Salivary Cortisol Research Articles

Emphasizing the Communal Demands of a Leader Role Makes Job Interviews Less Stressful for Women But Not More Successful

AbstractThe cultural construal of leadership as masculine impedes women’s attainment of leader roles. This research examined whether adding feminine demands to a leader role relieved the greater stress experienced by women than men in a job interview for a leadership position and considered the processes that mediated women’s less favourable interview outcomes. In a hiring simulation, management students (N = 209; 112 women, 97 men) interviewed for a leader role framed by either stereotypically feminine or masculine role requirements. As shown by the stress biomarker salivary cortisol, the feminine role framing alleviated women’s, but not men’s, physiological stress response during the interview. However, under both masculine and feminine role framing, women, compared with men, reported lesser fit, expected poorer interview performance, appraised greater threat relative to challenge, and evaluated their performance less favourably, as did external raters. An additional vignette study (N = 305; 189 women, 111 men, 5 diverse) found that the feminine role framing increased the leader role’s communal demands but still conveyed strong agentic demands not different from those of the masculine role. In conclusion, although a feminine role framing alleviated women’s physiological stress response, it did not change their less favourable outcomes, as indicated by participants’ self-reports and others’ reports.

Association Between Internet Addiction, Perceived Stress, Salivary Cortisol Level and Educational Declare in Dental Students

Background and Objectives: Internet addiction is one of the challenges of students that may affect their academic performance and cause stress. One of the metabolic changes related to stress is the salivary cortisol level. This study aims to evaluate the relationship of internet addiction with perceived stress, salivary cortisol level, and academic failure in dental students. Methods: In this descriptive-analytical study with a cross-sectional design, 123 dental students from Qom University of Medical Sciences participated. They were selected by a census sampling method. A demographic form, the internet addiction test, and the perceived stress scale were completed by them. Their academic failure was assessed and their salivary cortisol level was measured by the ELISA method. Data were analyzed using ANOVA, t-test, Pearson correlation test, and regression analysis. Results: Internet addiction had a positive and significant relationship with perceived stress (r=0.21, P=0.003) and its two domains of negative perception (r=0.301, P=0.005) and positive perception (r=0.279, P=0.009). However, it had no significant relationship with salivary cortisol level (P=0.123) or academic failure (P=0.614). Conclusion: It seems that decreasing internet addiction can reduce the perceived stress of dental students.

Acute salivary cortisol response in children with ADHD during psychosocial intervention with and without therapy dogs

Acute salivary cortisol response in children with ADHD during psychosocial intervention with and without therapy dogs

Correlation of screen exposure to stress, learning, cognitive and language performance in children.

The omnipresence of mobile screens and convenience to operate them has led to increased screen time for young children whereas the sequelae of prolonged exposure are not known yet. 70 refugee children (RG) and 111 children of a clinical comparison group (CG) from a help-seeking population (age: M = 5.10; SD = 1.11; range 3.00-6.97years) were assessed concerning their amount of daily screen exposure time in relation to parental education and distress. Salivary cortisol was collected as a marker for biological stress and children were tested concerning learning performance, non-verbal IQ and vocabulary with the Kaufmann Assessment Battery for Children (KABC-II). Language skills were assessed in educator rating. The amount of children's screen exposure was negatively related to parental education and positively to distress. In the CG, higher amounts of screen time were associated with elevated cortisol levels and lower learning scores. On both measures, the RG and CG only differed in the condition of screen time less than one hour/day, for higher amounts of screen time the CG approached the more problematic scores of the RG. Whereas in the whole sample the amount of screen time was negatively correlated to language performance, it was not correlated to non-verbal IQ-scores. As a higher amount of media exposure in our clinical comparison group is associated with elevated biological stress, decreased learning and lower language performance, it should be classified as a relevant environmental factor and regularly considered in clinical assessments of children and therapeutical interventions, especially in vulnerable subgroups. German clinical trials register, registration number: DRKS00025734, date: 07-23-2021.

The Living Lab at Home: Feasibility and Acceptability of Multimodal In-Home Data Collection Among Youth Across the Developmental Spectrum.

Dynamic, real-time, in-home methods of data collection are increasingly common in child health research. However, these methods are rarely cocreated or used with families of youth with developmental disabilities. We aimed to determine the feasibility of codesigned methods for in-home data collection for youth across the developmental spectrum. Sixteen youth (14-18 years) with autism spectrum disorder, cerebral palsy, and/or chronic pain completed 14 days of data collection, wearing an accelerometer, answering Ecological Momentary Assessment (EMA) questionnaires, and collecting salivary cortisol samples. Participants completed a poststudy interview regarding their experiences. Data were analyzed for feasibility, quantity, and quality. At least 1 EMA response was provided on 73% of days, with 54% of the total number of administered prompts answered before the next prompt arrived. In total, 77% of participants wore the accelerometer ≥10 hours for at least 7 days. Adherence to 8-day saliva sampling after accounting for protocol violations and dry samples was 28%. No significant adverse events were reported aside from mild emotional distress (25%). Families reported generally high satisfaction, willingness to participate again, and acceptability, with moderate burden and interference. Qualitative interviews described: (1) the research question's value to the family as a motivator of engagement; (2) in-home data collection is not a passive or neutral experience; (3) personalized approaches and context are important to families; and (4) a clear need for continued iteration and engagement. In-home multimodal data collection is potentially feasible for families across the developmental spectrum but requires iteration based on family feedback to increase adherence.

Can salivary cortisol be used in diagnosing adrenal insufficiency during the acute and subacute phases of traumatic brain injury?

The diagnosis of adrenal insufficiency (AI) related to traumatic brain injury (TBI) remains a challenge. We investigated the basal and low-dose adrenocorticotropic hormone (ACTH)-stimulated serum cortisol and salivary cortisol (SaC) levels and the diagnostic utility of SaC levels during 28 days following TBI. Blood samples were collected for basal levels [sequentially from day 1 (D1) to D7 and on D28)] and for peak serum cortisol and SaC responses to the low-dose ACTH stimulation test (on D1, D7, and D28). After the patient enrollment period was completed, patients were retrospectively categorized as AI or AS (adrenal sufficiency) for each day separately, based on a basal serum cortisol cut-off level of 11 µg/dL, and data analysis was performed between the groups. Thirty-seven patients and 40 healthy controls were included. Median basal serum cortisol levels were higher in patients on D1 but were similar on other days. Median basal SaC levels were higher in patients on D1 and D2 but were similar on other days. Median peak serum cortisol and SaC levels were similar on D1 but were lower in patients on D7 and D28. Median basal SaC levels were higher in the AS group than in the AI group on all days. When evaluating AI during the course of TBI, the cut-off for basal SaC levels is 0.5-0.6 µg/dL throughout the first week, except for 1.38 µg/dL on D2. SaC levels may serve as a surrogate marker for accurately reflecting circulating glucocorticoid activity.

Environmental stress and salivary cortisol levels in preterm infants.

Preterm infants are exposed to numerous environmental stressors during their Neonatal Intensive Care Unit (NICU) stay, particularly during the first week after birth. The aim of this study is to assess whether salivary cortisol levels are correlated with Neonatal Infant Stressor Scale (NISS) scores in preterm infants during the first week of life. We also quantified the changes in both NISS scores and cortisol levels in the first week, and whether cortisol levels are associated with gestational age. Preterm infants (n = 38, birth weight <1250 g and/or gestational age <29 weeks) were included. Saliva samples were collected on day 0-3 (early) and day 4-7 (late), and cortisol concentrations were measured by immunoassay. NISS scores were assessed retrospectively for the six hours preceding each saliva collection. NISS scores were not significantly correlated with salivary cortisol levels at either time point. However, infants born at <28 weeks gestation had higher median cortisol levels than infants born at >28 weeks (p = 0.0068), and there was also a significant inverse relationship between NISS score and gestational age (p = 0.04). There was no significant difference between the early and late time points for either NISS scores or cortisol levels. Cortisol levels are elevated in infants <28 weeks gestation but do not correlate with NISS scores. NISS scores are inversely related to gestational age, likely reflecting increased exposure to interventions and invasive procedures for the smallest infants.

Systemic Effects and Absorption of Subepithelial Dexamethasone Vocal Fold Injections.

To compare the systemic changes following two office-based procedures-subepithelial vocal fold steroid injections (VFSI) and vocal fold augmentation (VFA), and to characterize the magnitude and chronicity of the effects observed. Prospective, controlled before-after comparative study. Patients prospectively underwent VFSI with 0.8-2 mg of dexamethasone or VFA. Serum cortisol, white cell count (WCC), and C-reactive protein (CRP) were measured at day 0 (pre-procedure), 1 and 7. Salivary cortisol was measured at baseline and daily for 7 days post-procedure. Fourteen patients underwent VFSI and 36 VFA. At baseline serum cortisol measured 304.6 ± 116.6 nmol/L and fell significantly to 48.1 ± 41.8 nmol/L 1 day following dexamethasone injection (p = 0.001) and recovered by day 7 to 303.7 ± 78.7 nmol/L. Salivary cortisol demonstrated a similar pattern with significant recovery demonstrated by day 3 (p = 0.001). White cell counts were affected by the systemic absorption of exogenous steroid and normalized by day 7. Patients who underwent VFA demonstrated no significant change in their serum or salivary cortisol and no significant change in their WCC. No significant changes in CRP or patient's physiological parameters were observed in either procedure. Our findings demonstrate systemic absorption of dexamethasone following VFSI, with acute hypothalamic-pituitary-adrenal (HPA) axis suppression which normalizes day 3 post-procedurally. 3 Laryngoscope, 2024.

Correlation Between Salivary Cortisol Levels and Diurnal Variation in Spirometric Parameters in Apparently Healthy Adults

Correlation Between Salivary Cortisol Levels and Diurnal Variation in Spirometric Parameters in Apparently Healthy Adults

Salivary Cortisol Detection with a Fully Inkjet-Printed Paper-Based Electrochemical Sensor

Electrochemical paper-based analytical devices (ePADs) offer an innovative, low-cost, and environmentally friendly approach for real-time diagnostics. In this study, we developed a functional all-inkjet paper-based electrochemical immunosensor using gold (Au) printed ink to detect salivary cortisol. Covalent binding of the cortisol monoclonal antibody onto the printed Au surface was achieved through electrodeposition of 4-carboxymethylaniline (CMA), with ethanolamine passivation to prevent non-specific binding. The ePAD exhibited a linear response within the physiological cortisol range (5–20 ng/mL), with sensitivities of 25, 23, and 19 Ω·ng/mL and R2 values of 0.995, 0.979, and 0.99, respectively. Additionally, interference studies against tumor necrosis factor-α (TNF-α) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) yielded excellent results. This novel ePAD, fabricated using inkjet printing technology on paper, simplifies the process, reduces environmental impact, and lowers fabrication costs.

Cortisol concentrations in substance use disorder patients undergoing short-term psychotherapy incorporating equine interaction compared to cognitive behavioral therapy: A preliminary study

Psychotherapy incorporating equine interaction (PIE) is emerging as an effective supplemental substance use disorder (SUD) treatment. Benefits are attributed to decreased stress levels associated with the presence of the horse, however, research concerning stress parameters related to short-term equine interaction during SUD treatment is limited. Therefore, the purpose of this preliminary study was to investigate cortisol concentrations in SUD patients participating in PIE for two weeks compared with those in traditional cognitive behavioral therapy (CBT). Salivary cortisol samples were collected from two populations of SUD patients: 1) PIE participants (n = 18) and 2) CBT participants (n = 5). The impacts of the therapy type and the week of sampling were analyzed using a mixed linear model in SAS. Significance level was set at P ≤ 0.05. When comparing PIE to CBT, no impact associated with therapy type was determined (P = 0.74). Cortisol concentrations lacked significant changes during the two-week period for both therapeutic interventions. While short-term intervention lacked improvement in cortisol levels for both therapy types, further research is warranted to determine the most effective approach and duration of therapy.

Oral State and Salivary Cortisol in Multiple Sclerosis Patients.

Background: MS patients experience gradual and progressive functional limitation, bulbar symptoms, cognitive dysfunction, and psychiatric disorders that can impinge on oral status. This study aimed to investigate the oral state, oral hygiene habits, and salivary cortisol levels in patients with relapsing-remitting multiple sclerosis (RRMS) compared to healthy controls. It also evaluated systemic parameters: disease duration, type of Disease Modifying Therapy (DMT), disability score, professional activity, and smoking in the study group. Methods: This study included 101 patients (71 women and 30 men, aged 16-71 years) and 51 healthy volunteers (36 women and 15 men, aged 28-82 years). The oral examination assessed the number of teeth, type and number of dental fillings and prosthetic restoration, oral hygiene state, and salivary cortisol. Results: It was found that MS patients had significantly more professional activity, swallowing problems, pronunciation issues, dry mouth, and taste disturbances than the control group. They brushed their teeth twice daily significantly less often. The API was higher, while the SBI was lower in MS patients. Disease duration positively correlated with age and number of missing teeth. The Expanded Disability Status Scale positively correlated with age, disease duration, number of missing teeth, number of composite fillings, and right and left-hand Nine Hole Peg test scores, and negatively correlated with the Sulcus Bleeding Index. Salivary cortisol levels did not differ between groups and correlated only with the disability scale. Conclusions: MS patients require ongoing dental care and preventive measures to manage both general and oral health symptoms effectively.

Ganaxolone Therapy After Preterm Birth Restores Cerebellar Oligodendrocyte Maturation and Myelination in Guinea Pigs.

The postnatal environment is challenging for the preterm neonate with exposure to hypoxic and excitotoxic events, amplified by premature loss of placentally derived neurosteroids. Between preterm birth and term equivalent age (TEA), cerebellar development continues despite these challenges. We hypothesize that neurosteroid replacement therapy during this time will support optimal cerebellar development. Guinea pig sows delivered at term (∼69 days gestation) or were induced to deliver preterm (∼62 days), with preterm pups receiving ganaxolone or vehicle until TEA. Postnatal assessments comprised salivary cortisol (corrected postnatal age [CPA] 0, 7, 38), behavioral analysis (CPA7, 38), and tissue collection (CPA0 and CPA40). Neurodevelopmental markers (MBP, Olig2, and NeuN) were assessed in the cerebellum by immunohistochemistry, whereas RT-PCR was utilized to investigate key inhibitory/excitatory pathways and oligodendrocyte lineage markers. Following preterm birth, there was evidence of a hyperactive phenotype, increased salivary cortisol concentrations, and impaired myelination and oligodendrocyte maturation at the protein level. mRNA expressions of key inhibitory/excitatory pathways and myelin stability were also altered following preterm birth. Importantly, we showed that neurosteroid replacement therapy returns cerebellar development and behavior toward a term-like phenotype. Therefore, ganaxolone may reduce the vulnerability of the cerebellum to postnatal challenges arising from preterm birth.

The effect of live-performed music therapy with physical contact in preterm infants on parental perceived stress and salivary cortisol levels.

Parents of preterm infants face a stressful life event which might have long term impact on the parent-child relation as well as on the infant's cognitive and socio-emotional development. Both music therapy (MT) and physical contact (PC) are stress-reducing interventions for parents and preterm infants on the neonatal intensive care unit (NICU). Meanwhile, especially close PC is considered as standard care (SC) in most NICUs. However, the effect of live performed MT with PC on parental perceived stress and cortisol levels has barely been investigated. We hypothesized that MT with PC leads to reduced stress levels and lower salivary cortisol concentrations compared to SC in parents of preterm infants during the first 4 weeks after birth. Randomized-controlled trial enrolling the parents of 99 preterm infants (MT n = 50, SC n = 49 infants). The infants received either MT with PC or SC only. Perceived stress was measured with the perceived stress questionnaire 20 (PSQ-20) after birth and 4 weeks later. Salivary cortisol levels were obtained and measured weekly after birth for 4 weeks. Forty-two mothers and eight fathers of the intervention group (MT with PC) as well as n = 43 mothers and n = 6 fathers of the control group (SC) were enrolled. For the intervention group, salivary cortisol was reduced 4 weeks after birth [mothers 5.5 nmol/l (confidence interval (CI) 3.6-7.5); fathers 8.3 (CI 7.2-9.4)] compared to the control group [mothers 10.3 nmol/l (CI 5.4-15.3); fathers 14.8 (CI 8.9-20.7)]. Overall perceived stress scores decreased in the intervention group (mothers -17.6; fathers -12.6) and increased in the control group (mothers +6.1; fathers +21.4) over 4 weeks. Live-performed MT with PC in preterm infants might be an effective, non-invasive intervention to reduce parental stress and cortisol levels. Future studies should investigate the long-term effects of this intervention on the parent-infant relation as well as on the infants' cognitive and socio-emotional development. https://drks.de/search/en/trial/DRKS00025755 identifier [DRKS00025755].

Role of oxidative stress in the occurrence of periodontitis in the background of metabolically associated diseases

Oxidative stress is an important component of slow pathological inflammation in metabolic diseases and chronic periodontitis. Periodontal diseases are interrelated with somatic pathology. This results in both local and systemic inflammatory reactions, which increases the risk of the onset and progression of somatic diseases. Psychological stress associated with oxidative stress with increased production of oxidants and oxidative damage is an important factor in the etiology of both periodontitis and metabolic disorders. Objective — to analyze the possible bond between chronic periodontitis, 8‑hydroxydeoxyguanosine (8‑OHdG), as a biomarker of oxidative stress, and cortisol in persons with metabolic‑associated diseases. Materials and methods. 68 people were surveyed, of which 47 had metabolically ‑associated diseases that were diagnosed according to domestic and international criteria. The control group consisted of systematically healthy people, representative by age and article that did not receive dental therapeutic and preventive measures for the last 6 months. The diagnosis of «chronic periodontitis» was carried out in accordance with existing recommendations provided at World Workshop on the Classification of Periodontal and Peri­Implant Diseases and Conditions (2017). The concentration of 8‑OHdG in plasma and the level of saliva cortisol were measured by the immunoenzyme method according to the manufacturer’s instructions. The arithmetic mean, standard error, and Student’s t‑test were calculated to compare the characteristics. Pearson’s correlation test was used to identify the relationship between the indicators. Results. Each of the groups had patients who had a healthy periodontium and those who had chronic periodontitis. The 8‑OHdG level in the main group was much higher (p&lt;0.001) than in the control group, and the difference in the concentration of 8‑OHdG was also observed between those patients who had periodontal disease and those who had a healthy periodontium. The level of salivary cortisol in patients with chronic periodontitis was much higher compared to patients with clinically healthy periodontium (p=0.00). A correlation was found between cortisol levels and the presence of periodontal disease (r=0.619; p=0.00), between plasma 8OHdG levels and the epithelial attachment loss index (r=0.537; p=0.00), the hygiene index (r=0.599; p=0.00), and between 8OHdG levels and salivary cortisol concentrations (r=0.292; p=0.036). Conclusions. Oxidative stress plays an important role in delayed pathological inflammation in both metabolic diseases and chronic periodontitis. 8‑OHdG is a key and universal biomarker for the evaluation of DNA oxidative damage. There is a positive relationship between the oxidative marker, periodontitis and cortisol.

Efficacy of Vagal nerve stimulation on anxiety among elderly retired teachers during COVID-19 pandemic.

Excessive fear, worry and behavioral disturbances define anxiety, with particular significance attributed to vagal nerve, a crucial transmitter of information to the brain regions governing anxiety. Highlighting the importance of vagal nerve, transcutaneous auricular vagal nerve stimulation (TaVNS) emerges as a tolerable and safe technique. The success of non-invasive vagal nerve stimulation in alleviating anxiety underscores the pivotal role of the vagal nerve. The purpose of this study was to assess the effectiveness of physiotherapy interventions in mitigating anxiety among retired teachers during the COVID-19 pandemic, emphasizing the relevance of targeting the vagal nerve for improved mental well-being. 60 retired teachers diagnosed with anxiety were chosen through random allocation. Participants were divided into two groups: Group A (Experimental group) received transcutaneous auricular vagal nerve stimulation (TaVNS), and Group B (Control group) underwent the Jacobson relaxation technique. Intervention period spanned 4 weeks, with four sessions per week, lasting 30 minutes. The outcome measures included Generalized Anxiety Disorder-7 (GAD-7) questionnaire and salivary cortisol levels. Following the 4-week intervention, both groups exhibited a significant reduction in Generalized Anxiety Disorder-7 (GAD-7) scores and salivary cortisol levels (P < 0.001). Notably, Group A demonstrated a significantly higher effectiveness rate compared to Group B. The study concludes that transcutaneous auricular vagal nerve stimulation (TaVNS) is effective in reducing anxiety among retired teachers. Transcutaneous auricular vagal nerve stimulation (TaVNS) proves to be a powerful and effective intervention in alleviating anxiety among retired teachers, emphasizing its potential significance in enhancing mental well-being.

Competition and stereotypic behavior in Thoroughbred horses: The value of saliva as a diagnostic marker of stress.

Many horses exhibit stereotypies, especially when living in human controlled environments that may prevent horses from satisfying natural needs in terms of feeding, drinking, moving, and socializing. In human medicine, obsessive compulsive disorder and other severe psychiatric disturbances are associated with stereotypic behaviors; salivary biomarkers evaluation is considered a reliable tool for diagnosis of common mental health disorders because saliva collection easy to obtain and noninvasive. In this study, we hypothesized that salivary cortisol concentrations, in addition to alpha-amylase (sAA) and butyrylcholinesterase (BChE) activities, are considered stress biomarkers that may be influenced in horses trained for racing competition with stereotypic behaviors. Saliva at rest condition was obtained from ten non-stereotypic Thoroughbreds horses involved in high-level competition; eleven Thoroughbreds high-level competition horses showing stereotypic behaviors, and five Thoroughbreds leisure non-competition horses. Cortisol was found to be higher in high-level competition non-stereotypic horses and sAA was significantly higher in non-stereotypic leisure horses when compared to horses involved in competition, while BChE did not change between groups. These results may represent the basis for further behavioural evaluation to elucidate how stereotypic horses and horses involved in competition overcome stressful situations.

8689 Salivary cortisol and cortisone levels in obese and non-obese Korean children

Abstract Disclosure: M. Jung: None. M. Kim: None. Y. Choi: None. H. Yoo: None. S. Lee: None. E. Yoo: None. Purpose: Measurement of salivary cortisol is non-invasive and the level correlates well with that of free cortisol, but data in children are insufficient. We measured salivary cortisol and cortisone levels in obese children and compared with those in non-obese healthy children. Methods: A Total of 84 (45 obese and 39 non-obese) children aged 6 to 12 years were recruited. Children with acute or chronic illness were excluded. Salivary samples were analyzed for cortisol and cortisone using liquid chromatography-tandem mass spectrometry. Serum cortisol levels were measured only in obese children. Results: There was no significant difference in salivary cortisol and cortisone levels between the non-obese and obese children. There was no gender difference in salivary cortisol and cortisone levels. Salivary cortisol correlated to serum cortisol levels in obese children (ρ = 0.428, P = 0.007). Salivary cortisone levels were related with salivary cortisol (ρ = 0.537, P &amp;lt;0.001), and inversely with sampling time range (ρ = -0.282, P= 0.009). There was no significant correlations between salivary cortisol or cortisone values and age or body mass index. Conclusions: There was no significant difference in salivary cortisol and cortisone levels between non-obese and obese children. Salivary cortisol correlated well with serum cortisol in obese children. Presentation: 6/1/2024

7071 Cushing disease presenting with Dilated Cardiomyopathy

Abstract Disclosure: H. Majeed: None. C. Nguyen: None. R. Galagan: None. D. Lovre: None. Background: Hypercortisolism manifests with numerous ways due to the wide distribution of glucocorticoid receptors. Here we describe a case of Cushing’s disease presenting with reversible non-ischemic cardiomyopathy. Case Presentation: A 30-year-old male presented to ER with palpitations, dyspnea, and atypical chest pain. His exam was notable for a BMI of 30.26 kg/m2, HR 76 bpm and BP of 200/110 mm Hg. His EKG revealed Left ventricular hypertrophy. Echocardiogram (ECHO) showed an EF of 25-30% with diffuse hypokinesis. An angiogram demonstrated normal coronary anatomy. He was started on Lisinopril, Carvedilol, and Spironolactone for non-ischemic cardiomyopathy. He also complained of a 40 lb weight gain, loss of libido, hot flashes and breast tenderness. He was referred to endocrinology. Initial evaluation demonstrated total testosterone (TT) of 171 ng/dl (286-1511 ng/dl), FSH 3.8 IU/L (2-12 IU/L), LH 5.6 IU/L (2-9 IU/L) consistent with secondary hypogonadism. Further pituitary workup revealed AM cortisol level 31.22 mcg/dl (4.3-22.4mcg/dl), ACTH 79 pg/ml (7.2 - 63.3pg/ml), IGF-1 257 ng/mL (88-246 ng/mL), Prolactin 23.7 ng/dl (2.1- 17.7ng/dl), TSH 0.54 mIU/l (0.35-3.74mIU/l) and FT4 0.6 ng/dl (0.76-1.46 ng/dl). A 24hr urine cortisol was 167 ug(0-50ug/24h) and midnight salivary cortisol 0.160 ug/dl (&amp;lt;0.010-0.090 ug/dl). An overnight 1mg dexamethasone suppression test (DST) resulted in AM cortisol of 20.95 mcg/dl (&amp;lt;1.8mcg/dl) and 8mg DST cortisol fell from 34 mcg/dl to 4.16 mcg/dl. A pituitary MRI revealed a left 6 mm x 4 mm microadenoma. He was treated with levothyroxine pre-op for central hypothyroidism. He underwent transsphenoidal resection of the pituitary adenoma. Post-op AM cortisol was 1.1 mcg/dl. His steroid withdrawal syndrome was treated with a prolonged course of tapered hydrocortisone. Two months post-op ECHO showed EF of 55-60%. His BP normalized on carvedilol alone. Eighteen months post-op he no longer required any hormone replacement. Repeat ACTH 24.4 pg/ml, Total Testosterone 584ng/dl, TSH 0.57 mIU/l and FT4 0.93 and 24hr urine cortisol was 24ug/dl, MN salivary cortisol &amp;lt;0.10 ug/dl confirming remission of his cushing's disease and resolution of secondary hypogonadism and hypothyroidism. Conclusion: Prolonged hypercortisolism can cause abnormal cardiac remodeling resulting in cardiomyopathy. Surgical remission of Cushing’s disease reverses hypercortisolism which may restore normal cardiac function. Presentation: 6/2/2024

6927 Metyrapone To Reset The Nocturnal Cortisol Rhythm In Mild Autonomous Cortisol Secretion (MACS) - Safety And Impact On Cardiometabolic Risk Factors

Abstract Disclosure: S. Berry: None. A. Iqbal: None. J.D. Newell-Price: Consulting Fee; Self; HRA Pharmaceuticals. M. Debono: Consulting Fee; Self; HRA Pharmaceuticals. Grant Recipient; Self; HRA Pharmaceuticals. Speaker; Self; HRA Pharmaceuticals. Background: MACS is associated with increased cardiometabolic risk including hypertension, type 2 diabetes and dyslipidemia. In MACS, serum and salivary cortisol and cortisone levels are significantly higher in the nocturnal period but follow the usual daytime pattern. Combined early and late evening dosing with the short-acting 11-beta hydroxylase inhibitor, metyrapone, has previously been shown to acutely ‘re-set’ this abnormal part of the cortisol curve to normal. We have now assessed the impact of long-term evening metyrapone on cardiometabolic dysfunction in MACS. Method: A retrospective, controlled, longitudinal study evaluated the safety and tolerability of nocturnal metyrapone and its impact on cardiometabolic risk factors. We included all patients (n=15) who were initiated on metyrapone treatment, 250mg-500mg at 6pm and 250mg at 10pm, for MACS at a tertiary endocrinology center between 2015 and 2022. Age and sex-matched controls were selected from patients with adrenal incidentalomas and non-suppressed serum cortisol following 1mg overnight dexamethasone suppression testing. Systolic blood pressure (SBP), diastolic blood pressure (DBP), weight, HbA1c and non-HDL cholesterol were assessed at baseline and after 6 months. Morning serum cortisol values were evaluated to check for adrenal axis over-suppression. Wilcoxon signed-rank test was used to compare pre/post-treatment, and Mann-Whitney U test was used to compare metyrapone group to controls. Results: Metyrapone was tolerated by 12/15 patients - two stopped due to diarrhea and one due to high androgens in a female. There were no occurrences of adrenal crises. The morning cortisol after metyrapone was 365 nmol/L (IQR 254-431nmol/L, n=13). ACTH increased from 4.5 pg/ml to 7.5 pg/ml (SE±2.15, n=12) after treatment. In the metyrapone group compared to controls, there were significant decreases in SBP (-26.4 SE±8.1mmHg, p=0.008, n=9) and DBP (-12.9 SE±5.5mmHg, p=0.024). Four patients in the control group had up-titration of antihypertensive medication between measurements compared to only one in the metyrapone group. The differences between groups in HbA1c, weight and non-HDL cholesterol were not statistically significant. However, the increase in HbA1c was less in the metyrapone group compared to the control group by 3.0 SE±4.5mmol/mol, as was the non-HDL cholesterol by 0.4 SE±0.33mmol/L (n=10). Conclusion: Evening metyrapone is associated with significant reductions in SBP and DBP in patients with MACS, without causing adrenal insufficiency and with preservation of normal morning serum cortisol. Monitoring 9am cortisol is important to avoid over-treatment. A larger, powered, prospective study is needed to definitively investigate the broader metabolic outcomes and assess the clinical utility of metyrapone in MACS. Presentation: 6/3/2024