Home Waking Salivary Cortisone to Screen for Adrenal Insufficiency

BackgroundWorldwide, adults and children are at risk of adrenal insufficiency as a result suppression from use anti-inflammatory glucocorticoids opiates, well infectious diseases. The adrenocorticotropin (ACTH) stimulation test is the reference standard for diagnosis but requires clinic attendance venesection. Salivary cortisone reflects free serum cortisol, samples can be collected home posted to laboratory. We tested whether waking salivary level could used screen insufficiency.MethodsA prospective, diagnostic accuracy study was performed in patients high insufficiency. Patients sample on then attended clinical facility an ACTH test. measured by liquid chromatography–tandem mass spectrometry. Receiver-operating characteristic curves were computed, positive negative predictive values calculated.ResultsTwo hundred twenty recruited. As test, prevalence 44%. area under receiver-operating curve predictor 0.95 (95% confidence interval [CI], 0.92 0.97). Cutoffs ensure minimum 95% sensitivity specificity gave value 96% CI, 90 99) 87 exclude confirm insufficiency, respectively. Waking data provided information similar that 70% participants. Eighty-three percent preferred collection attendance.ConclusionsHome sampling has found at-home more convenient than hospital-based (Funded National Institute Health Research.)