Low-dose Synachten test with measurement of salivary cortisol in adult patients with β-thalassemia major

Alberto G Ambrogio, Leila Danesi, Marina Baldini, Raffaella Radin, Elena Cassinerio, Giovanna Graziadei, Nadia Mirra, Emanuela D'Angelo, Alessia Marcon, Marta Mancarella, Alessandra Orsatti, Federico Bonetti, Massimo Scacchi, Maria Domenica Cappellini, Luca Persani, Francesca Pecori Giraldi

Research output: Contribution to journalArticlepeer-review


PURPOSE: Beta-thalassemia major is a severe, congenital hematological disorder and, if untreated, leads to early mortality. Progress in therapeutical strategies improved clinical outcomes and life expectancy; however, increased survival led to the development of new disorders, including endocrinopathies. Little is known on the possible impairment of adrenocortical function, a potentially life-threatening condition, in long-term thalassaemic survivors. We therefore decided to assess adrenal reserve and the value of salivary cortisol during ACTH stimulation in the diagnosis of adrenocortical insufficiency in adult patients with β-thalassemia major.

METHODS: Cross-sectional study including 72 adults with β-thalassemia major. Patients were tested with 1 µg ACTH for serum and salivary cortisol.

RESULTS: Subnormal serum cortisol responses to ACTH stimulation (i.e., <500 nmol/l) were registered in 15 out of 72 patients. Salivary cortisol increased in parallel with serum cortisol and a clear-cut positive correlation was detected at each timepoint. Moreover, peak salivary cortisol values after ACTH stimulation were significantly lower in patients with impaired adrenal reserve (513.6 ± 52.33 vs. 914.1 ± 44.04 nmol/l p < 0.0001).

CONCLUSIONS: Our results attest to the need for testing for adrenal insufficiency among adult thalassaemic patients, as up to 20% presented impaired adrenal reserve. Salivary and serum cortisol levels during stimulation with ACTH were closely correlated and the use of salivary cortisol sampling during ACTH testing may represent a surrogate to serum cortisol in these patients.

Original languageEnglish
Pages (from-to)348-354
Number of pages7
Issue number2
Publication statusPublished - May 2018


  • Adrenal Insufficiency/diagnosis
  • Adrenocorticotropic Hormone
  • Adult
  • Cross-Sectional Studies
  • Female
  • Humans
  • Hydrocortisone/blood
  • Italy/epidemiology
  • Male
  • Middle Aged
  • Prevalence
  • Saliva/chemistry
  • Young Adult
  • beta-Thalassemia/complications


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