Low-dose Synachten test with measurement of salivary cortisol in adult patients with β-thalassemia major

Research output: Contribution to journalArticle

Abstract

PURPOSE: Beta-thalassemia major is a severe, congenital hematological disorder and, if untreated, leads to early mortality. Progress in therapeutical strategies improved clinical outcomes and life expectancy; however, increased survival led to the development of new disorders, including endocrinopathies. Little is known on the possible impairment of adrenocortical function, a potentially life-threatening condition, in long-term thalassaemic survivors. We therefore decided to assess adrenal reserve and the value of salivary cortisol during ACTH stimulation in the diagnosis of adrenocortical insufficiency in adult patients with β-thalassemia major.

METHODS: Cross-sectional study including 72 adults with β-thalassemia major. Patients were tested with 1 µg ACTH for serum and salivary cortisol.

RESULTS: Subnormal serum cortisol responses to ACTH stimulation (i.e., <500 nmol/l) were registered in 15 out of 72 patients. Salivary cortisol increased in parallel with serum cortisol and a clear-cut positive correlation was detected at each timepoint. Moreover, peak salivary cortisol values after ACTH stimulation were significantly lower in patients with impaired adrenal reserve (513.6 ± 52.33 vs. 914.1 ± 44.04 nmol/l p < 0.0001).

CONCLUSIONS: Our results attest to the need for testing for adrenal insufficiency among adult thalassaemic patients, as up to 20% presented impaired adrenal reserve. Salivary and serum cortisol levels during stimulation with ACTH were closely correlated and the use of salivary cortisol sampling during ACTH testing may represent a surrogate to serum cortisol in these patients.

Original languageEnglish
Pages (from-to)348-354
Number of pages7
JournalEndocrine
Volume60
Issue number2
DOIs
Publication statusPublished - May 2018

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beta-Thalassemia
Hydrocortisone
Adrenocorticotropic Hormone
Serum
Congenital, Hereditary, and Neonatal Diseases and Abnormalities
Adrenal Insufficiency
Life Expectancy
Survivors
Cross-Sectional Studies
Survival
Mortality

Keywords

  • Adrenal Insufficiency/diagnosis
  • Adrenocorticotropic Hormone
  • Adult
  • Cross-Sectional Studies
  • Female
  • Humans
  • Hydrocortisone/blood
  • Italy/epidemiology
  • Male
  • Middle Aged
  • Prevalence
  • Saliva/chemistry
  • Young Adult
  • beta-Thalassemia/complications

Cite this

@article{3e15af8811e746c791c9795f90667288,
title = "Low-dose Synachten test with measurement of salivary cortisol in adult patients with β-thalassemia major",
abstract = "PURPOSE: Beta-thalassemia major is a severe, congenital hematological disorder and, if untreated, leads to early mortality. Progress in therapeutical strategies improved clinical outcomes and life expectancy; however, increased survival led to the development of new disorders, including endocrinopathies. Little is known on the possible impairment of adrenocortical function, a potentially life-threatening condition, in long-term thalassaemic survivors. We therefore decided to assess adrenal reserve and the value of salivary cortisol during ACTH stimulation in the diagnosis of adrenocortical insufficiency in adult patients with β-thalassemia major.METHODS: Cross-sectional study including 72 adults with β-thalassemia major. Patients were tested with 1 µg ACTH for serum and salivary cortisol.RESULTS: Subnormal serum cortisol responses to ACTH stimulation (i.e., <500 nmol/l) were registered in 15 out of 72 patients. Salivary cortisol increased in parallel with serum cortisol and a clear-cut positive correlation was detected at each timepoint. Moreover, peak salivary cortisol values after ACTH stimulation were significantly lower in patients with impaired adrenal reserve (513.6 ± 52.33 vs. 914.1 ± 44.04 nmol/l p < 0.0001).CONCLUSIONS: Our results attest to the need for testing for adrenal insufficiency among adult thalassaemic patients, as up to 20{\%} presented impaired adrenal reserve. Salivary and serum cortisol levels during stimulation with ACTH were closely correlated and the use of salivary cortisol sampling during ACTH testing may represent a surrogate to serum cortisol in these patients.",
keywords = "Adrenal Insufficiency/diagnosis, Adrenocorticotropic Hormone, Adult, Cross-Sectional Studies, Female, Humans, Hydrocortisone/blood, Italy/epidemiology, Male, Middle Aged, Prevalence, Saliva/chemistry, Young Adult, beta-Thalassemia/complications",
author = "Ambrogio, {Alberto G} and Leila Danesi and Marina Baldini and Raffaella Radin and Elena Cassinerio and Giovanna Graziadei and Nadia Mirra and Emanuela D'Angelo and Alessia Marcon and Marta Mancarella and Alessandra Orsatti and Federico Bonetti and Massimo Scacchi and Cappellini, {Maria Domenica} and Luca Persani and {Pecori Giraldi}, Francesca",
year = "2018",
month = "5",
doi = "10.1007/s12020-018-1562-z",
language = "English",
volume = "60",
pages = "348--354",
journal = "Endocrine",
issn = "1355-008X",
publisher = "Humana Press Inc.",
number = "2",

}

TY - JOUR

T1 - Low-dose Synachten test with measurement of salivary cortisol in adult patients with β-thalassemia major

AU - Ambrogio, Alberto G

AU - Danesi, Leila

AU - Baldini, Marina

AU - Radin, Raffaella

AU - Cassinerio, Elena

AU - Graziadei, Giovanna

AU - Mirra, Nadia

AU - D'Angelo, Emanuela

AU - Marcon, Alessia

AU - Mancarella, Marta

AU - Orsatti, Alessandra

AU - Bonetti, Federico

AU - Scacchi, Massimo

AU - Cappellini, Maria Domenica

AU - Persani, Luca

AU - Pecori Giraldi, Francesca

PY - 2018/5

Y1 - 2018/5

N2 - PURPOSE: Beta-thalassemia major is a severe, congenital hematological disorder and, if untreated, leads to early mortality. Progress in therapeutical strategies improved clinical outcomes and life expectancy; however, increased survival led to the development of new disorders, including endocrinopathies. Little is known on the possible impairment of adrenocortical function, a potentially life-threatening condition, in long-term thalassaemic survivors. We therefore decided to assess adrenal reserve and the value of salivary cortisol during ACTH stimulation in the diagnosis of adrenocortical insufficiency in adult patients with β-thalassemia major.METHODS: Cross-sectional study including 72 adults with β-thalassemia major. Patients were tested with 1 µg ACTH for serum and salivary cortisol.RESULTS: Subnormal serum cortisol responses to ACTH stimulation (i.e., <500 nmol/l) were registered in 15 out of 72 patients. Salivary cortisol increased in parallel with serum cortisol and a clear-cut positive correlation was detected at each timepoint. Moreover, peak salivary cortisol values after ACTH stimulation were significantly lower in patients with impaired adrenal reserve (513.6 ± 52.33 vs. 914.1 ± 44.04 nmol/l p < 0.0001).CONCLUSIONS: Our results attest to the need for testing for adrenal insufficiency among adult thalassaemic patients, as up to 20% presented impaired adrenal reserve. Salivary and serum cortisol levels during stimulation with ACTH were closely correlated and the use of salivary cortisol sampling during ACTH testing may represent a surrogate to serum cortisol in these patients.

AB - PURPOSE: Beta-thalassemia major is a severe, congenital hematological disorder and, if untreated, leads to early mortality. Progress in therapeutical strategies improved clinical outcomes and life expectancy; however, increased survival led to the development of new disorders, including endocrinopathies. Little is known on the possible impairment of adrenocortical function, a potentially life-threatening condition, in long-term thalassaemic survivors. We therefore decided to assess adrenal reserve and the value of salivary cortisol during ACTH stimulation in the diagnosis of adrenocortical insufficiency in adult patients with β-thalassemia major.METHODS: Cross-sectional study including 72 adults with β-thalassemia major. Patients were tested with 1 µg ACTH for serum and salivary cortisol.RESULTS: Subnormal serum cortisol responses to ACTH stimulation (i.e., <500 nmol/l) were registered in 15 out of 72 patients. Salivary cortisol increased in parallel with serum cortisol and a clear-cut positive correlation was detected at each timepoint. Moreover, peak salivary cortisol values after ACTH stimulation were significantly lower in patients with impaired adrenal reserve (513.6 ± 52.33 vs. 914.1 ± 44.04 nmol/l p < 0.0001).CONCLUSIONS: Our results attest to the need for testing for adrenal insufficiency among adult thalassaemic patients, as up to 20% presented impaired adrenal reserve. Salivary and serum cortisol levels during stimulation with ACTH were closely correlated and the use of salivary cortisol sampling during ACTH testing may represent a surrogate to serum cortisol in these patients.

KW - Adrenal Insufficiency/diagnosis

KW - Adrenocorticotropic Hormone

KW - Adult

KW - Cross-Sectional Studies

KW - Female

KW - Humans

KW - Hydrocortisone/blood

KW - Italy/epidemiology

KW - Male

KW - Middle Aged

KW - Prevalence

KW - Saliva/chemistry

KW - Young Adult

KW - beta-Thalassemia/complications

U2 - 10.1007/s12020-018-1562-z

DO - 10.1007/s12020-018-1562-z

M3 - Article

VL - 60

SP - 348

EP - 354

JO - Endocrine

JF - Endocrine

SN - 1355-008X

IS - 2

ER -