ArticleThe Journal of clinical endocrinology and metabolism2024
Salivary Cortisol and Cortisone Can Circumvent Confounding Effects of Oral Contraceptives in the Short Synacthen Test.
Article in The Journal of clinical endocrinology and metabolism, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
What it found
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Who cites it
6 citing papers in PubMed, 8 citations in OpenAlex.
- Adrenal insufficiency after long-term high-dose ethinylestradiol use in a transgender woman.JCEM case reports · 2026Article
- Old and new pituitary biomarkers: evidence for sex-specificity.Pituitary · 2026Review
- Waking Salivary Cortisone vs Serum Cortisol in the Short Synacthen Test in Screening for Adrenocortical Insufficiency: Results of a Service Evaluation.Clinical endocrinology · 2025Article
- Severe hypoglycaemia secondary to chronic opioid-induced hypothalamic-pituitary-adrenal axis suppression: an under-recognised phenomenon.The Medical journal of Australia · 2025Article
- Utility of Salivary Cortisol and Cortisone in the Diagnostics of Adrenal Insufficiency.The Journal of clinical endocrinology and metabolism · 2025Article
- Salivary Cortisol and Cortisone Can Circumvent Confounding Effects of Oral Contraceptives in the Short Synacthen Test.The Journal of clinical endocrinology and metabolism · 2024Article
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7 authors at 1 institution in 1 country.
Funding
Abstract
contextAdrenal insufficiency (AI) is usually diagnosed by low plasma cortisol levels following a short Synacthen test (SST). Most plasma cortisol is bound to corticosteroid-binding globulin, which is increased by estrogen in combined estrogen-progestin oral contraceptives (COCs). Women with AI using COCs are therefore at risk of having an apparently normal plasma cortisol level during SST, which would not adequately reflect AI.
objectiveThis work aimed to test whether salivary cortisol or cortisone during SST is more robust against the COC effect and to calculate the lower reference limits (LRLs) for these to be used as tentative diagnostic cutoffs to exclude AI.
methodsForty-one healthy women on COCs and 46 healthy women without exogenous estrogens underwent an SST with collection of plasma and salivary samples at 0, 30, and 60 minutes after Synacthen injection. The groups were compared using regression analysis with age as covariate and the LRLs were calculated parametrically.
resultsSST-stimulated plasma cortisol levels were significantly higher in the COC group vs controls, while mean salivary cortisol and cortisone levels were slightly lower in the COC group. Importantly, COC use did not significantly alter LRLs for salivary cortisol or cortisone. The smallest LRL difference between groups was seen for salivary cortisone.
conclusionSalivary cortisol and especially salivary cortisone are considerably less affected by COC use than plasma cortisol during SST. Due to similar LRLs, a common cutoff for salivary cortisol and cortisone during SST can be used to exclude AI in premenopausal women irrespective of COC use.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.