Early morning salivary cortisol and cortisone, and adrenal responses to a simplified low‐dose short Synacthen test in children with asthma. (5th September 2013)

• Record Type: Journal Article
• Authors: Blair, Joanne; Lancaster, Gillian; Titman, Andrew; Peak, Matthew; Newlands, Paul; Collingwood, Catherine; Chesters, Christine; Moorcroft, Teresa; Wallin, Naomi; Hawcutt, Daniel; Gardner, Christopher; Didi, Mohammed; Lacy, David; Couriel, Jonathan
• Is Part Of: Clinical endocrinology. Volume 80:Number 3(2014:Mar.)
• Page Start: 376
• Page End: 383
• Publication Date: 2013-09-05
• Subjects: Endocrinology -- Periodicals; 616.4005
• DOI: 10.1111/cen.12302
• Languages: English
• ISSNs: 0300-0664

Abstract

<abstract abstract-type="main" id="cen12302-abs-0001"> <title>Abstract</title> <sec id="cen12302-sec-0001" sec-type="section"> <title>Objective</title> <p>To examine serum cortisol responses to a simplified low‐dose short Synacthen test (LDSST) in children treated with inhaled corticosteroids (ICS) for asthma and to compare these to early morning salivary cortisol (EMSC) and cortisone (EMSCn) levels.</p> </sec> <sec id="cen12302-sec-0002" sec-type="section"> <title>Design</title> <p>Early morning salivary cortisol and EMSCn samples were collected for three consecutive days. On day three, Synacthen 500 ng/1·73 m<sup>2</sup> was administered intravenously. Samples were collected at 0, 15, 25, 35 min.</p> </sec> <sec id="cen12302-sec-0003" sec-type="section"> <title>Results</title> <p>A total of 269 subjects (160 M: 109 F), median (range) age 10·0 (5·1–15·2) years were studied. Peak cortisol in the LDSST was <500 nmol/l in 101 subjects (37·5%) and <350 nmol/l in 12 subjects (4·5%). Basal cortisol correlated with peak cortisol: <italic>r</italic> = 0·55, (95% CI: 0·46, 0·63, <italic>P</italic> < 0·0001). Time at which peak cortisol concentration was achieved was significantly related to the value of peak cortisol (<italic>P</italic> < 0·0001), with higher cortisol peaks occurring later in the test and lower cortisol peaks occurring earlier. EMSC and EMSCn had no predictive value for the identification of patients with a peak cortisol <500 nmol/l. EMSCn was superior to EMSC in identifying patients with a peak cortisol <350 nmol/l: a minimum EMSCn cut‐off value of 12·5 nmol/l gave a negative predictive value of 99·2% and positive predictive value of 30·1%.</p> </sec> <sec id="cen12302-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Our data illustrate that basal measures of cortisol are likely to be of value in screening populations for patients at greatest risk of adrenal crisis. EMSCn shows promise as a screening tool for the identification of patients with severe adrenal insufficiency.</p> </sec> </abstract>