L. Tucci, F. Fanelli, Ilaria Improta, Valentina Bissi, Claudia Lena, Greta Galante, M. Mezzullo, Matteo Magagnoli, Anna Bianca Lalumera, Giacomo Colombin, Kimberly Coscia, Laura Rotolo, V. Vicennati, U. Pagotto, G. Di Dalmazi
{"title":"通过唾液类固醇监测肾上腺功能不全:一项试点研究。","authors":"L. Tucci, F. Fanelli, Ilaria Improta, Valentina Bissi, Claudia Lena, Greta Galante, M. Mezzullo, Matteo Magagnoli, Anna Bianca Lalumera, Giacomo Colombin, Kimberly Coscia, Laura Rotolo, V. Vicennati, U. Pagotto, G. Di Dalmazi","doi":"10.1093/ejendo/lvae037","DOIUrl":null,"url":null,"abstract":"BACKGROUND\nVarious glucocorticoid replacement treatments (GRT) are available for adrenal insufficiency (AI). However, their effectiveness in restoring glucocorticoid rhythm and exposure lacks adequate biochemical markers. We described the diurnal salivary cortisol (SalF) and cortisone (SalE) rhythm among different GRTs and analysed the associations between saliva-derived parameters and life quality questionnaires.\n\n\nMETHODS\nControl subjects (CS, n=28) and AI patients receiving hydrocortisone (HC, n=9), cortisone acetate (CA, n=23), dual-release hydrocortisone once (DRHC-od, n=10) and twice a day (DRHC-td, n=6) collected 9 saliva samples from 07:00 to 23:00. Patients compiled Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale and Addison disease specific quality-of-life questionnaires. SalE and SalF were measured by liquid chromatography-mass spectrometry. Exposure was monitored using SalE for HC and DRHC, and SalF for CA. Area under the curve (AUC) was computed. Different GRTs were compared by Z-scores calculated from saliva-derived parameters. Questionnaires results predictors were evaluated with multiple regression analysis.\n\n\nRESULTS\nCompared to controls, all GRTs resulted in glucocorticoid over-exposure in the morning. HC, CA, and DRHC-td caused over-exposure also in afternoon and evening. Compared to other treatments, CA determined increased Z-score-07:00 (p<0.001), DRHC-td determined increased Z-score-AUC07:00→14:00 (p=0.007) and DRHC-od induced lower Zscore-AUC14:00→23:00 (p=0.015). Z-scores-AUC14:00→16:00 ≥ 0.619 best predicted questionnaire scores.\n\n\nCONCLUSIONS\nNone of the GRTs mimics normal glucocorticoid rhythmicity and exposure. SalE, SalF and Z-score may be useful markers for monitoring and comparing different GRTs. Excess glucocorticoid in early afternoon best associated with depressive symptoms and worse life and sleep quality.","PeriodicalId":11884,"journal":{"name":"European Journal of Endocrinology","volume":null,"pages":null},"PeriodicalIF":5.3000,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Monitoring adrenal insufficiency through salivary steroids: a pilot study.\",\"authors\":\"L. Tucci, F. Fanelli, Ilaria Improta, Valentina Bissi, Claudia Lena, Greta Galante, M. Mezzullo, Matteo Magagnoli, Anna Bianca Lalumera, Giacomo Colombin, Kimberly Coscia, Laura Rotolo, V. Vicennati, U. Pagotto, G. Di Dalmazi\",\"doi\":\"10.1093/ejendo/lvae037\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"BACKGROUND\\nVarious glucocorticoid replacement treatments (GRT) are available for adrenal insufficiency (AI). However, their effectiveness in restoring glucocorticoid rhythm and exposure lacks adequate biochemical markers. We described the diurnal salivary cortisol (SalF) and cortisone (SalE) rhythm among different GRTs and analysed the associations between saliva-derived parameters and life quality questionnaires.\\n\\n\\nMETHODS\\nControl subjects (CS, n=28) and AI patients receiving hydrocortisone (HC, n=9), cortisone acetate (CA, n=23), dual-release hydrocortisone once (DRHC-od, n=10) and twice a day (DRHC-td, n=6) collected 9 saliva samples from 07:00 to 23:00. Patients compiled Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale and Addison disease specific quality-of-life questionnaires. SalE and SalF were measured by liquid chromatography-mass spectrometry. Exposure was monitored using SalE for HC and DRHC, and SalF for CA. Area under the curve (AUC) was computed. Different GRTs were compared by Z-scores calculated from saliva-derived parameters. Questionnaires results predictors were evaluated with multiple regression analysis.\\n\\n\\nRESULTS\\nCompared to controls, all GRTs resulted in glucocorticoid over-exposure in the morning. HC, CA, and DRHC-td caused over-exposure also in afternoon and evening. Compared to other treatments, CA determined increased Z-score-07:00 (p<0.001), DRHC-td determined increased Z-score-AUC07:00→14:00 (p=0.007) and DRHC-od induced lower Zscore-AUC14:00→23:00 (p=0.015). Z-scores-AUC14:00→16:00 ≥ 0.619 best predicted questionnaire scores.\\n\\n\\nCONCLUSIONS\\nNone of the GRTs mimics normal glucocorticoid rhythmicity and exposure. SalE, SalF and Z-score may be useful markers for monitoring and comparing different GRTs. Excess glucocorticoid in early afternoon best associated with depressive symptoms and worse life and sleep quality.\",\"PeriodicalId\":11884,\"journal\":{\"name\":\"European Journal of Endocrinology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":5.3000,\"publicationDate\":\"2024-04-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Endocrinology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ejendo/lvae037\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ENDOCRINOLOGY & METABOLISM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Endocrinology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ejendo/lvae037","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
引用次数: 0
摘要
背景各种糖皮质激素替代疗法(GRT)可用于治疗肾上腺功能不全(AI)。然而,它们在恢复糖皮质激素节律和暴露方面的有效性缺乏适当的生化指标。我们描述了不同 GRT 的昼夜唾液皮质醇(SalF)和可的松(SalE)节律,并分析了唾液衍生参数与生活质量问卷之间的关联。方法对照组(CS,n=28)和接受氢化可的松(HC,n=9)、醋酸可的松(CA,n=23)、双释放氢化可的松一次(DRHC-od,n=10)和一天两次(DRHC-td,n=6)治疗的人工智能患者在 7:00 至 23:00 期间采集了 9 份唾液样本。患者填写匹兹堡睡眠质量指数、医院焦虑和抑郁量表以及阿狄森病特定生活质量问卷。通过液相色谱-质谱法测量 SalE 和 SalF。使用 SalE 监测 HC 和 DRHC 的暴露情况,使用 SalF 监测 CA 的暴露情况。计算曲线下面积(AUC)。根据唾液衍生参数计算出的 Z 分数对不同的 GRT 进行比较。结果与对照组相比,所有 GRT 均导致早晨糖皮质激素暴露过度。HC、CA和DRHC-td也会导致下午和晚上的过度暴露。与其他处理相比,CA导致Z-score-07:00增加(p<0.001),DRHC-td导致Z-score-AUC07:00→14:00增加(p=0.007),DRHC-od导致Z-score-AUC14:00→23:00降低(p=0.015)。Z-scores-AUC14:00→16:00≥0.619最能预测问卷得分。SalE、SalF和Z-score可能是监测和比较不同GRT的有用标记。下午早些时候过量的糖皮质激素与抑郁症状以及生活和睡眠质量的恶化最有关联。
Monitoring adrenal insufficiency through salivary steroids: a pilot study.
BACKGROUND
Various glucocorticoid replacement treatments (GRT) are available for adrenal insufficiency (AI). However, their effectiveness in restoring glucocorticoid rhythm and exposure lacks adequate biochemical markers. We described the diurnal salivary cortisol (SalF) and cortisone (SalE) rhythm among different GRTs and analysed the associations between saliva-derived parameters and life quality questionnaires.
METHODS
Control subjects (CS, n=28) and AI patients receiving hydrocortisone (HC, n=9), cortisone acetate (CA, n=23), dual-release hydrocortisone once (DRHC-od, n=10) and twice a day (DRHC-td, n=6) collected 9 saliva samples from 07:00 to 23:00. Patients compiled Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale and Addison disease specific quality-of-life questionnaires. SalE and SalF were measured by liquid chromatography-mass spectrometry. Exposure was monitored using SalE for HC and DRHC, and SalF for CA. Area under the curve (AUC) was computed. Different GRTs were compared by Z-scores calculated from saliva-derived parameters. Questionnaires results predictors were evaluated with multiple regression analysis.
RESULTS
Compared to controls, all GRTs resulted in glucocorticoid over-exposure in the morning. HC, CA, and DRHC-td caused over-exposure also in afternoon and evening. Compared to other treatments, CA determined increased Z-score-07:00 (p<0.001), DRHC-td determined increased Z-score-AUC07:00→14:00 (p=0.007) and DRHC-od induced lower Zscore-AUC14:00→23:00 (p=0.015). Z-scores-AUC14:00→16:00 ≥ 0.619 best predicted questionnaire scores.
CONCLUSIONS
None of the GRTs mimics normal glucocorticoid rhythmicity and exposure. SalE, SalF and Z-score may be useful markers for monitoring and comparing different GRTs. Excess glucocorticoid in early afternoon best associated with depressive symptoms and worse life and sleep quality.
期刊介绍:
European Journal of Endocrinology is the official journal of the European Society of Endocrinology. Its predecessor journal is Acta Endocrinologica.
The journal publishes high-quality original clinical and translational research papers and reviews in paediatric and adult endocrinology, as well as clinical practice guidelines, position statements and debates. Case reports will only be considered if they represent exceptional insights or advances in clinical endocrinology.
Topics covered include, but are not limited to, Adrenal and Steroid, Bone and Mineral Metabolism, Hormones and Cancer, Pituitary and Hypothalamus, Thyroid and Reproduction. In the field of Diabetes, Obesity and Metabolism we welcome manuscripts addressing endocrine mechanisms of disease and its complications, management of obesity/diabetes in the context of other endocrine conditions, or aspects of complex disease management. Reports may encompass natural history studies, mechanistic studies, or clinical trials.
Equal consideration is given to all manuscripts in English from any country.