1
|
Voltan G, Antonelli G, Mondin A, Tizianel I, Sabbadin C, Barbot M, Basso D, Scaroni C, Ceccato F. Heat inactivation of SARS-CoV 2 enabled the measurement of salivary cortisol during COVID-19 pandemic. Endocrine 2024; 83:775-782. [PMID: 37991703 PMCID: PMC10901918 DOI: 10.1007/s12020-023-03597-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND AND AIM Salivary cortisol has become an essential tool in the management of cortisol-related disease. In 2020 the sudden outbreak of COVID-19 pandemic caused several concerns about the use of saliva, due to the risk of contamination, and a European consensus further discourage using salivary cortisol. To decrease infectious risk, we handled specimens by applying a heat treatment to inactivate viral particles, further evaluating the impact of the COVID-19 pandemic on the use of salivary cortisol in clinical practice. MATERIAL AND METHODS Saliva samples were exposed for 10 min at 70 °C, then cortisol was measured using LC-MS/MS. The number of salivary cortisol examinations from 2013 to 2022 was extracted from the local electronic database: those performed in 2019, 2020, and 2021 were analyzed and compared with the historical data. RESULTS During 2020 we observed a decrease of 408 (-20%) examinations (p = 0.05) compared to 2019; especially in salivary cortisol daily rhythm and salivary cortisol/cortisone ratio (respectively reduction of 47% and 88%, p = 0.003 and p = 0.001). Analyzing year 2021 compared with 2020 we reported an increase of 420 examinations (+20%, p = 0.01), with a complete recovery of salivary cortisol measurement (considering 2019: p = 0.71). Major differences were observed between morning salivary cortisol (-20%, p = 0.017), LNSC (-21%, p = 0.012) and salivary cortisol rhythm (-22%, p = 0.056). No Sars-Cov2 infections related to working exposure were reported among laboratory's employers. CONCLUSIONS We speculate that the adoption of an appropriate technique to inactivate viral particles in saliva specimens allowed the safety maintenance of salivary collections, also during the Sars-CoV-2 outbreak.
Collapse
Affiliation(s)
- Giacomo Voltan
- Department of Medicine DIMED, University of Padova, Padova, Italy
- Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy
| | - Giorgia Antonelli
- Department of Medicine DIMED, University of Padova, Padova, Italy
- Laboratory Medicine Unit, University-Hospital of Padova, Padova, Italy
| | - Alessandro Mondin
- Department of Medicine DIMED, University of Padova, Padova, Italy
- Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy
| | - Irene Tizianel
- Department of Medicine DIMED, University of Padova, Padova, Italy
- Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy
| | - Chiara Sabbadin
- Department of Medicine DIMED, University of Padova, Padova, Italy
- Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy
| | - Mattia Barbot
- Department of Medicine DIMED, University of Padova, Padova, Italy
- Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy
| | - Daniela Basso
- Department of Medicine DIMED, University of Padova, Padova, Italy
- Laboratory Medicine Unit, University-Hospital of Padova, Padova, Italy
| | - Carla Scaroni
- Department of Medicine DIMED, University of Padova, Padova, Italy
- Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy
| | - Filippo Ceccato
- Department of Medicine DIMED, University of Padova, Padova, Italy.
- Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy.
| |
Collapse
|
2
|
Ciancia S, van den Berg SAA, van den Akker ELT. The Reliability of Salivary Cortisol Compared to Serum Cortisol for Diagnosing Adrenal Insufficiency with the Gold Standard ACTH Stimulation Test in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1569. [PMID: 37761530 PMCID: PMC10527706 DOI: 10.3390/children10091569] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/03/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023]
Abstract
The ACTH (adrenocorticotropic hormone) stimulation test is the gold standard for the diagnosis of adrenal insufficiency (AI), performed with ACTH high dose (HDT) or low dose (LDT). As salivary cortisol has been proposed as an alternative to serum cortisol, our aim was to evaluate the reliability of salivary cortisol compared to serum cortisol for diagnosing AI in children. Data were collected retrospectively. Salivary and serum cortisol values derived by 80 ACTH stimulation tests were obtained (39 F, 36 M; median age 11.5 years, IQR 6.9). Sampling was performed at baseline and after 30 and 60 min from ACTH administration during the HDT, and at baseline and 10, 20, 30, 40 and 60 min after the stimulation for the LDT. A serum cortisol level > 420 nmol/L ruled out AI. The correlation coefficients between serum and salivary cortisol for the HDT (n = 24) were 0.80 at t0, 0.48 at t30 and 0.75 at t60. All patients were adrenal sufficient. In 41% of the LDT, peak serum cortisol indicated insufficient adrenal function. The correlation coefficients between serum and salivary cortisol were 0.59 at t0 and 0.33 at the peak. For a cut-off of salivary cortisol < 15 nmol/L, sensitivity was 73.9% and specificity 69.6%. Our data do not support salivary cortisol as a valid alternative to serum cortisol during LDT. Regarding the HDT, results are more encouraging, however, further studies are needed.
Collapse
Affiliation(s)
- Silvia Ciancia
- Division of Endocrinology, Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, University Medical Center, 3015 Rotterdam, The Netherlands
| | - Sjoerd A. A. van den Berg
- Department of Clinical Chemistry, Erasmus University Medical Center, 3015 Rotterdam, The Netherlands
| | - Erica L. T. van den Akker
- Division of Endocrinology, Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, University Medical Center, 3015 Rotterdam, The Netherlands
| |
Collapse
|
3
|
Mattone MC, Gil S, Costanzo M, Galluzzo Mutti ML, Casanovas A, Zaidman V, Lazzati JM, Ciaccio M, Belgorosky A, Guercio G. Pediatric adrenocortical tumors cohort characteristics and long-term follow-up at a single Argentinian tertiary center. J Pediatr Endocrinol Metab 2022; 35:19-27. [PMID: 34674406 DOI: 10.1515/jpem-2021-0392] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/04/2021] [Indexed: 12/25/2022]
Abstract
UNLABELLED Pediatric adrenocortical tumors are rare and heterogeneous endocrine malignancies. OBJECTIVES To report clinical, biochemical, and histological features, staging, and therapeutic interventions in a cohort of 28 patients treated at a single tertiary center. METHODS A retrospective review of medical records of children with PACT (diagnosed before <18 years of age) followed between 1987-2018 at Hospital de Pediatría Garrahan, Buenos Aires, Argentina. RESULTS Mean age at diagnosis was 4.6 years (range, 0.3-17.3 years) and median follow-up was 4.17 years (range, 0-12 years). Female to male ratio was 2.5:1. Signs and symptoms that prompted medical intervention were hormonal overproduction (57%), abdominal complaints (36%), and hypertensive encephalopathy (7%). In patients with clinically virilizing tumors (n=16) mean height standard deviation score (SDS) and bone age advance were significantly higher while body mass index (BMI) SDS was significantly lower than in those with clinical Cushing's (n=10) (p<0.05). Serum dehydroepiandrosterone sulfate (DHEAS) levels were significantly higher in stage IV than in stage I (p=0.03). Total adrenalectomy was performed in 26 patients. Eight patients (stage III-IV) received adjuvant chemotherapy. Five-year overall and disease-free survival were 100% for ST I-II, and 51% (95% CI 21-82) and 33% (95% CI 1.2-65) for ST III-IV, respectively (p=0.002). No statistical difference was found when comparing 2-year parameters with and without adjuvant chemotherapy. CONCLUSIONS Height SDS and BMI SDS seem to mirror hormonal secretion in pediatric adrenocortical tumors. Higher DHEAS levels were found in patients with more advanced disease. Further large-scale studies are needed to validate a possible role for DHEAS as a biochemical marker of tumor stage and to draw robust conclusions on the use of adjuvant chemotherapy.
Collapse
Affiliation(s)
- María Celeste Mattone
- Hospital de Pediatría Garrahan, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Silvia Gil
- Hospital de Pediatría Garrahan, Buenos Aires, Argentina
| | | | | | - Alejandra Casanovas
- Hospital de Pediatría Garrahan, Buenos Aires, Argentina
- Instituto Nacional del Cáncer, Buenos Aires, Argentina
| | | | | | - Marta Ciaccio
- Hospital de Pediatría Garrahan, Buenos Aires, Argentina
| | - Alicia Belgorosky
- Hospital de Pediatría Garrahan, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Gabriela Guercio
- Hospital de Pediatría Garrahan, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| |
Collapse
|
4
|
Laulhé M, Dumaine C, Chevenne D, Leye F, Faye A, Dozières B, Strullu M, Viala J, Hogan J, Houdouin V, Léger J, Simon D, Carel JC, Storey C, Guilmin-Crépon S, Martinerie L. Glucocorticoid induced adrenal insufficiency in children: Morning cortisol values to avoid LDSST. Front Pediatr 2022; 10:981765. [PMID: 36589156 PMCID: PMC9798323 DOI: 10.3389/fped.2022.981765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Glucocorticoid-induced adrenal insufficiency (GI-AI) is a common side effect of glucocorticoid therapy. However, its diagnosis currently relies on the realization of a Low Dose Short Synacthen Test (LD-SST) that requires an outpatient hospital and several blood samples. Our goal was to evaluate whether morning cortisol values could predict the response to LD-SST, in children, to avoid useless dynamic tests and facilitate diagnosis of glucocorticoid induced adrenal insufficiency. STUDY DESIGN We recorded data of 91 pediatric patients who underwent a LD-SST in our center between 2016 and 2020 in a retrospective observational study. We selected LD-SST realized following administration of supra-physiologic doses of glucocorticoids during more than 3 weeks and performed at least four weeks after treatment was stopped. Adrenal deficiency was defined as a plasma cortisol concentration inferior to 500 nmol/l at LD-SST. RESULTS Glucocorticoid-induced adrenal insufficiency was diagnosed in 60% of our cohort. Morning cortisol values were predictive of the response to the LD-SST (AUC ROC 0.78). A plasma cortisol concentration of less than 144 nmol/l predicted glucocorticoid induced adrenal insufficiency with a specificity of 94% and a value over 317 nmol/l predicted recovery of the HPA axis with a sensitivity of 95%. We did not find any other predictive factor for glucocorticoid-induced adrenal insufficiency. CONCLUSIONS Morning cortisol values can safely assess recovery of the HPA axis in children treated chronically with glucocorticoids. Using these thresholds, more than 50% of LD-SST could be avoided in children.
Collapse
Affiliation(s)
- Margaux Laulhé
- Pediatric Endocrinology Department, AP-HP, Reference Center for Growth and Development Endocrine Diseases Hôpital Universitaire Robert-Debré, Paris, France.,Université Paris-Saclay, Inserm 1185, Physiologie et Physiopathologie Endocriniennes, Le Kremlin-Bicêtre, France
| | - Cécile Dumaine
- General Pediatrics and Infectious Diseases Department, AP-HP, Hôpital Universitaire Robert-Debré, Paris, France
| | - Didier Chevenne
- Biochemistry Unit, AP-HP, Hôpital Universitaire Robert-Debré, Paris, France
| | - Fallou Leye
- Clinical Epidemiology Unit, AP-HP, Hôpital Universitaire Robert-Debré, Paris, France
| | - Albert Faye
- General Pediatrics and Infectious Diseases Department, AP-HP, Hôpital Universitaire Robert-Debré, Paris, France.,UFR Médecine, Université Paris Cité, Paris, France
| | - Blandine Dozières
- Pediatric Neurology Department, AP-HP, Hôpital Universitaire Robert-Debré, Paris, France
| | - Marion Strullu
- UFR Médecine, Université Paris Cité, Paris, France.,Pediatric Hematology and Immunology Department, AP-HP, Hôpital Universitaire Robert-Debré, Paris, France
| | - Jérome Viala
- UFR Médecine, Université Paris Cité, Paris, France.,Pediatric Gastroenterology and Hepatology Department, AP-HP, Hôpital Universitaire Robert-Debré, Paris, France
| | - Julien Hogan
- UFR Médecine, Université Paris Cité, Paris, France.,Pediatric Nephrology Department, AP-HP, Hôpital Universitaire Robert-Debré, Paris, France
| | - Véronique Houdouin
- UFR Médecine, Université Paris Cité, Paris, France.,Pediatric Pulmonology and Allergology Department, AP-HP, Hôpital Universitaire Robert-Debré, Paris, France
| | - Juliane Léger
- Pediatric Endocrinology Department, AP-HP, Reference Center for Growth and Development Endocrine Diseases Hôpital Universitaire Robert-Debré, Paris, France.,UFR Médecine, Université Paris Cité, Paris, France
| | - Dominique Simon
- Pediatric Endocrinology Department, AP-HP, Reference Center for Growth and Development Endocrine Diseases Hôpital Universitaire Robert-Debré, Paris, France
| | - Jean-Claude Carel
- Pediatric Endocrinology Department, AP-HP, Reference Center for Growth and Development Endocrine Diseases Hôpital Universitaire Robert-Debré, Paris, France.,UFR Médecine, Université Paris Cité, Paris, France.,Université Paris Cité, Inserm 1141, NeuroDiderot, Paris, France
| | - Caroline Storey
- Pediatric Endocrinology Department, AP-HP, Reference Center for Growth and Development Endocrine Diseases Hôpital Universitaire Robert-Debré, Paris, France
| | - Sophie Guilmin-Crépon
- Clinical Epidemiology Unit, AP-HP, Hôpital Universitaire Robert-Debré, Paris, France.,UFR Médecine, Université Paris Cité, Paris, France
| | - Laetitia Martinerie
- Pediatric Endocrinology Department, AP-HP, Reference Center for Growth and Development Endocrine Diseases Hôpital Universitaire Robert-Debré, Paris, France.,Université Paris-Saclay, Inserm 1185, Physiologie et Physiopathologie Endocriniennes, Le Kremlin-Bicêtre, France.,UFR Médecine, Université Paris Cité, Paris, France
| |
Collapse
|
5
|
Ceccato F, Selmin E, Antonelli G, Barbot M, Daniele A, Boscaro M, Plebani M, Scaroni C. Low-dose short synacthen test with salivary cortisol in patients with suspected central adrenal insufficiency. Endocr Connect 2021; 10:1189-1199. [PMID: 34424852 PMCID: PMC8494418 DOI: 10.1530/ec-21-0404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/23/2021] [Indexed: 12/26/2022]
Abstract
CONTEXT The low-dose short synacthen test (LDSST) is recommended for patients with suspected central adrenal insufficiency (AI) if their basal serum cortisol (F) levels are not indicative of an intact hypothalamic-pituitary-adrenal (HPA) axis. OBJECTIVE To evaluate diagnostic threshold for salivary F before and 30 min after administering 1 μg of synacthen, performed before 09:30 h. DESIGN A cross-sectional study from 2014 to 2020. SETTING A tertiary referral university hospital. PATIENTS In this study, 174 patients with suspected AI, 37 with central AI and 137 adrenal sufficient (AS), were included. MAIN OUTCOME MEASURE The diagnostic accuracy (sensitivity (SE), specificity (SP)) of serum and salivary F levels measured, respectively, by chemiluminescence immunoassay and liquid chromatography-tandem mass spectrometry. RESULTS Low basal serum or salivary F levels could predict AI. For the LDSST, the best ROC-calculated threshold for serum F to differentiate AI from AS was 427 nmol/L (SE 79%, SP 89%), serum F > 500 nmol/L reached SP 100%. A salivary F peak > 12.1 nmol/L after administering synacthen reached SE 95% and SP 84% for diagnosing central AI, indicating a conclusive reduction in the likelihood of AI. This ROC-calculated threshold for salivary F was similar to the 2.5th percentile of patients with a normal HPA axis, so it was considered sufficient to exclude AI. Considering AS those patients with salivary F > 12.1 nmol/L after LDSST, we could avoid unnecessary glucocorticoid treatment: 99/150 subjects (66%) had an inadequate serum F peak after synacthen, but salivary F was >12.1 nmol/L in 79 cases, who could, therefore, be considered AS. CONCLUSIONS Salivary F levels > 12.1 nmol/L after synacthen administration can indicate an intact HPA axis in patients with an incomplete serum F response, avoiding the need to start glucocorticoid replacement treatment.
Collapse
Affiliation(s)
- Filippo Ceccato
- Department of Medicine DIMED, University of Padova, Padova, Italy
- Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy
- Department of Neuroscience DNS, University of Padova, Padova, Italy
- Correspondence should be addressed to F Ceccato:
| | - Elisa Selmin
- Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Giorgia Antonelli
- Department of Medicine DIMED, University of Padova, Padova, Italy
- Laboratory Medicine, University-Hospital of Padova, Padova, Italy
| | - Mattia Barbot
- Department of Medicine DIMED, University of Padova, Padova, Italy
- Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy
- Department of Neuroscience DNS, University of Padova, Padova, Italy
| | - Andrea Daniele
- Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Marco Boscaro
- Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Mario Plebani
- Department of Medicine DIMED, University of Padova, Padova, Italy
- Laboratory Medicine, University-Hospital of Padova, Padova, Italy
| | - Carla Scaroni
- Department of Medicine DIMED, University of Padova, Padova, Italy
- Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy
| |
Collapse
|
6
|
Ramirez Alcantara J, Halper A. Adrenal insufficiency updates in children. Curr Opin Endocrinol Diabetes Obes 2021; 28:75-81. [PMID: 33278125 DOI: 10.1097/med.0000000000000591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The current article will review the newest diagnostic tools, genetic causes, and treatment of adrenal insufficiency in children. RECENT FINDINGS It is common practice to perform an adrenocorticotropin hormone (ACTH) stimulation test when adrenal insufficiency is suspected. The indications for use of a high-dose or low-dose of synthetic ACTH in children have been refined. In addition, newer studies propose adding 15 and 30-min serum or salivary cortisol levels to the low-dose ACTH stimulation test to correctly identify adrenal insufficiency. Recent identification of genetic mutations in children with non-classic steroidogenic acute regulatory protein and other mutations associated with primary and secondary adrenal insufficiency have expanded the cause and pathophysiology of monogenic adrenal insufficiency. In addition, newer hydrocortisone formulations and delivery methods and medications to use in combination with hydrocortisone are being explored to improve treatment for children with adrenal insufficiency. SUMMARY Improved diagnostic aids, detection of newer genetic mutations, and better treatment options and delivery systems will help correctly identify and manage children with adrenal insufficiency to improve health outcomes and quality of life. VIDEO ABSTRACT http://links.lww.com/COE/A21.
Collapse
Affiliation(s)
- Jonanlis Ramirez Alcantara
- Division of Pediatric Endocrinology, Department of Pediatrics, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts, USA
| | | |
Collapse
|