Salivary cortisol levels during Ramadan fasting in hydrocortisone-treated secondary adrenal insufficiency patients
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ORIGINAL ARTICLE
Salivary cortisol levels during Ramadan fasting in hydrocortisone-treated secondary adrenal insufficiency patients Melika Chihaoui 1 Wiem Madhi1 Meriem Yazidi1 Bessem Hammami2 Ibtissem Oueslati1 Nadia Khessairi1 Wafa Grira1 Amina Bibi3 Moncef Feki2 Fatma Chaker1 ●
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Received: 26 May 2020 / Accepted: 1 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Objective Patients with adrenal insufficiency have difficulties in fasting during the month of Ramadan with an increased risk of complications. Cortisol levels are unknown in these patients. The objective of this study was to assess the daily cortisol profile in hydrocortisone-treated patients with secondary adrenal insufficiency (SAI) and healthy controls during a fasting day. Methods A cross-sectional matched case-control study on 50 hydrocortisone-treated SAI patients and 69 controls who are used to fast. Clinical and therapeutic data were collected. Five salivary samples for cortisol measurement were collected throughout a fasting day of the third week of Ramadan 2019. Results Salivary cortisol levels were significantly higher on awakening, at midnight and before the predawn meal in patients compared with controls. The circadian cortisol rhythm was disrupted in patients. The area under the salivary cortisol level versus time curve (AUC) was lower than the 2.5th percentile of the controls in one patient (2.5%) and higher than the 97.5th percentile in 23 patients (59%) who were considered overtreated. Age ≥ 35 years was independently associated with overtreatment (adjusted odds ratio = 12.0; 95% CI (2.0–70.4); p = 0.006). Seven patients broke their fasting for a complication compared with no one of the controls (p = 0.001). No factor was associated with this risk. Conclusions Salivary cortisol levels were high in fasting hydrocortisone-treated SAI patients with a disruption of the circadian rhythm. Keywords Salivary cortisol Secondary adrenal insufficiency: Fasting Hydrocortisone Circadian rhythm ●
Introduction Immediate release hydrocortisone is the most widely used replacement therapy in adrenal insufficiency (AI). However, studies have shown that it is far from perfectly replicate the physiological circadian cortisol rhythm [1]. So, patients
* Melika Chihaoui [email protected] 1
Department of Endocrinology, University Hospital La Rabta, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Department of Biochemistry, University Hospital La Rabta, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Department of Biochemistry, National Institute of Nutrition, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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may suffer from symptoms of under treatment with a decrease in the quality of life or from the consequences of chronic overtreatment such as metabolic disturbances and a loss of bone mineral density [2]. Reproducing the physiological secretion of cortisol during Ra
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