Glucocorticoid-induced adrenal insufficiency in kidney transplant recipients: assessing the role of salivary cortisone
Vincenzo Delsinne, Delphine Kemlin, Natacha Driessens, Alain Le MoineAbstract
Background and Aims
Glucocorticoids are widely used in kidney transplant recipients, placing them at risk of adrenal insufficiency due to suppression of the hypothalamic-pituitary-adrenal axis. This retrospective study evaluated the proportion of patients at high risk of adrenal insufficiency based on morning serum cortisol concentrations, identified associated risk factors, and assessed the role of salivary cortisol and cortisone.
Methods
Morning serum cortisol was measured in 64 kidney transplant recipients (≥1 year post-transplantation) receiving stable oral methylprednisolone for ≥6 months and compared with concomitant waking salivary cortisol and cortisone concentrations.
Results
Forty-seven percent of patients were classified as high risk of adrenal insufficiency. Morning serum cortisol concentrations <150 nmol/L classified patients as high risk of adrenal insufficiency, whereas concentrations >300 nmol/L classified patients as low risk. Morning serum cortisol was significantly associated with daily methylprednisolone dose (P = 0.018). Morning serum cortisol highly correlated with salivary cortisone concentrations (r = 0.903) and showed excellent agreement for adrenal insufficiency risk classification (quadratic weighted Cohen's κ = 0.88).
Conclusions
A substantial proportion of kidney transplant recipients were classified as high risk of adrenal insufficiency. Waking salivary cortisone showed strong agreement with morning serum cortisol, supporting its further evaluation for adrenal insufficiency risk assessment.