Abstract
AbstractThe study aimed to evaluate salivary cortisol (SC) contamination and determine
the associated factors in secondary adrenal insufficiency (SAI) patients treated
with hydrocortisone (Hc). A randomized crossover trial involved SAI patients. SC
was measured before the morning Hc dose, then at one, two, and four hours after.
The procedure was performed twice on two days of a week: one day while taking Hc
in tablet form (tablet set) and one day while taking Hc in capsule form (capsule
set). Area under the curve (AUC) of SC levels over time was calculated in each
participant for the two sets. SC contamination was defined as AUCtablet above
the 95th percentile of AUCcapsule. Thirty-four patients (24 females and 10
males) with a median age of 48 years were enrolled. Post-Hc dose SC levels were
higher in tablet than in capsule set, particularly at one hour. Prevalence and
extent of SC contamination were estimated to 32% and 88%, respectively. In
capsule set, SC measured two hours after Hc intake showed the strongest
correlation with AUC (r=0.88, p<0.001). In multivariate analysis, serum
potassium≥3.9 mEq/l was the only predictor for SC contamination [multi-adjusted
OR (95% CI): 7.1 (1.4–36.1); p=0.018]. SC measured during the two hours after Hc
intake is inaccurate for glucocorticoid replacement therapy assessment in SAI
patients treated with Hc in tablet form.