Assessment of adrenal function in patients with end stage renal disease through salivary steroids in response to low-dose ACTH test

ARREGGER AL, CARDOSO EM, TUMILASCIO OR, CANALIS M, CASTIGLIONE E, CONTRERAS LN

Boston, USA

Congreso; The Endocrine Society's 88 th Annual Meeting; 2006

Endocrine Society

  Adrenal dysfunction is not uncommon among hypotensive patients with end stage renal disease on dialysis (ESRD) (1). ACTH stimulation test with conventional dose (250 µg) may mask subtle adrenal deficiencies (2). The aim of this study was to investigate the response of salivary cortisol (SAF) and salivary aldosterone (SAL)   to low dose ACTH test (LDT) in hypotensive ESRD patients. For this purpose we studied 24 ESRD (16 female and 8 male) with systolic blood pressure lower than 100 mmHg.  Twenty one healthy subjects were studied as controls (C). Baseline blood and whole saliva  samples were obtained at 8 a.m. from all individuals. Saliva was collected after 30 minutes of an intramuscular injection of 25 g of synthetic ACTH as previously described (2). SAF (nmol/L) and SAL (pmol/L) were assessed by RIA in all saliva samples (3).  Plasma ACTH and renin were assessed in blood by IRMA to confirm  the origin of adrenal disfunction. Results: in C SAF and SAL levels reached values ≥20 nmol/L and ≥100 pmol/L at 30 minutes after ACTH, respectively.  In ESRD salivary steroid responses at 30´ were: a) not different than C in 8 patients (SAF: 62.7 ± 39.9 nmol/L, p=0.075  and SAL: 237.5±233.7.pmol/L, p =0.731) b) lower than C in two (SAF: 5.6±1.9 nmol/L, p=0.025 and SAL: 51.7±54.9 pmol/L, p=0.025); c) lower in SAF (8.4±7.9 nmol/L, p=0.025) and not different in SAL (175.0±7.0 pmol/L p=0.701) in two; d) not different in SAF (38.7±27.7 nmol/L, p=0.553) and lower in  SAL (13.7± 0.2 pmol/L, p=0.002 ) in four ESRD and e) not different in SAF (34.0±11.8 nmol/L p=0.296) associated to high basal SAL (260.0±212.3 pmol/L p<0.001) in eight ESRD. Conclusion: 8 out of 24 ESRD showed abnormal steroid responses to LDT. Primary adrenal insufficiency was confirmed in 2 ESRD while secondary adrenal insufficiency and selective hypoaldosteronism were further diagnosed in 2 and 4, respectively. Eight ESRD showed physiological aldosterone adaptation to volume depletion. Adrenal function was accurately and easily evaluated through salivary steroids in patients with ESRD.