a glucocorticoid and a stress hormone (1),
an important Biomarker, has diverse effects on inflammation and protein synthesis. As Cortisol is under the influence of Hypothalamo-Pituitary-Adrenal (HPA) axis, it is secreted in response to stress whether-physical, chemical or psychological. Various
researches indicate that Salivary Cortisol is nearly as accurate as Serum Cortisol (2), and even preferred over Serum Cortisol in cases of Child
(3) and Maternal care
(4), adrenal disease
(5,6), neurological disease.
The method of collection of Salivary Cortisol is a simpler,
non-invasive approach, causing minimal-to no- discomfort to the patient (7). It reduces the risk of false values related to needle-stress (7). For this
purpose, Salivary Cortisol is routinely used in
western clinical setups (6, 8). It is also used as a Biomarker in Stress Research
(9, 10). Altered diurnal variation in Cortisol secretion is
indicated in various disease states (11). However, In
Indian Clinical scenario Serum Cortisol is being used for diagnostic and prognostic purposes,
there are fewer studies done on salivary cortisol. We aim to comparatively evaluate and correlate the salivary and Serum Cortisol levels
in order to establish preference of Salivary Cortisol over Serum Cortisol and to use Salivary Cortisol as a substitute to Serum Cortisol Assay in Indian Population.
Objectives of the Study:
estimate the levels of Salivary and Serum Cortisol in Healthy Adults.
2. To correlate the morning Salivary and Serum Cortisol
3. To study the mean
difference between morning and evening Salivary Cortisol levels.
Material and Methods:
Cross sectional study.
This study will be conducted among apparently normal Individuals.
2mL un-stimulated whole saliva sample will be collected 5
min after rinsing mouth repeatedly with distilled water, centrifuged at 3000rpm for 15 min, supernatant will be used for Salivary Cortisol Assay (12).
2mL venous blood will be drawn in
a vaccutainer, centrifuged at 3000rpm for 15 min; supernatant will be used for Serum cortisol Assay.
and salivary samples
are collected between 7-10am. And again between 4-8pm,
will be collected.
To study the correlation between saliva and serum,
n=25 will be chosen, for the power of 0.9, number of predictor -1, with alpha
significance of 0.05 and effect size f2-0.35.
To study the mean difference between the morning
and evening Salivary Cortisol groups- n=25 will be chosen for the power of 0.8,
0.05 alpha significance, large effect size-0.35.
From 25 participants morning
and evening saliva samples and morning serum sample will be collected.
Cortisol will be estimated by ECLIA method in both saliva and serum samples.
Age group: 18-40years.
Sex: Both males and females.
Healthy individuals with Sound Sleep before collecting samples.
Age: < 18 years and > 40years.
Chronic illness: liver disease, acute or chronic renal failure,
disease, Haematopoeitic disease.
Autoimmune Disorders: Rheumatoid Arthritis, Sjögren’s Syndrome, SLE.
Head and Neck Surgery, Periodontitis.
Neuropsychological disorders: Stress, Depression.
alcoholics, tobacco chewers.
will be done to study the correlation between saliva and serum cortisol levels.
To determine the significance of mean difference between the morning and
evening saliva levels groups, Mann- Whitney U test will be used.
Implications of the Study:
For estimating night Serum Cortisol level in
paediatric age group or even in adults, the stress caused by needle stick prick
and waking the patient in the night will falsely elevate the cortisol levels causing
loss of diurnal variation and will affect the report interpretation.
For improved patient care and better prognosis, this study is directed toward the measurement of Salivary Cortisol, which
is a simple and non-invasive method,
and is especially required in pediatric age group, where collecting
Serum is cumbersome and painful.
Our study reinforces the use
of Serum Cortisol Assay as better, simple and non-invasive method.
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