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Salivary Steroids in Response to ACTH: A Less Invasive Approach to Assess Adrenal Function in Hypotensive Patients With Chronic Renal Failure

Contreras, Liliana N. MD*; Arregger, Alejandro L. MD†; Tumilasci, Omar MD‡; Persi, Gabriel MD§; Zucchini, Alfredo MD¶; Cardoso, Estela M. PhD∥

CME Review Article #4
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The aim of this study was to use salivary cortisol and salivary aldosterone after an ACTH stimulation test to assess adrenal function in patients with chronic renal failure (CRF). Salivary samples for the measurement of cortisol and aldosterone were obtained before and after stimulation with 250 μg ACTH intramuscularly. Twenty patients with chronic renal failure and 24 healthy subjects were enrolled in the study. Salivary cortisol and salivary aldosterone concentrations were measured at baseline and 30 minutes after ACTH stimulation. Adrenal insufficiency was diagnosed in 5 patients. Selective hypoaldosteronism was found in 4 patients. The salivary steroid measurement after ACTH stimulation proves to be a useful test to diagnose adrenal insufficiency in patients with renal failure.

*Chief, Endocrine Research Department, Department of Nephrology, Instituto de Investigaciones Mèdicas A. Lanari, University of Buenos Aires, and Consejo Nacional de Investigaciones Cientificas y Tecnologicas (CONICET); †Associate Clinical Researcher, Department of Nephrology, Instituto de Investigaciones Mèdicas A. Lanari, University of Buenos Aires; ‡Chief, Salivary Glands Laboratory, School of Medicine, University of Buenos Aires and Consejo Nacional de Investigaciones Cientificas y Tecnologicas (CONICET); §Assistant Researcher, Endocrine Research Department, Instituto de Investigaciones Mèdicas A. Lanari, University of Buenos Aires; ¶Chief, Department of Nephrology, Instituto de Investigaciones Mèdicas A. Lanari, University of Buenos Aires; and ∥Chief, Laboratory Endocrine Research Department, Endocrine Research Department, Department of Nephrology, Instituto de Investigaciones Mèdicas A. Lanari, University of Buenos Aires and Consejo Nacional de Investigaciones Cientificas y Tecnologicas (CONICET), Buenos Aires, Argentina.

This work was supported in part by a “Ramon Carrillo–Arturo Oñativia” grant 2004.

The authors have disclosed that they have no significant relationships with or financial interests in any commercial company that pertains to this educational activity.

Wolters Kluwer Health has identified and resolved all faculty conflicts of interest regarding this educational activity.

Reprints: Liliana N. Contreras, Endocrine Research Department, Instituto de Investigaciones Médicas A. Lanari, Avenida Combatientes de Malvinas 3150, CP 1427. Buenos Aires, Argentina. E-mail: endoexp2000@yahoo.com.

Chief Editor's Note: This article is the 4th of 36 that will be published in 2006 for which a total of up to 36 Category 1 CME credits can be earned. Instructions for how credits can be earned precede the CME Examination at the back of this issue.

© 2006 Lippincott Williams & Wilkins, Inc.