Use of salivary cortisol and cortisone in the high and low dose synacthen test

Abstract

Context

Salivary cortisone reflects serum cortisol levels, is more sensitive than salivary cortisol at lower values of serum cortisol and is non-invasive.

Objective

To investigate the relationship between serum cortisol and salivary cortisol and cortisone following low and high-dose synacthen.

Design and Setting

Prospective pharmacodynamic studies in clinical research facilities.

Participants and Intervention

35 dexamethasone-suppressed, healthy adult males underwent an intravenous synacthen test: N=23 low-dose (1mcg), N=12 high-dose (250mcg). Paired serum and salivary samples were taken at 15 sampling points over 120 minutes.

Main outcome measure

Serum cortisol and salivary cortisol and cortisone were analyzed for correlations and by a mixed effects model.

Results

At baseline the correlation between serum cortisol and salivary cortisol was weak with many samples undetectable (r=0.45, NS), but there was a strong correlation with salivary cortisone (r=0.94, p<0.001). Up to 50 minutes following synacthen the correlation coefficient between serum cortisol and salivary cortisol and cortisone was <0.8, but both had a stronger correlation at 60 minutes (salivary cortisol r=0.89, p<0.001, salivary cortisone r=0.85, p<0.001). The relationship was examined excluding samples in the dynamic phase (baseline to 60 minutes). Salivary cortisol and cortisone showed a close relationship to serum cortisol. Salivary cortisone showing the stronger correlation: Salivary cortisol r=0.82, p<0.001, salivary cortisone r=0.96, p<0.001.

Conclusion

Following synacthen, both salivary cortisol and cortisone reflect serum cortisol levels but there is a lag in their rise up to 60mins. The results support further research for possible future use of a 60min salivary cortisone measurement during the synacthen test.

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