Psychoneuroendocrinology. 2005 Sep;30(8):744-52. Epub 2005 Apr
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    Impact of exogenous glucocorticoid use on salivary cortisol
measurements among adults with asthma and rhinitis.

        * Masharani U,
        * Shiboski S,
        * Eisner MD,
        * Katz PP,
        * Janson SL,
        * Granger DA,
        * Blanc PD.

    Department of Medicine, University of California San Francisco,
94143-1222, USA. ubm@itsa.ucsf.edu

    The diurnal rhythm of cortisol secretion in chronic disease can
reflect the interactions between exogenous and endogenous factors.
Exogenous glucocorticoid use may impact salivary cortisol measurements,
but this has not been well-studied in ambulatory settings. In this
report salivary cortisol levels were used to evaluate aspects of the
diurnal rhythm of cortisol secretion within an ambulatory population of
patients with asthma and allergic rhinitis. 183 persons with asthma with
or without concomitant rhinitis and 34 persons with rhinitis alone were
asked to collect at home, two saliva samples, 30 min after awakening and
12h later. The salivary cortisol levels were quantified by enzyme
immunoassay. The recent use of glucocorticoids in the study group was
determined by interview and direct examination of medications. We report
that the median salivary cortisol levels 30 min post-awakening
significantly differed by exogenous steroid status: no glucocorticoid
use (n = 91), 10.1 nmol/l; nasal gluco-corticoid use alone (n = 25),
11.4 nmol/l; inhaled glucocorticoids (with or without concomitant nasal
glucocorticoids; n = 76), 9.0 nmol/l; systemic glucocorticoids (n = 17),
4.0 nmol/l; (P = 0.02). 12-h post-awakening salivary cortisol values
among the groups were similar (P = 0.85). The median 30-min
post-awakening cortisol differed significantly by type and amount of
inhaled steroid used: non-fluticasone users (n = 21), 11.5 nmol/l; lower
dose fluticasone (<800 microg per day, n = 35); 9.2 nmol/l; and higher
dose fluticasone (> or =800 microg, n=20), 5 nmol/l; (P=0.01). We
conclude that in an ambulatory setting, exogenous glucocorticoid use can
decrease the 30 min post-awakening but not the 12-h post-awakening
salivary cortisol levels, an effect that should be taken into account in
assessing the effects of other potential determinants on cortisol secretion.

    PMID: 15919580 [PubMed - indexed for MEDLINE]