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Measurement of Salivary Cortisol Concentration in the Assessment of Adrenal Function in Critically Ill Subjects


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Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2007-0181

The Journal of Clinical Endocrinology & Metabolism Vol. 92, No. 8 2965-2971

Copyright ? 2007 by The Endocrine Society


Measurement of Salivary Cortisol Concentration in the Assessment of Adrenal Function in Critically Ill Subjects: A Surrogate Marker of the Circulating Free Cortisol

Baha M. Arafah, Fumie J. Nishiyama, Haytham Tlaygeh and Rana Hejal


Divisions of Clinical and Molecular Endocrinology (B.M.A., F.J.N.) and Pulmonary and Critical Care Medicine (H.T., R.H.), University Hospitals/Case Medical Center and Case Western Reserve University, Cleveland, Ohio 44106


Address all correspondence and requests for reprints to: Baha M. Arafah, M.D., Division of Clinical and Molecular Endocrinology, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, Ohio 44106. E-mail: baha.arafah@case.edu.


Methods: Baseline and cosyntropin-stimulated serum (total and free) and salivary cortisol concentrations were measured, in the early afternoon, in 51 critically ill patients and healthy subjects. Patients were stratified according to their serum albumin at the time of testing: those whose serum albumin levels were 2.5 gm/dl or less vs. others whose levels were greater than 2.5 gm/dl.


Results: Baseline and cosyntropin-stimulated serum free cortisol levels were similar in the two groups of critically ill patients and were severalfold higher (P


Conclusions: Salivary cortisol measurements are simple to obtain, easy to measure in most laboratories, and provide an indirect yet reliable and practical assessment of the serum free cortisol concentrations during critical illnesses. The concentrations of the two measures of unbound cortisol determined in two different body fluids correlated very well, regardless of the serum protein concentrations. Measurements of salivary cortisol can serve as a surrogate marker for the free cortisol in the circulation.

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Hi Mary,


I know the point of this research is to confirm the utility and usefulness of salivary tests, it is good to know that at least in this scenario the salivary and serum values correlated, but something else came to my mind as well. I recently ask a doctor if my elevated UFC's could be related to something other than a tumor (although I have those as well), perhaps some type of inflammatory process and he said no. When I read this I didn't get the impression that suspicion of endocrine problems was part of the criteria for testing, just that the patient had to be critically ill for whatever reason.


It doesn't seem to me to be a huge reach to conclude that cortisol is part of the body's response to critical illness. I think that is a given. But, it might explain why sometimes it is so difficult to hang the hypercortisolism on a tumor.



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