Irina-Alexandra Bacila, J. Adaway, J. Hawley
Dec 1, 2019
Citations
1
Influential Citations
25
Citations
Quality indicators
Journal
The Journal of clinical endocrinology and metabolism
Abstract
BACKGROUND Monitoring of hormonal control represents a key part of the management in congenital adrenal hyperplasia (CAH). Monitoring strategies remain suboptimal as they rely on frequent blood tests and are not specific for adrenal-derived hormones. Recent evidence suggests a crucial role of adrenal-specific 11-oxygenated-C19 androgens in the pathogenesis of CAH. OBJECTIVE To establish the correlation between plasma and salivary adrenal-specific androgens in CAH as a novel non-invasive monitoring strategy. DESIGN This prospective cross-sectional study recruited patients between 2015-2018. SETTING Multi-center study including 13 tertiary centers in the UK. PARTICIPANTS Seventy-eight children with CAH and sixty-two matched healthy controls. METHODS Using liquid-chromatography tandem mass spectrometry, plasma and salivary concentrations of five steroids were measured: 17-hydroxyprogesterone, androstenedione, testosterone, 11-hydroxyandrostenedione and 11-ketotestosterone. The correlation between plasma and salivary steroids was analyzed to assess their use in clinical practice. RESULTS Strong correlations between plasma and salivary steroid concentrations in patients with CAH were detected: 17-hydroxyprogesterone (rs=0.871, p<0.001), androstenedione (rs=0.931, p<0.001), testosterone (rs=0.867, p<0.001), 11-hydroxyandrostenedione (rs=0.876, p<0.001), 11-ketotestosterone (rs=0.944, p<0.001). These results were consistent for patient subgroups based on gender and age. Analyzing patient subgroups based on 17-hydroxyprogesterone concentrations established clear correlations between plasma and salivary concentrations of the adrenal specific androgen 11-ketotestosterone. CONCLUSIONS The present study identified tight correlations between plasma and saliva for the adrenal-derived 11oxygenated-C19 androgen 11-ketotestosterone, as well as 17-hydroxyprogesterone and androstenedione, which are widely used for monitoring treatment in CAH. This novel combination of steroid hormones will serve as an improved non-invasive salivary test for disease monitoring of patients with CAH.