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Hydrocortisone Dosage Requirements for Patients With Adrenal Insufficiency Unlikely to Be Determined by Salivary Monitoring: Presented at ENDO 2006 By Maria Bishop BOSTON, MA -- June 30, 2006 -- Salivary monitoring is unlikely to be a useful determinant of hydrocortisone dosage requirements in patients with adrenal insufficiency, researchers reported here at the Endocrine Society's 88th Annual Meeting (ENDO 2006). Hydrocortisone is the standard replacement therapy for adrenal insufficiency, but saliva measurement is not yet considered part of a conventional adrenal workup. While saliva measurement holds a great deal of promise in allowing the determination of hormone levels in patients requiring assessment of glandular health and balance, its degree of reliability remains to be fully evaluated. Led by E. Marie Freel, MD, research student, Medical Research Council Blood Pressure Group, Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow, Scotland, the study sought to determine dosage requirements and the value of salivary monitoring in these patients. The study assessed variability in cortisol metabolism, as well as relationships between plasma and salivary cortisol profiles in 10 patients with primary adrenal insufficiency (7 females) and 17 patients with secondary adrenal insufficiency (9 females). Cortisol levels were measured in saliva by radioimmunoassay (125I-cortisol) and in plasma by high-performance liquid chromatograph following solvent extraction. The researchers discovered a significant correlation between plasma and salivary area under the curve (AUC) within 2 to 8 hours after intravenous administration of a 20 mg hydrocortisone bolus (P = .00), but differences between predicted and measured plasma AUCs ranged from 3% to 90% (median 18%). There was also a poor correlation between plasma and saliva AUC within 2 to 6 hours after oral administration of 10 to 20 mg hydrocortisone tablets (P = .08). Due to the wide variability identified in the way individual patients handled the hydrocortisone, the researchers concluded that it would be difficult to recommend a standard dose of hydrocortisone based on salivary monitoring in this population. [Presentation title: Hydrocortisone Replacement Therapy -- the Controversy Continues. Abstract 752] E-mail this page to a friend or colleague! To print, use this version