{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T18:23:53Z","timestamp":1789237433903,"version":"build-2803163510"},"reference-count":37,"publisher":"The Endocrine Society","issue":"2","license":[{"start":{"date-parts":[[2023,9,28]],"date-time":"2023-09-28T00:00:00Z","timestamp":1695859200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000866","name":"Cardiff University","doi-asserted-by":"publisher","award":["521809"],"award-info":[{"award-number":["521809"]}],"id":[{"id":"10.13039\/501100000866","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>The serum total cortisol response to the ACTH stimulation test is widely used to assess adrenocortical function but is affected by changes in cortisol-binding globulin (CBG) concentration. Salivary cortisol reflects free cortisol concentrations and may offer a reliable alternative.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>(1) To establish the salivary cortisol response to ACTH stimulation in healthy volunteers and patients with altered CBG concentrations; (2) to evaluate the performance of a lower reference limit (LRL) determined in healthy volunteers in patients with suspected hypoadrenalism (SH-patients).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A 250 \u00b5g ACTH stimulation test was undertaken in 139 healthy volunteers, 24 women taking an estradiol-containing oral contraceptive pill (OCP-females), 10 patients with low serum protein concentration (LP-patients), and 30 SH-patients. Salivary cortisol was measured by liquid chromatography-tandem mass spectrometry. Mean and LRL of the 30-minute salivary cortisol response (mean\u20141.96 standard deviation) were derived from log-transformed concentrations. The LRL was applied as a diagnostic cut-off in SH-patients, with comparison to the serum response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Mean CBG concentrations (range) were 58 (42-81) mg\/L, 64 (43-95) mg\/L, 41 (28-60) mg\/L, and 116 (84-159) mg\/L in males, females, LP-patients, and OCP-females, respectively. The mean 30-minute salivary cortisol concentration was 19.3 (2.5th-97.5th percentile 10.3-36.2) nmol\/L in healthy volunteers. Corresponding values were not different in OCP-females [19.7 (9.5-41.2) nmol\/L; P = .59] or LP-patients [19.0 (7.7-46.9) nmol\/L; P = .97]. Overall diagnostic agreement between salivary and serum responses in SH-patients was 79%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Salivary cortisol response to ACTH stimulation offers a reliable alternative to serum and may be especially useful in conditions of altered CBG concentration.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/clinem\/dgad576","type":"journal-article","created":{"date-parts":[[2023,9,27]],"date-time":"2023-09-27T08:47:04Z","timestamp":1695804424000},"page":"e579-e588","source":"Crossref","is-referenced-by-count":14,"title":["Salivary Cortisol Response to ACTH Stimulation Is a Reliable Alternative to Serum Cortisol in Evaluating Hypoadrenalism"],"prefix":"10.1210","volume":"109","author":[{"given":"Nadia","family":"El-Farhan","sequence":"first","affiliation":[{"name":"Department of Medical Biochemistry, Royal Gwent Hospital , Newport 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