Salivary Cortisol Values Research Articles

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Introduction: Serum free cortisol level is gaining acceptance as the appropriate marker for critical illness related corticosteroid insufficiency (CIRCI). Cortisol levels in saliva are in equilibrium and correlate well with serum free cortisol. Although, salivary cortisol has been shown to correlate well with serum free cortisol in critically ill adults, no studies have been conducted to establish the relationship in critically ill children. Hypothesis: We hypothesize that salivary cortisol levels in critically ill children correlate with plasma free cortisol levels and can be used as a marker for CIRCI in children. Methods: This is a prospective observational study in which salivary cortisol (Salivette® collection system), serum free cortisol and serum total cortisol were measured simultaneously in 37 critically ill children admitted to a tertiary care Pediatric Intensive care unit. Samples were collected between the hours of 8am and 12 pm and within 24 hours of admission. Patients were excluded if they had bleeding or coagulopathy, abnormal LFT’s, were receiving steroids or had steroids in the last month. Patients who did not have both salivary and serum free cortisol results available were excluded from the statistical analysis (n=17). The association between free and salivary cortisol was estimated using the Pearson correlation coefficient with 95% confidence interval. Results: Salivary and serum free cortisol values from 20 patients had a correlation coefficient (r) of 0.92 (95% Confidence Interval 0.79 – 0.97). The total serum and salivary cortisol values had a correlation coefficient (r) of.76 (95% Confidence interval.45-.90) and the total serum and serum free cortisol values had a correlation coefficient (r) of.86 (95% Confidence interval.64-.94). Conclusions: Serum free and salivary cortisol values correlate in critically ill children. Salivary cortisol is a cost effective and less invasive measure of bioavailable cortisol and offers an alternate and accurate method for assessing CIRCI in children.

Assessment of salivary free cortisol levels by liquid chromatography with tandem mass spectrometry (LC-MS/MS) in patients treated with mitotane

Mitotane is an adrenocytolytic agent used in adrenocortical carcinoma, inducing adrenal insufficiency, requiring replacement treatment. Such therapy is not easy to monitor because of mitotane interference. Salivary cortisol reflects a free fraction of plasma cortisol and may be useful in such patients. The aim of our study was to evaluate salivary cortisol by HPLC coupled to tandem-mass spectrometry (LC-MS/MS) and by an electrochemiluminescence immunoassay (ECLIA) in patients treated with mitotane. We enrolled 6 patients receiving mitotane and 2 Addison disease patients as negative controls and determined salivary cortisol rhythm. We also determined the salivary cortisol rhythm in 8 healthy subjects. Salivary samples (n=112) were assayed by ECLIA, using Roche Modular E170, and by LC-MS/MS. The mean values obtained by ECLIA were significantly higher than those obtained by LC-MS/MS in the mitotane group (p<0.001). In fact, in the group measured by LC-MS/MS, we observed several peaks eluting at a retention time different from the cortisol group, presumably due to cortisol-like analogues. In Addison disease, since steroidogenesis is absent, salivary cortisol values measured by the two methods did not show any significant difference (p=0.61). Salivary cortisol measured by LC-MS/MS is a selective method, excluding cortisol analogues accumulating in treated patients. Therefore, LC-MS/MS offers an effective system to monitor replacement therapy in mitotane treated patients.

Effects of Owner–Dog Relationship and Owner Personality on Cortisol Modulation in Human–Dog Dyads

ABSTRACTThe aim of our study was to examine the influence of dyadic attachment, owner and dog personality, and owner gender on stress hormone dynamics in owner–dog dyads. We hypothesized that owner personality modulates dyadic relationships and, hence, would affect the cortisol levels resulting from acute and chronic stressors. Data were collected during three meetings with 10 male and 12 female owners aged 23–68 years, with their medium-to-large, intact male dogs aged 1.5–6.0 years. These owner-dog dyads were observed and video-taped during different tasks. The NEO-FFI (Five-Factor Inventory) was used to determine owner personality, and questionnaires covering owner–dog relationship and attachment were employed. Salivary cortisol levels were measured from samples collected during the dyads' daily routine and after experimental challenges. It was found that our experimental tasks had little effect on the salivary cortisol levels of either dog or owner except that dogs and male owners showed elevated levels during the first 20 minutes of our visit to their homes. However, owners who scaled high in neuroticism (NEO-FFI dimension 1) or low in conscientiousness (NEO-FFI dimension 5) showed high morning salivary cortisol values, in contrast to their dogs, which were low in morning salivary cortisol. In general, dogs of owners who considered them as being “social partners” and “meaningful companions” showed low morning salivary cortisol values. We conclude that the main individual and dyadic factors for stress coping in owner–dog dyads are owner personality, relationship with the dog, and attachment to the dog, and that relationship had generally a greater effect on dog cortisol levels than our experimental tasks.

Changes in Eye Temperature and Stress Assessment in Horses During Show Jumping Competitions

High stress levels in horses during sporting events can influence the animal’s performance in competitions as well as their welfare. This study investigated the use of infrared thermography (IRT) measurement as a rapid, noninvasive, and accurate method for stress assessment in horses during sport competitions and compared IRT with a commonly used physiological method used for stress assessment and salivary cortisol. IRT and salivary cortisol responses were measured 3 hours before the competition, immediately following the competition, and 3 hours after the competition, each day during the 3 days of a show jumping event. Salivary cortisol values ranged from −0.11 ± 4.51 ng/mL in 5-year-old animals to 1.10 ± 2.20 ng/mL in 4-year-old animals, whereas eye temperature values ranged from 35.84 ± 1.16°C in 6-year-old animals to 36.08 ± 1.11°C in 5-year-old animals. The results obtained suggested that IRT measurements constitute an effective method for detecting stress in horses subjected to the acute events of show jumping.

Cardiovascular, cortisol and coping responses in urban Africans : the SAPBA study

To assess the relationships between progression of target-organ damage and cardiovascular, cortisol and coping responses in black urban Africans. Urban black African gender groups (n = 200) aged 21-62 years from the Sympathetic Activity and Ambulatory Blood Pressure in Africans study were stratified into normotensive and hypertensive groups. Resting and reactivity Finometer blood pressure, fasting sodium fluoride glucose and salivary cortisol values were obtained before and after applying the Stroop and cold pressor tests. Coping strategies were determined and high-resolution ultrasound carotid intima-media scans were done to determine progression of target-organ damage. A trend of high-normal resting cortisol values during sampling time 1 was demonstrated in all hypertensive men. Both hypertensive gender groups showed increased vascular responses during both mental stressors. During the cold pressor test, vascular responses predicted sub-clinical atherosclerosis in all hypertensive men, independent of sampling time. Early morning vascular responses in all the hypertensive men could have occurred secondarily to the permissive effect of cortisol on norepinephrine secretion, with subsequent α-adrenergic vasoconstriction. Their α-adrenergic vascular responses during the cold pressor test, however, predicted sub-clinical atherosclerosis, independent of sampling time and cortisol level.

Salivary cortisol levels as a predictor of preeclampsia in adolescents

Objective: To determine the usefulness of salivary cortisol as a predictor of preeclampsia in adolescents.Methods: We carried out a nested case- control study. Somatometric, clinical, and biochemical data were obtained from 100 healthy pregnant adolescents and salivary cortisol was measured at 8:00, 12:00, and 20:00 hours on twooccasions during pregnancy, before 20 weeks, and after 30 weeks of gestation. The cortisol values between the group of healthy pregnant women and the group that developed preeclampsia were compared by using the Student’s t, Mann-Whitney, and Wilcoxon tests. Also, the ROC curve of cortisol values and the Positive and Negative Predictive values of cortisol were estimated.Results: Values &gt;14.9 nmol/L of cortisol were observed in the group that developed preeclampsia, providing a positive predictive value of 1 (100%). Values &lt;10.1 nmol/L were observed in the control group, the negativepredictive value was 1 (100%). The cutoff point of the ROC curve -before 20 weeks of gestation- in the members of the cohort was 13.9 nmol/L.Conclusions: The salivary cortisol values observed in the two evaluations made to each of the groups showed statistically significant differences between the groups at 8 and 12 hours of the day. The values obtained enable establishing gradients that allow separating the group of healthy women that got ill with preeclampsia from the group that did not develop the illness before week 20. After week 30, the cortisol gradients are established more clearly in the group with preeclampsia and in the control group. The validation of these findings in larger samples would allowimplementing this procedure as a screening test for preeclampsia in groups of pregnant adolescents.

Diagnostic Value of Salivary Cortisol in the CRH Stimulation Test in Premature Infants

According to a recent nationwide survey in Japan, a significant proportion of very low birth weight infants (VLBWI) develop late-onset circulatory collapse after the first week of life. Small doses of glucocorticoid are very effective in these patients, and relative adrenal insufficiency is suspected to be the main cause of the condition. Although the CRH test is required to evaluate the hypothalamic-pituitary-adrenal axis, obtaining multiple blood samples is invasive. The present study was carried out to validate the consistency of the cortisol profiles of matched serum and saliva samples collected as part of the CRH test from VLBWI. In 23 VLBWI with a gestational age of less than 29 wk, we performed CRH tests at 2 wk after birth and at term. Their cortisol values were measured at the baseline and 30 min after the administration of a single dose of human CRH (1 μg/kg) using matched serum and saliva samples. In 26 CRH tests in 19 infants, we were able to measure both serum and salivary cortisol. Significant correlations were detected between the infants' serum and salivary cortisol values (r=0.78; P<0.0001), the increases in these values induced in response to the CRH test (r=0.81; P<0.0001), and their peak serum and salivary cortisol values (r=0.68; P=0.0001). This study indicated that using salivary cortisol measurements for the CRH test could be a reliable method for evaluating the hypothalamic-pituitary-adrenal axis in VLBWI with gestational age of less than 29 wk.

Salivary Cortisol Increases After Bariatric Surgery in Women

Cortisol increases have been associated with psychological and physiological stress; however, cortisol dynamics after weight loss (bariatric) surgery have not been defined. Obese participants not using exogenous glucocorticoids were eligible to participate. Female participants (n=24) provided salivary cortisol samples at bedtime, upon awakening the following morning, and 30 min after awakening before, and at 6 or 12 months after bariatric surgery. The Medical Outcomes Study Short Form-12 version 2 questionnaire regarding health-related quality of life was also completed. Preoperatively, mean body mass index was 45.1±8.1 kg/m2. Mean late night (1.8±1.1 nmol/l), awakening (10.7±7.4 nmol/l), and after-awakening (11.5±7.9 nmol/l) salivary cortisol values were within normal ranges. The cortisol awakening response (mean 21.1±79.7%, median 13.7%) was at the low end of normal. Preoperatively, participants had lower mental and physical health-related quality of life scores than US adult norms (p<0.001). Salivary cortisol was not correlated with measures of health-related quality of life. Mean BMI decreased over time (p<0.001) and participants experienced improved physical and mental health-related quality of life (p≤0.011). Postoperative late night salivary cortisol was not different from preoperative values. Awakening and after-awakening cortisol levels were higher than preoperative values (15.3±7.7 nmol/l, p=0.013; 17.5±10.2 nmol/l, p=0.005; respectively), but the cortisol awakening response was not changed (mean 26.7±66.2%; median 7.8%). Morning salivary cortisol increased at long-term follow-up after bariatric surgery. Although self-evaluated mental and physical health improved after surgery, the cortisol awakening response is at the low end of normal, which may indicate continued physiological stress.

The relationship of salivary and cord blood cortisol inpreterm infants

Recent studies reveal that salivary cortisol measurements accurately reflect blood cortisol levels in older children and adults; yet, the relationship between the two values in premature infants has not been established. This study explores the use of salivary cortisol as an accurate measure of adrenal steroid concentrations in premature infants to provide a reliable and less invasive tool for investigating hormonal stress response. Premature infants (n=51) were recruited, with saliva and blood collected immediately after birth, and cortisol levels measured by radioimmunoassay. A linear relationship emerged between cord plasma and salivary cortisol values in the 102 paired samples [(salivary cortisol) = 0.546 +/- 0.192 x (plasma cortisol), r = 0.481 and p = 0.0003]. Findings demonstrated that salivary and plasma cortisol levels were correlated in premature infants. This information will be useful in future studies that assess use of salivary cortisol to evaluate neonatal stress axis function.

Adrenocortical function in young adults with diabetes mellitus type 1

In 75 young adults with diabetes mellitus type 1 (DM 1) we have performed a cross-sectional study to gain more information about their adrenocortical function. We have found in a surprisingly large portion of patients (25%) a subnormal response (<500 nmol/L, low responders) of the serum cortisol during low-dose Synacthen test, accompanied by significantly decreased stimulated values of aldosterone and salivary cortisol. Basal serum cortisol, aldosterone, and dehydroepiandrosterone sulphate (in women only) were significantly reduced in low responders as well, while ACTH, cortisol binding globulin, plasma renin activity, urinary free cortisol/24 h, and salivary cortisol did not differ. The results indicate that the disorder of adrenocortical function in low responders occurs in all adrenocortical zones. The patients with the highest risk in respect to revealed hypocorticalism were DM 1 with autoimmune thyroiditis, 13 out of 36 in contrast to 5 out of 39 suffered from isolated form of DM 1, with onset around 30 years, independently on sex. The biorhythm of salivary cortisol in low responders under real-life conditions did not significantly differ from normal responders, except of the decreased values in the morning. Antibodies against 21-hydroxylase and adrenal cortex were negative in the entire group of diabetics studied. In conclusion, this is the first study to demonstrate in as much as 25% of young adults with DM 1 patients without any signs of adrenal autoimmunity decreased both basal and stimulated serum cortisol and aldosterone levels, implying existence of subclinical primary hypocorticalism.

Clinical accuracy of midnight salivary cortisol measured by automated electrochemiluminescence immunoassay method in Cushing's syndrome

The diagnosis of Cushing's syndrome (CS) represents a challenge for endocrinologists. Several screening tests are used, but none of them seems to be the gold standard for the diagnosis. The aim of this study was to confirm the diagnostic value of salivary cortisol (SC) as a first-level screening test and to evaluate the clinical performance of a electrochemiluminescence immunoassay (ECLIA) method. In 33 patients with a strong clinical suspicion of CS, we evaluated urinary free cortisol, circadian rhythm plasma cortisol (PC) and morning PC after low-dose dexamethasone suppression test (LDDST). At the same sampling times, we evaluated SC analysed by the same automated method. Correlation studies were evaluated by Spearman index (significance P < 0.05). On the basis of biochemical results CS was confirmed in 21/33. SC was significantly correlated to PC at 12:00 and 23:00. Thus, we chose 8.3 nmol/L as midnight SC cut-off value with 100% sensitivity and 97.4% specificity. The cut-off chosen after LDDST was 1.7 nmol/L (100% sensitivity and 72% specificity). SC assay showed a good clinical accuracy and the ECLIA method can be used in clinical routine to obtain fast results easily.

Salivary Cortisol Concentrations in Healthy Dogs and Dogs with Hypercortisolism

Measurement of salivary cortisol is a useful diagnostic test for hypercortisolism (HC) in humans. To determine whether measurement of salivary cortisol concentration is a practical alternative to plasma cortisol to diagnose HC, to validate the use of salivary cortisol, and to examine the effect of time of day and sampling location on salivary cortisol. Thirty healthy dogs and 6 dogs with HC. Prospective, observational clinical trial including healthy volunteer dogs and dogs newly diagnosed with HC. Salivary and plasma cortisol concentrations were measured with an immunoassay analyzer. Intra- and interassay variability, linearity, and correlation between salivary and plasma cortisol concentrations were determined. The required 300 microL of saliva could not be obtained in 88/326 samples from healthy dogs and in 15/30 samples from dogs with HC. The intra-assay variability for measurement of salivary cortisol was 5-17.7%, the interassay variability 8.5 and 17.3%, and the observed to expected ratio 89-125%. The correlation (r) between salivary and plasma cortisol was 0.98. The time of day and location of collection did not affect salivary cortisol concentrations. Dogs with HC had significantly higher salivary cortisol values than healthy dogs (10.2 +/- 7.3 nmol/L versus 1.54 +/- 0.97 nmol/L; P < .001). The ROCHE Elecsys immunoassay analyzer correctly measured salivary cortisol in dogs. However, a broad clinical application of the method seems limited, because of the large sample volume required.

Cutoff values of midnight salivary cortisol for the diagnosis of overt hypercortisolism are highly influenced by methods

Background Midnight salivary cortisol (MSC) concentration has been considered as a sensitive marker of overt hypercortisolism. Because no studies on commercially available automated, non-isotopic MSC assays have been reported, we determined and compared the diagnostic performance of an automated electrochemiluminescent immunoassay (ECLIA, Elecsys E170) and an in-house radioimmunoassay (RIA) for MSC measurement. Methods The study involved 126 consecutive patients referred for evaluation because of symptoms of Cushing's syndrome, obesity, or the presence of incidentally discovered adrenal adenoma. Using detailed clinical, hormonal and radiological evaluation overt endogenous hypercortisolism was confirmed in 9 patients and was excluded in 117 patients. Results ROC analysis indicated that the best performance of MSC was obtained at cutoff value of 0.35 µg/dl using ECLIA (sensitivity, 100%; specificity, 88%) and 0.29 µg/dl (sensitivity, 100%; specificity, 71%) using RIA. When the findings were compared to those obtained from low dose dexamethasone test, both ECLIA and RIA of MSC showed a better diagnostic performance. Conclusion MSC measurement is useful for the diagnosis of overt hypercortisolism but the cutoff value is highly dependent on the method used. We recommend the use of automated ECLIA for MSC assay, and we propose further studies on other automated immunoassay analyzers potentially suitable for MSC measurements.

Physiological and Psychological Effects of Escape from a Sunken Submarine on Shore and at Sea

The stress effects induced by diverse military scenarios are usually studied under tightly controlled conditions, while only limited research has addressed realistic scenarios. This study was designed to compare the effects of two levels of realism in stressful training for escape from a sunken submarine. Thirteen qualified submariners served as subjects. All had previously participated in underwater escape training using a simulated submarine in a land-based tank submerged at a depth of 6 m; for this study, they repeated the simulator escape, following which six of them executed escape from an actual submarine lying at a depth of 30 m on the sea floor. The men were studied before the exercises, immediately after surfacing, and 2 h later. Measured variables included sympathovagal balance, salivary cortisol, perceived mood, and sleep, as well as short-term and declarative memory. Compared to the simulator exercise in the tank, the escape at sea showed the following significant differences: 1) higher salivary cortisol values (6.33 +/- 3.9 nmol x L(-1) on shore and 13.38 +/- 7.5 nmol x L(-1) at sea); 2) greater adverse changes in mood, including vigor, tension, and ability to fall asleep; and 3) impairment in declarative memory. Responses were found to differ further for the five submariners who had prior experience of accident or injury while at sea. The psychophysiological and cognitive effects of military exercises may be influenced by the realism of conditions and by prior exposure to life-threatening situations.

Simultaneous measurement of cortisol and cortisone in human saliva using liquid chromatography–tandem mass spectrometry: Application in basal and stimulated conditions

Immunoassays used for the measurement of salivary cortisol are limited by variable interference from cortisone. Salivary cortisone is a consequence of the salivary glands expressing 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) which converts cortisol to cortisone. We report a combined salivary cortisol and cortisone (SalF and SalE respectively) liquid chromatography–tandem mass spectrometry (LC–MS/MS) assay to address the cortisone cross-reactivity in cortisol immunoassays and as a tool to study 11β-HSD2 activity. The method was linear up to 400 nmol/L for SalF and 200 nmol/L for SalE and the lower limits of quantitation were 0.39 nmol/L (SalF) and 0.78 nmol/L (SalE). No evidence of ion suppression was found and precision, accuracy and recovery were within internationally accepted limits. No interference was identified from 13 structurally related steroids. SalF, SalE and SalF/SalE were significantly greater in the morning than at bed-time and following stimulation of the adrenal glands. As serum cortisol increased, an exponential rise was observed in SalF and a linear increase in SalE which reached a plateau at higher SalF concentrations. We have developed a novel, robust LC–MS/MS assay for the combined measurement of SalF and SalE. Our results confirm the 11β-HSD2 activity of the salivary glands resulting in high SalE concentrations and the enzyme saturation at high substrate concentrations. This method can be used as a simple, non-invasive and highly specific tool to assess the value of salivary cortisol as a surrogate for free serum cortisol and as a potential novel way to assess 11β-HSD2 activity.

Gender as a determinant of responses to a self-screening questionnaire on anxiety and depression by patients with coronary artery disease

Because patients with coronary artery disease (CAD) could benefit from interventions to decrease psychological distress, it is important to identify these individuals. Both salivary cortisol level and the Hospital Anxiety and Depression Scale (HADS) are recognized measures of stress/anxiety and depression. This study was designed to determine whether there is an association between anxiety and depression, as measured by the HADS, and salivary cortisol levels among patients with CAD, and whether this association is affected by gender. All adult residents of Alberta, Canada, undergoing their first cardiac catheterization for CAD (>or=50% occlusion of >or=2 coronary arteries) were eligible for participation in this study. A 14-question survey (the HADS) and 3 saliva-collection devices (a 1-day supply) were sent to the participants' home within 1 week of their initial cardiac catheterization. Participants were asked to take saliva samples for determination of cortisol levels on waking and at 30 and 60 minutes after waking, and then return the completed questionnaire and saliva samples using a prepaid express mailing envelope. Seventy-one adults (52 men and 19 women) participated in the study. Mean (SD) ages were 68.4 (4.6) years for men and 69.1 (4.4) years for women. Among the women, significant negative correlations were found between the HADS anxiety score and the wake-up and 30-minute cortisol levels (higher HADS scores were associated with lower cortisol levels) (all, P < 0.05). Also among women, negative correlations were found between the HADS depression score and the salivary cortisol values, but the differences were not statistically significant. Conversely, among the men, nonsignificant positive correlations were found between the HADS anxiety scores and the salivary cortisol levels (higher HADS scores were associated with higher cortisol levels), and statistically significant positive correlations were observed between the HADS depression scores and all 3 salivary cortisol values (all, P < 0.05). Our findings suggest that the HADS is an appropriate screening instrument for anxiety and depression in patients with CAD. In particular, the scale appears to be sensitive for measuring anxiety in women and depression in men. When the HADS is used clinically as a screening tool, it should be examined through a "gender-based lens.".

Salivary Cortisol as an alternative for serum Cortisol in the low-dose adrenocorticotropic hormone stimulation test?

Salivary cortisol is unaffected by cortisol binding globulin and reflects free serum cortisol as compared to total serum cortisol. The aim of the present study was to compare the salivary cortisol response with the serum cortisol response in a low-dose (1-microg) ACTH test in a clinical setting and to determine the optimal cut-off value of salivary cortisol as an alternative to serum cortisol. We measured serum and salivary cortisol responses to iv administration of 1-microg ACTH in 51 patients (17 males) referred to the Department of Clinical Chemistry for ACTH-testing. Serum cortisol was assessed before, 20, and 30 min after ACTH-administration, and salivary cortisol was assessed before and 30 min after ACTH administration. Mean cortisol at baseline, 20, and 30 min were 0.44 micromol/l (SD: 0.22), 0.64 micromol/l (SD: 0.24), and 0.70 micromol/l (SD: 0.25), respectively. Median basal salivary cortisol was 8.4 nmol/l [interquartile range (IQR): 3.8-14.2]. Salivary cortisol at 30 min equaled 35.9 nmol/l (IQR: 21.1-46.2). Basal salivary cortisol was significantly correlated with salivary cortisol at 30 min (r=0.53; p<0.001). Salivary cortisol at 30 min of 23.5 nmol/l had a sensitivity and specificity of 78.1% and 70.0%, respectively as compared to the serum cortisol cut-off values of >0.50 micromol/l. The salivary low-dose ACTH-test yields more dynamic responses than serum cortisol. However, the sensitivity and specificity of salivary cortisol are too low to be adequate as an alternative to the serum cortisol measurements. In women on estrogen therapy, however, the use of salivary cortisol might be superior to serum cortisol.

Diagnostic value of salivary cortisol in Cushing's syndrome (CS)

The diagnosis of Cushing's syndrome (CS) remains a challenge in clinical endocrinology. The aim of this study was to determine the reproducibility and diagnostic value of late-night salivary cortisol (SAF(23)) for CS and its utility along the follow-up of treated patients. In addition, using the same radioimmunoassay reactives, the cut-off values for saliva and serum cortisol, assessed synchronically after the overnight 1 mg dexamethasone suppression test (DST), were defined. Twenty-one patients with confirmed CS and 121 volunteers were studied. All the subjects collected 24-h urine for cortisol (UFC). On the same day whole saliva was obtained from the subjects at 23 h for SAF(23). The intraclass coefficient of correlation (ICC) of SAF(23) was estimated in 47 subjects (21 CS and 26 C). At 8 h, after DST, simultaneous saliva and serum samples for cortisol (SAF(dex) and F(dex), respectively) were obtained in 51 subjects (17 CS and 34 C). After specific therapy, 18 patients with CS were followed with SAF(23) measurements. SAF and F were expressed as nM. The intraclass coefficient of correlation of SAF(23) was 0.89 in CS and 0.83 in C. SAF(23) > 3.8 nM showed a sensitivity and specificity of 100% and 97.5%, respectively, for diagnosing CS. SAF(23) correlated positively with UFC (r = 0.685; P = 0.0001). After DST, SAF(dex) significantly correlated with F(dex) (r = 0.61, P < 0.0001). A cut-off value of SAF(dex) > 2.0 nM and F(dex) > 50.0 nM detected CS with 100% sensitivity and specificity. After successful surgical therapy, 13 patients with CS had SAF(23) levels < 3.8 nM (1.4 +/- 0.8 nM). SAF(23) and SAF(dex) seem to be good screening tools based on their noninvasive nature, remarkable reproducibility and diagnostic performances.

Salivary cortisol and IgA levels in patients with myofascial pain treated with occlusal appliances in the short term

In many studies, the endocrinological response of individuals to different kinds of stresses has been tested. There seems to be widespread agreement that stress, depression, disability and dysfunctional illness behaviors are critical aspects of patients suffering from symptoms like pain, arising out of temporomandibular disorders (TMD). We aimed to explore treatment-induced changes in salivary cortisol, IgA and flow rate values in TMD patients suffering from myofascial pain. Temporomandibular disorders patients (n = 39) were randomized into two groups and treated with two different occlusal appliances. Perceived stress regarding family, work, economy, relationships, general health and stress in general was evaluated at baseline according to a verbal scale. Paraffin-stimulated saliva samples were collected before treatment and during follow-up at 6 and 10 weeks. Flow rate was measured immediately after the saliva collection while salivary cortisol and IgA were determined from samples stored at -70 degrees C. No clear association between reported stress and cortisol or IgA values could be observed at baseline. At 10 weeks follow-up, 92% of the patients felt 'better, much better, symptom-free' and no difference was found between the two appliance groups. Cortisol, IgA and flow rate values showed no systematic between appliance groups' differences. All salivary parameters showed interindividual differences but stayed intra-individually on a similar level throughout the study and no statistically significant changes could be observed when comparing before and after treatment levels. To conclude, there were no treatment-induced changes in saliva parameters despite successful appliance therapy in myofascial pain patients.

Normative salivary cortisol values and responsivity in children

This was a descriptive study on normative salivary cortisol values and responsivity to a hospital clinic visit and an intravenous (IV) procedure in children. The study presented was a subproject of a primary research study that examined parents coaching their children requiring an IV placement in the use of distraction. One measure of child response in the primary study, salivary cortisol, was included to further our understanding of children's physiologic response to stressful and painful stimuli. Salivary cortisol samples were obtained from 384 children aged between 4 and 10 years upon arrival to the clinic and 20 minutes after their IV insertion. Baseline samples were collected at home on a typical day for the children. Data from baseline samples were used to establish normative values between 8:00 a.m. and 3:00 p.m. on a nonprocedural day. Results demonstrate that normative cortisol levels in children follow a pattern similar to the circadian pattern in adults, decreasing from early morning to mid afternoon. Matched samples from control group children were used to evaluate group responsivity. Salivary cortisol levels on the baseline day were lower than those obtained during the day of the procedure and tapered over time as expected (−8.7% ± 6.7%, p = .431). Cortisol levels on the clinic day increased from baseline and increased further in response to IV placement (15.7% ± 6.7%, p = .023). A Location×Time interaction was significant ( p = .019). Findings demonstrate that salivary cortisol is a useful measure of stress response that can be used to evaluate intervention effectiveness.