Diagnostic value of salivary cortisol in end stage renal disease

ARREGGER AL, CARDOSO EML, TUMILASCI O, CONTRERAS LN

STEROIDS

Año: 2008 p. 77 - 82

0039-128X

Summary Objectives  Salivary cortisol has been proposed a surrogate marker for free serum cortisol  measurements. The aim of this study was to ascertain the diagnostic value of basal and stimulated salivary cortisol for the detection of adrenal insufficiency (AI) in hypotensive end stage renal disease (ESRD) patients. Basal salivary cortisol  and basal total serum cortisol were studied in order to determine the accuracy of both biomarkers in predicting  AI. Patients and methods Twenty-nine ESRD patients with sustained hypotension were investigated for possible AI. salivary cortisol was assessed at baseline and 30 minutes after 25 mg ACTH i.m. (LDTs). The dosage of salivary aldosterone was performed in salivary cortisol hypo-responders. Basal blood samples were drawn for steroids, renin and ACTH measurements. Results A clear separation between patients with normal and impaired adrenal function was obtained through salivary cortisol levels at 30 minutes after ACTH. AI was detected in six  cases (21%) through impaired salivary cortisol responses; stimulated salivary aldosterone  helped to differentiate primary (n=3) from secondary  AI (n=3). ROC curves showed that cutoff values for basal SAF ¡Ü4.4 nM and serum cortisol ¡Ü232.0 nM suggest AI (sensitivities: 93% and 69%; specificities: 86.4% and 91%, respectively). Conclusions  We conclude that  ACTH stimulated SAF is an accurate  biomarker for the diagnosis of AI in hypotensive ESRD patients. Neither basal salivary cortisol or serum cortisol showed 100% sensitivities for the detection of AI.