Salivary cortisol as a tool for physiological studies and diagnostic strategies.

Salivary cortisol is an index of plasma free cortisol and is obtained by a noninvasive procedure. We have been using salivary cortisol as a tool for physiological and diagnostic studies, among them the emergence of circadian rhythm in preterm and term infants. The salivary cortisol circadian rhythm in term and premature infants was established between 8 and 12 postnatal weeks. In the preterm infants the emergence of circadian rhythm was parallel to the onset of sleep rhythm. We also studied the use of salivary cortisol for screening for Cushing's syndrome (CS) in control and obese outpatients based on circadian rhythm and the overnight 1 mg dexamethasone (DEX) suppression test. Salivary cortisol was suppressed to less than 100 ng/dl after 1 mg DEX in control and obese patients. A single salivary cortisol measurement at 23:00 h and again after 1 mg DEX above the 90th percentile of the obese group values had sensitivity and specificity of 93 and 93% (23:00 h), and 91 and 94% (after DEX), respectively. The sensitivity improved to 100% when we combined both parameters. We also studied 11 CS children and 21 age-matched primary obese children for whom salivary cortisol sensitivity and specificity were 100/95% (23:00 h), and 100/95% (1 mg DEX), respectively. Similar to adults, sensitivity and specificity of 100% were obtained by combining 23:00 h and 1 mg DEX. The measurement of salivary cortisol is a useful tool for physiological studies and for the diagnosis of CS in children and adults on an outpatient basis.

[1]  I. McMillen,et al.  Development of Circadian Sleep-Wake Rhythms in Preterm and Full-Term Infants , 1991, Pediatric Research.

[2]  B. Fielding,et al.  Age of appearance of circadian rhythm in salivary cortisol values in infancy. , 1983, Archives of disease in childhood.

[3]  H. Raff,et al.  Diagnosis and differential diagnosis of Cushing's syndrome. , 2001, Endocrinology and metabolism clinics of North America.

[4]  J. Doppman,et al.  Biochemical and radiologic diagnosis of Cushing's syndrome. , 1994, Endocrinology and metabolism clinics of North America.

[5]  Out-patient screening for Cushing's syndrome: the sensitivity of the combination of circadian rhythm and overnight dexamethasone suppression salivary cortisol tests. , 1999, The Journal of clinical endocrinology and metabolism.

[6]  A. Moreira,et al.  Food and the circadian activity of the hypothalamic-pituitary-adrenal axis. , 1997, Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas.

[7]  A. Moreira,et al.  Longitudinal evaluation of the development of salivary cortisol circadian rhythm in infancy , 1996, Clinical endocrinology.

[8]  M. Shimada,et al.  Development of the Sleep and Wakefulness Rhythm in Preterm Infants Discharged from a Neonatal Care Unit , 1993, Pediatric Research.

[9]  D. Orth.  Differential diagnosis of Cushing's syndrome. , 1991, The New England journal of medicine.

[10]  D. Igoe,et al.  THE OVERNIGHT DEXAMETHASONE TEST IS A WORTHWHILE SCREENING PROCEDURE , 1990, Clinical endocrinology.

[11]  L. N. Contreras,et al.  Urinary cortisol in the assessment of pituitary-adrenal function: utility of 24-hour and spot determinations. , 1986, The Journal of clinical endocrinology and metabolism.

[12]  R. Walker,et al.  Adrenal status assessed by direct radioimmunoassay of cortisol in whole saliva or parotid saliva. , 1978, Clinical chemistry.

[13]  J. Marcondes,et al.  Salivary cortisol for the evaluation of Cushing's syndrome. , 1985, Clinica chimica acta; international journal of clinical chemistry.

[14]  R. Boyar,et al.  Circadian cortisol secretory rhythms in Cushing's disease. , 1979, The Journal of clinical endocrinology and metabolism.

[15]  D. Papanicolaou,et al.  A single midnight serum cortisol measurement distinguishes Cushing's syndrome from pseudo-Cushing states. , 1998, The Journal of clinical endocrinology and metabolism.

[16]  G. Benda,et al.  Variability of Plasma Cortisol Levels in Extremely Low Birth Weight Infants , 1997 .

[17]  Hiramatsu Ryoji,et al.  Use of saliva for monitoring unbound free cortisol levels in serum , 1981 .

[18]  A. Vagenakis,et al.  Diurnal Variation of Plasma Cortisol Levels in Infancy , 1998, Journal of pediatric endocrinology & metabolism : JPEM.

[19]  P. Thomopoulos,et al.  Evening urinary free corticoids: a screening test in Cushing's syndrome and incidentally discovered adrenal tumours. , 1988, Acta endocrinologica.

[20]  A. Moreira,et al.  Salivary cortisol for screening of Cushing's syndrome in children , 1999, Clinical endocrinology.

[21]  W. Winkelmann,et al.  DIAGNOSIS OF CUSHING'S SYNDROME , 1969 .

[22]  A. Moreira,et al.  The emergence of salivary cortisol circadian rhythm and its relationship to sleep activity in preterm infants , 2000, Clinical endocrinology.

[23]  A. Grossman,et al.  A single sleeping midnight cortisol has 100% sensitivity for the diagnosis of Cushing's syndrome , 1995, Clinical endocrinology.

[24]  A. Grossman,et al.  Investigation, management and therapeutic outcome in 12 cases of childhood and adolescent Cushing's syndrome , 1995, Clinical endocrinology.

[25]  D. Papanicolaou,et al.  A Single Midnight Serum Cortisol Measurement Distinguishes Cushing’s Syndrome from Pseudo-Cushing States , 1998 .

[26]  J. Doppman,et al.  Cushing's syndrome in children and adolescents. Presentation, diagnosis, and therapy. , 1994, The New England journal of medicine.

[27]  J. Liu,et al.  Characterization of the twenty-four hour secretion patterns of adrenocorticotropin and cortisol in normal women and patients with Cushing's disease. , 1987, The Journal of clinical endocrinology and metabolism.

[28]  G. Beall,et al.  AEROSOLIZED STEROIDS AND INDUCED CUSHING'S SYNDROME. , 1965, Archives of internal medicine.

[29]  M. Mirmiran,et al.  Circadian rhythms in early human development. , 1991, Early human development.

[30]  J. Luton,et al.  [Cushing's disease]. , 1996, La Revue du praticien.

[31]  K. Watterberg,et al.  Effect of Gestational Age, Postnatal Age, and Illness on Plasma Cortisol Concentrations in Premature Infants , 1995, Pediatric Research.

[32]  R. Caldeyro-barcia,et al.  A simplified method for diagnosis of gestational age in the newborn infant. , 1978, The Journal of pediatrics.

[33]  L. Crapo.  Cushing's syndrome: a review of diagnostic tests. , 1979, Metabolism: clinical and experimental.

[34]  F. H. Tyler,et al.  DIAGNOSIS OF CUSHING'S SYNDROME; SINGLE DOSE DEXAMETHASONE SUPPRESSION TEST. , 1965, Archives of internal medicine.