The use of salivary cortisone in the diagnosis and management of adrenal disease

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This project aims to develop, validate and introduce new salivary tests into the NHS (and worldwide) to simplify the diagnosis and treatment of patients with adrenal insufficiency. The adrenal produces the essential stress hormone cortisol without which patients die from circulatory collapse in what is called an adrenal crisis. Adrenal insufficiency may be caused by prolonged steroid treatment which is commonly used in inflammatory disorders such as asthma, rheumatoid arthritis and most recently Covid-19\. Currently, diagnosis of adrenal insufficiency requires a day case visit to hospital, however Professor Brian Keevil, at the Manchester University NHS Foundation Trust, has developed a salivary test that will greatly simplify the diagnosis and treatment of adrenal insufficiency. Salivary testing will save lives through early diagnosis, reduce the need for unnecessary clinician-patient contact, reduce the burden to patients and reduce cost through home sampling and remote testing in hospital laboratories. The secondment of Professor Keevil to Diurnal, a UK Company with world-leading expertise in developing hormone pharmaceutical products, through the Innovation Scholars award the Manchester University NHS Foundation Trust will allow the project to examine the validation of the specific salivary steroid (cortisone and cortisol) assays and their introduction in to the everyday care of patients. It is critical that good ideas that will benefit patients find a way to move through to clinical practice in the shortest timeframe possible. Without the correct infrastructure and support many projects fail to reach completion. The key to introducing medical innovation to healthcare is collaboration and early involvement with industry. The Innovation Scholars secondment is the ideal vehicle to develop Professor Keevil's innovation at **Manchester University NHS Foundation Trust,** providing a pathway to accelerate the new salivary diagnostic tests directly into clinical practice with the appropriate industry forethought and backing.