Plasma, salivary and urinary cortisol levels following physiological and stress doses of hydrocortisone in normal volunteers

Jung, Caroline, Greco, Santo, Nguyen, Hanh H. T., Ho, Jui T., Lewis, John G., Torpy, David J. and Inder, Warrick J. (2014) Plasma, salivary and urinary cortisol levels following physiological and stress doses of hydrocortisone in normal volunteers. BMC Endocrine Disorders, 14 91: 1-10. doi:10.1186/1472-6823-14-91


Author Jung, Caroline
Greco, Santo
Nguyen, Hanh H. T.
Ho, Jui T.
Lewis, John G.
Torpy, David J.
Inder, Warrick J.
Title Plasma, salivary and urinary cortisol levels following physiological and stress doses of hydrocortisone in normal volunteers
Journal name BMC Endocrine Disorders   Check publisher's open access policy
ISSN 1472-6823
Publication date 2014-11-26
Year available 2014
Sub-type Article (original research)
DOI 10.1186/1472-6823-14-91
Open Access Status DOI
Volume 14
Issue 91
Start page 1
End page 10
Total pages 10
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2015
Language eng
Formatted abstract
Background

Glucocorticoid replacement is essential in patients with primary and secondary adrenal insufficiency, but many patients remain on higher than recommended dose regimens. There is no uniformly accepted method to monitor the dose in individual patients. We have compared cortisol concentrations in plasma, saliva and urine achieved following “physiological” and “stress” doses of hydrocortisone as potential methods for monitoring glucocorticoid replacement.

Methods

Cortisol profiles were measured in plasma, saliva and urine following “physiological” (20 mg oral) or “stress” (50 mg intravenous) doses of hydrocortisone in dexamethasone-suppressed healthy subjects (8 in each group), compared to endogenous cortisol levels (12 subjects). Total plasma cortisol was measured half-hourly, and salivary cortisol and urinary cortisol:creatinine ratio were measured hourly from time 0 (between 0830 and 0900) to 5 h. Endogenous plasma corticosteroid-binding globulin (CBG) levels were measured at time 0 and 5 h, and hourly from time 0 to 5 h following administration of oral or intravenous hydrocortisone. Plasma free cortisol was calculated using Coolens’ equation.

Results

Plasma, salivary and urine cortisol at 2 h after oral hydrocortisone gave a good indication of peak cortisol concentrations, which were uniformly supraphysiological. Intravenous hydrocortisone administration achieved very high 30 minute cortisol concentrations. Total plasma cortisol correlated significantly with both saliva and urine cortisol after oral and intravenous hydrocortisone (P <0.0001, correlation coefficient between 0.61 and 0.94). There was no difference in CBG levels across the sampling period.

Conclusions

An oral dose of hydrocortisone 20 mg is supraphysiological for routine maintenance, while stress doses above 50 mg 6-hourly would rarely be necessary in managing acute illness. Salivary cortisol and urinary cortisol:creatinine ratio may provide useful alternatives to plasma cortisol measurements to monitor replacement doses in hypoadrenal patients.
Keyword Adrenal Cortex
HPA axis (hypothalamic-pituitary-adrenal)
Cortisol
Hydrocortisone
Glucocorticoid replacement therapy
Modified release hydrocortisone
Adrenal insufficiency
Addisons disease
Circadian therapy
Cushings syndrome
Serum
Management
Illness
Suppression
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
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