Blair Joanne, Adaway Jo, Keevil Brian, Ross Richard
aAlder Hey Children's Hospital, Liverpool bUniversity Hospital South Manchester cManchester Healthcare Academy, Manchester dThe University of Sheffield, Sheffield, UK.
Curr Opin Endocrinol Diabetes Obes. 2017 Jun;24(3):161-168. doi: 10.1097/MED.0000000000000328.
A resurgence of interest in salivary biomarkers has generated evidence for their value in assessing adrenal function. The advantages of salivary measurements include only free hormone is detected, samples can be collected during normal daily routines and stress-induced cortisol release is less likely to occur than during venepuncture. We review the use of salivary biomarkers to diagnose and monitor patients for conditions of cortisol excess and deficiency and discuss the value of measuring salivary cortisone versus salivary cortisol.
Developments in laboratory techniques have enabled the measurement of salivary hormones with a high level of sensitivity and specificity. In states of altered cortisol binding, salivary biomarkers are more accurate measures of adrenal reserve than serum cortisol. Salivary cortisone is a superior marker of serum cortisol compared with salivary cortisol, specifically when serum cortisol is low and during hydrocortisone therapy when contamination of saliva may result in misleading salivary cortisol concentrations.
Salivary cortisol and cortisone can be used to assess cortisol excess, deficiency and hydrocortisone replacement, with salivary cortisone having the advantage of detection when serum cortisol levels are low and there is no interference from oral hydrocortisone.
对唾液生物标志物的兴趣再度兴起，已产生证据证明其在评估肾上腺功能方面的价值。唾液检测的优势包括仅检测游离激素、样本可在日常活动中采集，且与静脉穿刺相比，应激诱导的皮质醇释放不太可能发生。我们综述了唾液生物标志物在诊断和监测皮质醇过多和缺乏症患者中的应用，并讨论了测量唾液可的松与唾液皮质醇的价值。
实验室技术的发展使得能够以高灵敏度和特异性测量唾液激素。在皮质醇结合改变的状态下，唾液生物标志物比血清皮质醇更能准确测量肾上腺储备。与唾液皮质醇相比，唾液可的松是血清皮质醇的更好标志物，特别是当血清皮质醇水平较低时，以及在氢化可的松治疗期间，此时唾液污染可能导致唾液皮质醇浓度产生误导。
唾液皮质醇和可的松可用于评估皮质醇过多、缺乏以及氢化可的松替代情况，唾液可的松具有在血清皮质醇水平较低且无口服氢化可的松干扰时进行检测的优势。
