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Salivary cortisol and cortisone can circumvent confounding effects of oral contraceptives in the short synacthen test
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.ORCID iD: 0000-0003-2110-4602
Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.ORCID iD: 0000-0001-7765-0413
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.ORCID iD: 0000-0001-8608-0168
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.ORCID iD: 0009-0007-5476-1525
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2024 (English)In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 109, no 7, p. 1899-1906Article in journal (Refereed) Published
Abstract [en]

Context: Adrenal insufficiency (AI) is usually diagnosed by low plasma cortisol levels following a short Synacthen test (SST). Most plasma cortisol is bound to corticosteroid-binding globulin, which is increased by estrogen in combined estrogen-progestin oral contraceptives (COCs). Women with AI using COCs are therefore at risk of having an apparently normal plasma cortisol level during SST, which would not adequately reflect AI.

Objective: To test whether salivary cortisol or cortisone during SST is more robust against the COC effect and to calculate the lower reference limits (LRLs) for these to be used as tentative diagnostic cutoffs to exclude AI.

Methods: Forty-one healthy women on COCs and 46 healthy women without exogenous estrogens performed an SST with collection of plasma and salivary samples at 0, 30, and 60 min after Synacthen injection. The groups were compared using regression analysis with age as covariate and the LRLs were calculated parametrically.

Results: SST-stimulated plasma cortisol levels were significantly higher in the COC group versus controls, while mean salivary cortisol and cortisone levels were slightly lower in the COC group. Importantly, COC use did not significantly alter LRLs for salivary cortisol or cortisone. The smallest LRL difference between groups was seen for salivary cortisone.

Conclusion: Salivary cortisol and especially salivary cortisone are considerably less affected by COC use than plasma cortisol during SST. Due to similar LRLs, a common cutoff for salivary cortisol and cortisone during SST can be used to exclude AI in premenopausal women irrespective of COC use.

Place, publisher, year, edition, pages
Oxford University Press, 2024. Vol. 109, no 7, p. 1899-1906
Keywords [en]
short Synacthen test, salivary cortisol, salivary cortisone, oral contraceptives, adrenal insufficiency, reference limits
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:umu:diva-222629DOI: 10.1210/clinem/dgad763ISI: 001140071500001PubMedID: 38173358Scopus ID: 2-s2.0-85196301347OAI: oai:DiVA.org:umu-222629DiVA, id: diva2:1846528
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Region VästerbottenUmeå UniversityAvailable from: 2024-03-22 Created: 2024-03-22 Last updated: 2024-07-02Bibliographically approved

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Bäcklund, NilsLundstedt, StaffanTornevi, AndreasWihlbäck, Anna-CarinOlsson, TommyDahlqvist, PerBrattsand, Göran

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