Blood Sciences, Royal Wolverhampton NHS Trust, Wolverhampton, UK.
Endocrinology and Diabetes, Royal Wolverhampton NHS Trust, Wolverhampton, UK.
Ann Clin Biochem. 2020 Nov;57(6):456-460. doi: 10.1177/0004563220961745. Epub 2020 Oct 13.
The 0.25 mg short synacthen test is used to assess recovery from hypothalamic-pituitary-adrenal suppression due to chronic glucocorticoid administration. We assessed the potential role of salivary cortisol and cortisone in predicting hypothalamic-pituitary-adrenal function using the short synacthen test as the gold standard test.
Between 09:00 and 10:30, salivary and blood samples were collected just prior to a short synacthen test to assess hypothalamic-pituitary-adrenal axis recovery in patients previously treated with oral glucocorticoids. The cut-off for a normal short synacthen test was a 30-min cortisol ≥450 nmol/L.
Fifty-six short synacthen tests were performed on 47 patients. Of these, 15 were normal. The area under receiver operating characteristic curves for serum cortisol, salivary cortisone and salivary cortisol were 0.772, 0.785 and 0.770, respectively. From the receiver operating characteristic analysis, the cut-offs for baseline serum cortisol (≥365 nmol/L) and salivary cortisone (≥37.2 nmol) predicted hypothalamic-pituitary-adrenal axis recovery with 100% specificity in 26.7% of pass short synacthen tests, whereas salivary cortisol predicted none. Baseline serum cortisol (≤170 nmol/L), salivary cortisone (≤9.42 nmol/L) and salivary cortisol (≤1.92 nmol/L) predicted hypothalamic-pituitary-adrenal suppression with 100% sensitivity in 58.5%, 53.7% and 51.2% of failed short synacthen tests, respectively. Using these cut-offs, baseline serum cortisol, salivary cortisone and salivary cortisol could reduce the need for short synacthen tests by 50%, 46% and 37%, respectively.
Although marginally inferior to early morning serum cortisol, early morning salivary cortisone may be used as a first-line test for assessing hypothalamic-pituitary-adrenal function. We plan to incorporate salivary cortisone into a home-based patient pathway to identify patients with hypothalamic-pituitary-adrenal recovery, continuing hypothalamic-pituitary-adrenal suppression and those who require a short synacthen test.
0.25 毫克短 Synacthen 试验用于评估因慢性糖皮质激素治疗而导致的下丘脑-垂体-肾上腺抑制的恢复情况。我们使用短 Synacthen 试验作为金标准测试，评估唾液皮质醇和皮质酮在预测下丘脑-垂体-肾上腺功能中的潜在作用。
在 09:00 至 10:30 之间，在短 Synacthen 试验前采集唾液和血液样本，以评估先前接受口服糖皮质激素治疗的患者的下丘脑-垂体-肾上腺轴恢复情况。正常短 Synacthen 试验的截止值为 30 分钟皮质醇≥450 nmol/L。
对 47 例患者进行了 56 次短 Synacthen 试验，其中 15 次为正常。血清皮质醇、唾液皮质酮和唾液皮质醇的受试者工作特征曲线下面积分别为 0.772、0.785 和 0.770。根据接收者操作特征分析，基础血清皮质醇（≥365 nmol/L）和唾液皮质酮（≥37.2 nmol）的截止值可在 26.7%的短 Synacthen 试验中预测下丘脑-垂体-肾上腺轴恢复，特异性为 100%，而唾液皮质醇则不能预测。基础血清皮质醇（≤170 nmol/L）、唾液皮质酮（≤9.42 nmol/L）和唾液皮质醇（≤1.92 nmol/L）在 58.5%、53.7%和 51.2%的失败短 Synacthen 试验中可预测下丘脑-垂体-肾上腺抑制，敏感性为 100%。使用这些截止值，基础血清皮质醇、唾液皮质酮和唾液皮质醇可分别减少 50%、46%和 37%的短 Synacthen 试验需求。
尽管略低于清晨血清皮质醇，但清晨唾液皮质酮可作为评估下丘脑-垂体-肾上腺功能的一线检测方法。我们计划将唾液皮质酮纳入基于家庭的患者途径，以识别下丘脑-垂体-肾上腺恢复的患者、持续的下丘脑-垂体-肾上腺抑制以及需要进行短 Synacthen 试验的患者。
