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Yoshida K, Fukuoka H, Odake Y, et al. Multiple Salivary Cortisol Measurements Are a Useful Tool to Optimize Metyrapone Treatment in Patients with Cushing's Syndromes Treatment: Case Presentations. Front Endocrinol (Lausanne). 2018;8:375doi: 10.3389/fendo.2017.00375.
Yoshida, K., Fukuoka, H., Odake, Y., Nakajima, S., Tachibana, M., Ito, J., Hosokawa, Y., Yamada, T., Miura, H., Suematsu, N., Matsumoto, R., Bando, H., Suda, K., Nishizawa, H., Iguchi, G., Ogawa, W., & Takahashi, Y. (2017). Multiple Salivary Cortisol Measurements Are a Useful Tool to Optimize Metyrapone Treatment in Patients with Cushing's Syndromes Treatment: Case Presentations. Frontiers in endocrinology, 8375. https://doi.org/10.3389/fendo.2017.00375
Yoshida, Kenichi, et al. "Multiple Salivary Cortisol Measurements Are a Useful Tool to Optimize Metyrapone Treatment in Patients with Cushing's Syndromes Treatment: Case Presentations." Frontiers in endocrinology vol. 8 (2017): 375. doi: https://doi.org/10.3389/fendo.2017.00375
Yoshida K, Fukuoka H, Odake Y, Nakajima S, Tachibana M, Ito J, Hosokawa Y, Yamada T, Miura H, Suematsu N, Matsumoto R, Bando H, Suda K, Nishizawa H, Iguchi G, Ogawa W, Takahashi Y. Multiple Salivary Cortisol Measurements Are a Useful Tool to Optimize Metyrapone Treatment in Patients with Cushing's Syndromes Treatment: Case Presentations. Front Endocrinol (Lausanne). 2018 Jan 11;8:375. doi: 10.3389/fendo.2017.00375. eCollection 2017. PMID: 29375480; PMCID: PMC5768610.
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Front Endocrinol (Lausanne). 2018 Jan 11;8:375. doi: 10.3389/fendo.2017.00375. eCollection 2017.

Multiple Salivary Cortisol Measurements Are a Useful Tool to Optimize Metyrapone Treatment in Patients with Cushing's Syndromes Treatment: Case Presentations.

Frontiers in endocrinology

Kenichi Yoshida, Hidenori Fukuoka, Yukiko Odake, Shinsuke Nakajima, Mariko Tachibana, Jun Ito, Yusei Hosokawa, Tomoko Yamada, Hiroshi Miura, Natsu Suematsu, Ryusaku Matsumoto, Hironori Bando, Kentaro Suda, Hitoshi Nishizawa, Genzo Iguchi, Wataru Ogawa, Yutaka Takahashi

Affiliations

  1. Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe, Japan.
  2. Division of Diabetes and Endocrinology, Kobe University Hospital, Kobe, Japan.

PMID: 29375480 PMCID: PMC5768610 DOI: 10.3389/fendo.2017.00375

Abstract

Measuring salivary cortisol is both convenient and non-invasive for patients; however, its usefulness as a marker for monitoring medical therapy has not yet been established. The aim of this study was to assess the utility of multiple salivary cortisol measurements in patients with Cushing's syndrome (CS) during medical therapy. Six patients with CS (three with cortisol-secreting adrenocortical adenoma and three with ACTH-secreting pituitary adenoma) were recruited. Samples for morning serum cortisol, urinary free cortisol (UFC), and multiple salivary cortisol levels were collected before and during metyrapone treatment. The area under the curve (AUC) and mean value (MV) of daily salivary cortisol levels were calculated. In five out of six patients, UFC were normalized; however, multiple salivary cortisol measurements revealed an impaired diurnal cortisol rhythm in these patients. To verify the usefulness of multiple salivary cortisol measurements, we performed a prospective case study of a patient in whom the excess secretion of cortisol was not controlled (UFC 211 μg/day) with 2,250 mg/day in four divided doses of metyrapone. Multiple measurements of salivary cortisol revealed that cortisol levels elevated before the next administration. Accordingly, we shortened the interval by increasing the number of administration from four to five times per day, with a slight increment of daily dose of 2,500 mg. These optimizations resulted in a drastic improvement of diurnal pattern as well as UFC level (101 μg/day). Changes in both the MV and AUC of salivary cortisol levels were more correlated with those in UFC levels (Correlation coefficient 0.75,

Keywords: Cushing’s syndrome; diurnal rhythm; metyrapone; monitoring marker; salivary cortisol

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