Significance of Exogenous Estradiol on Plasma Cortisol and Salivary Cortisol During Adrenocorticotropic Hormone Stimulation in Women With Pituitary Insufficiency
Authors' conclusion
In patients with overt adrenal insufficiency pTC was not influenced by estradiol supplementation. However, salivary cortisol decreased on oral estradiol concomitant with an increase in CBG levels. Our data may support the use of transdermal estradiol and the use of salivary cortisol when evaluating the adrenal axis.
Study context
- Population
- Hypogonadal women with secondary adrenal insufficiency or at risk of developing adrenal insufficiency (hypopituitary); mean age 42 ± 6 years
- Participants
- 17 women
- Comparison
- Oral estradiol vs transdermal estradiol vs no estradiol
- Outcome
- Plasma total cortisol (pTC) after 250 ug Synacthen-test (normal response pTC > 420 nmol/L, overt adrenal insufficiency pTC < 250 nmol/L)
- Follow-up
- 30 min
Main finding
As reported in the abstract
30-min pTC
Further findings
nmol/L
| Outcome | No estradiol | Oral estradiol | P value |
|---|---|---|---|
| 30-min salivary cortisolOral estradiol vs No estradiol · lower with oral estradiol | 10.4 (range 3.6–25.5) | 6.6 (range 1.6–23.0) | P = 0.04 |
| 30-min salivary cortisolOral estradiol vs Transdermal estradiol · lower with oral estradiol | P = 0.07 |
- Cortisol binding globulin (CBG) · Oral estradiol vs No estradiol · higher with oral estradiol
- P < 0.001
- CBG · Oral estradiol vs Transdermal estradiol · higher with oral estradiol
- P = 0.017
Change in adrenal insufficiency diagnosis based on plasma total cortisol (pTC) between interventions
- Patients with overt adrenal insufficiency crossing the cut-off
- 0
- Patients with borderline adrenal insufficiency (pTC 390-559 nmol/L) crossing the cut-off
- 3
Original publication
Significance of Exogenous Estradiol on Plasma Cortisol and Salivary Cortisol During Adrenocorticotropic Hormone Stimulation in Women With Pituitary Insufficiency. Clin Endocrinol (Oxf). Published 17 August 2025. doi:10.
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