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. 2018 Sep 1;7(9):965-974.
doi: 10.1530/EC-18-0257.

Improved salivary cortisol rhythm with dual-release hydrocortisone

Filippo Ceccato, Elisa Selmin, Chiara Sabbadin, Miriam Dalla Costa, Giorgia Antonelli, Mario Plebani, Mattia Barbot, Corado Betterle, Marco Boscaro, Carla Scaroni

Improved salivary cortisol rhythm with dual-release hydrocortisone

Filippo Ceccato et al. Endocr Connect. .

Abstract

Introduction and aim: The purpose of replacement therapy in adrenal insufficiency (AI) is mimicking endogenous cortisol levels as closely as possible: dual release hydrocortisone (DR-HC) has been introduced to replicate the circadian cortisol rhythm. Multiple daily saliva collections could be used to assess the cortisol rhythm during real life: our aim was to study the salivary cortisol profile in AI.

Materials and methods: We prospectively evaluated, in an observational study, 18 adult outpatients with AI (11 primary and 7 secondary AI), switched from conventional treatment (conv-HC, 25 mg/day) to the same dose of DR-HC. We collected six samples of saliva in a day, measuring cortisol (F) and cortisone (E) with LC-MS/MS. Forty-three matched healthy subjects served as controls.

Results: F levels were similar in the morning (and higher than controls) in patients treated with conv-HC or DR-HC; otherwise F levels and exposure were lower in the afternoon and evening in patients with DR-HC, achieving a cortisol profile closer to healthy controls. Daily cortisol exposure, measured with area under the curve, was lower with DR-HC. Morning F and E presented sensitivity and specificity >90% to diagnose AI (respectively threshold of 3 and 9.45 nmol/L). Total cholesterol and HbA1c levels reduced with DR-HC.

Conclusions: Salivary cortisol daily curve could be used as a new tool to assess the cortisol profiles in patients treated with conv-HC and DR-HC. A lower daily cortisol exposure was achieved with DR-HC (despite the same HC dose), especially in the afternoon-evening.

Keywords: salivary cortisol; adrenal insufficiency; glucocorticoid therapy; cortisol rhythm; dual-release hydrocortisone.

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Figures

Figure 1
Figure 1
Salivary cortisol (F) and cortisone (E) rhythm in patients with conv-HC (black line) and DR-HC (grey solid line), compared to healthy controls (grey area is included between the 10th and 90th percentile of controls, dotted grey line represents the median).
Figure 2
Figure 2
Spaghetti plot of salivary cortisol (F) and cortisone (E) rhythm in patients with conv-HC and DR-HC.
Figure 3
Figure 3
Linear regression (black dotted line) among cortisol or cortisone daily exposure (in term of AUC) and GC dose. Each dot represents a patient.
See this image and copyright information in PMC

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