortisol. The lower limit of the reference interval for salivary cortisol at 60 min was 26 nmol/L. 27/89 (30%) of tests with suspected HPA axis disorder failed the 60 min serum cortisol cut-off of 500 nmol/L. Of these, 24/27 (89%) had a salivary cortisol of < 26 nmol/L. In contrast, 12/19 (63%) tests and 5/43 (12%) tests where the 60 min serum cortisol was 500-599 and ae600 nmol/L, respectively had a salivary cortisol of < 26 nmol/L.Salivary cortisol provides additional diagnostic value during the 250 A mu g ACTH(1-24) stimulation test in patients with proven or suspected alterations in CBG and potentially those with a borderline 60 min serum cortisol 500-599 nmol/L.