Spleen immune status is affected after acute handling stress but not regulated by cortisol in Eurasian perch,Perca fluviatilis

The effects of acute stress on immune status and its regulation by cortisol/corticosteroid receptors have received little attention in percids. To address that question, we investigated the physiological and immune responses of Eurasian perch, Perca fluviatilis to acute stress. We exposed immature perch to an 1-min exondation and measured at 1 h, 6 h, 24 h and 72 h post-stress: (1) stress-related parameters including plasma cortisol and glucose levels, (2) immune parameters in the plasma and in the spleen (complement, respiratory burst and lysozyme activity, total immunoglobulins; gene expression of lysozyme, complement unit 3, apolipoprotein A1 and 14 kDa, hepcidin and chemotaxin) (3) the corticosteroid receptors gene expression in the spleen after having cloned them. In addition, the in vitro effects of cortisol on the spleen immune parameters were also investigated.Plasma cortisol and glucose levels increased markedly 1 h post-stress and returned at basal levels after 24 h. P. fluviatilis mineralocorticoid receptor, but not glucocorticoid receptors, was significantly up-regulated both in vivo after the stress and in vitro by cortisol at a physiological concentration (100 ng/ml). The plasma immune parameters were not significantly affected by the stress. In contrast, spleno-somatic index, spleen lysozyme activity, lysozyme and hepcidin gene expression were depleted and total immunoglobulins increased along the whole time-course (1–72 h). But, these immune parameters were not regulated in vitro by cortisol at physiological or supra-physiological doses.Our results indicate that handling stress may affect spleen antibacterial defences without clear effects on circulating immune compounds and that the elevation of plasma cortisol after handling stress may not be related to the regulation of this splenic response.     

Mixing at the beginning of fattening moderates social buffering in beef bulls

Cattle establish strong preferential associations early in their life that determine the cohesiveness within a group and can diminish fear responses (i.e. social buffering). Mixing beef bulls at the beginning of fattening may lead to less cohesiveness. Moreover, mixing beef bulls induces aggressive interactions, especially when the bulls are of similar weights. This study was aimed at evaluating the cohesiveness and fear responses of 64 bulls that were either mixed versus unmixed and of homogeneous vs. heterogeneous body weights (2 × 2 factorial design, four groups of four bulls each per treatment). Social cohesiveness was assessed during food competition and a social separation test. Fear responses were observed during the social separation test and pre-slaughter handling. During food competition, unmixed bulls exchanged more non-agonistic interactions (P < 0.05) and were more tolerant with each other than mixed bulls (time spent eating: P < 0.05). Unmixed bulls displayed less fear responses during physical separation (elimination: P < 0.05; startle: P < 0.01) and were less stressed by pre-slaughter handling (blood cortisol: P < 0.05). Very few effects could be attributed to the homogeneity of weights within groups. It is concluded that mixing bulls at the beginning of fattening reduces the strength of positive social relationships and renders social buffering less effective during subsequent fattening. We recommend maintaining familiar bulls together throughout fattening in order to preserve cohesiveness within groups and for animals to benefit from social buffering during stressful situations.     

Competition-related testosterone,cortisol, and perceived personal success in recreational women athletes

Thirty-five women participating in one or more intramural flag-football games provided saliva samples before, immediately after, and 10 min after competition and completed an after-competition questionnaire appraising their own performance during the game. As seen in other studies of elite athletes, these recreational athletes, on average, showed significant elevations in testosterone (T) and cortisol (C) across the competition period – the “competition effect”. In winners and losers, T levels at all time points measured were positively related to athletes' appraisals of their own individual performance. Results from this study show that the competition effect for T and C is evident in recreational women athletes and provide preliminary evidence about the relationship between cognitive appraisal and competition-related T levels.     

Effects of competition outcome on testosterone concentrations in humans: An updated meta-analysis

A contribution to a special issue on Hormones and Human Competition.Since Archer's (2006) influential meta-analysis, there has been a major increase in the number of studies investigating the effect of competition outcome on testosterone reactivity patterns in humans. Despite this increased research output, there remains debate as to whether competition outcome modulates testosterone concentrations. The present paper examines this question using a meta-analytic approach including papers published over the last 35 years. Moreover, it provides the first meta-analytic estimate of the effect of competition outcome on testosterone concentrations in women. Results from a meta-analysis involving 60 effect sizes and > 2500 participants indicated that winners of a competition demonstrated a larger increase in testosterone concentrations relative to losers (D = 0.20)—an effect that was highly heterogeneous. This ‘winner-loser’ effect was most robust in studies conducted outside the lab (e.g., in sport venues) (D = 0.43); for studies conducted in the lab, the effect of competition outcome on testosterone reactivity patterns was relatively weak (D = 0.08), and only found in studies of men (D = 0.15; in women: D = − 0.04). Further, the 'winner-loser' effect was stronger among studies in which pre-competition testosterone was sampled earlier than (D = 0.38, after trim and fill correction) rather than within (D = 0.09) 10 min of the start of the competition. Therefore, these results also provide important insight regarding study design and methodology, and will be a valuable resource for researchers conducting subsequent studies on the 'winner loser' effect.     

Effects of chronic heat stress on testicular structures,serum testosterone and cortisol concentrations in developing lambs

The objective of this study was to investigate the effect of high and moderate summer ambient temperatures on testicular structures and endocrine profile of developing ram lambs. Twenty fall-born ram lambs were randomly divided into two groups: animals were kept outdoor (n = 10) under ambient temperature (31–50 °C) or maintained indoor (26–32 °C) from May to October 2007. Daily maximum ambient temperature was recorded for both environments. Monthly serum testosterone and cortisol concentrations were compared between two groups throughout the experiment. The animals were slaughtered at the end of the study and their testes subjected to histopathology exam. The results showed that maximum outdoor ambient temperature was significantly higher than indoor. There was no difference between two groups on serum testosterone concentration. There was no effect on serum cortisol levels except in August and October. Histolopathological examination revealed a severe testicular degeneration with significant germ line degeneration without any impact on somatic cells. In conclusion, direct exposure of developing lambs during non-breeding season impairs testicular germ cells without significant effect on testicular endocrine function.     

Hair cortisol determination in sows in two consecutive reproductive cycles

Hair analysis has been proposed as a minimally invasive technique capable of furnishing information regarding the stress response during medium- and long-term periods. Bristle samples were collected from the rump region of sows at three key physiological phases (before delivery – BD; weaning time – WT; pregnancy diagnosis – PD) during consecutive reproductive cycles in order to test swine hair as a reliable matrix of cortisol evaluation. Cortisol was extracted from the bristles and assayed using radioimmunoassay. The highest mean hair cortisol concentrations were demonstrated (p < 0.001) at the PD time points (20.1 ± .95 and 16.29 ± 2.15 pg/mg). Moreover, cortisol was significantly higher (p < 0.001) at BD2 (10.48 ± 0.96 pg/mg) as compared to BD1 (5.17 ± 0.51 pg/mg) and WT1 (6.01 ± 0.47 pg/mg). The various physiological phases had a significant effect on cortisol concentration (p < 0.00001) with a higher cortisol concentration found during late pregnancy and lactation than in early-mid pregnancy. This could be due not only to the physiological hormonal status, but also to the different housing conditions (single crates vs. group housing). The season of the year was also observed to have an effect (p < 0.005), with the lowest cortisol concentration recorded during the hot season.     

Difficulties with emotion regulation moderate the association between childhood history of maltreatment and cortisol reactivity to psychosocial challenge in postpartum women

Exposure to child maltreatment can lead to long-term emotional difficulties and dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. However, no prior work has examined emotion regulation as a moderator of the association between childhood history of maltreatment and cortisol response to psychosocial challenge. Amongst a sample of 140 postpartum women, associations between childhood maltreatment, emotion regulation, and cortisol response to a computerized Emotional Stroop paradigm were examined using structural equation modeling. Three saliva samples (baseline, 20- and 40-min post-challenge) were collected and later assayed for cortisol. Stepwise regression analyses revealed that difficulties with emotion regulation significantly moderated the association between maternal history of child maltreatment and cortisol reactivity (β = − 0.17, CI_.95 = − 0.31, − 0.04, t = − 2.51, p = 0.01). Specifically, women with higher child maltreatment scores and greater difficulties with emotion regulation displayed reduced cortisol reactivity. This finding suggests that diminished emotion regulation capacity may uniquely contribute to blunted physiological reactivity in postpartum women exposed to higher levels of child maltreatment. As the postpartum period has significant implications for maternal well-being and infant development, these findings are discussed in terms of adaptive responsivity, maternal behaviour, and clinical practice.     

Development of a sensitive and selective method for the quantitative analysis of cortisol,cortisone, prednisolone and prednisone in human plasma

A highly selective, sensitive and robust LC–MS/MS method was developed for the simultaneous quantification of cortisol, cortisone, prednisolone and prednisone in human plasma. Prednisolone, cortisol and cortisone have similar fragmentation pattern. These three compounds were chromatographically separated, thus eliminating the inherent interference that fragments derived from the M + 2 and M isotopes of prednisolone contribute in the MRM channels of cortisol and cortisone, respectively. Additionally, by using a small particle (1.8 μm) analytical column, interferences present in the plasma samples from post-transplant recipients were successfully resolved from cortisol after a simple extraction consisting of protein precipitation, evaporation and reconstitution. The chromatographic separation was achieved on a Zorbax-SB Phenyl column under isocratic conditions during a run time of 8 min. Intra-run and inter-run precision and accuracy within ±15% were achieved during a 3-run validation for quality control samples at five concentration levels in charcoal-stripped plasma as well as in normal plasma, over a 500-fold dynamic concentration range. The lower limit of quantitation was 0.500 ng/mL for cortisone and prednisone, 1.00 ng/mL for cortisol and 2.00 ng/mL for prednisolone. The performance of the small particle column was maintained during more than 1200 injections in terms of peak retention time, symmetry and backpressure.     

Cortisol and testosterone associations with social network dynamics

This study integrates behavioral endocrinology and network science to explore links between hormones and social network dynamics. Specifically, we examine how cortisol (C) and testosterone (T) are associated with creation of new friendships and maintenance of existing friendships. A collegiate marching band was used as a model system of a mixed-sex social organization. Participants (n = 193; 53% female; M age = 19.4 years, 62.1% European-American) provided friendship nominations at time 1 and two months later at time 2. At time 1, participants donated saliva before and after rehearsal (later assayed for C and T). Stochastic actor-based models revealed that individuals with higher C levels were less likely to maintain their social relationships and more likely to create new friendships. In contrast, individuals with higher T levels were more likely to maintain friendships and less likely to create new relationships. Findings suggest that individual differences in C and T are associated with the initiation and maintenance of friendships and have several noteworthy theoretical implications.     

Signals from fat after injury: Plasma adipokines and ghrelin concentrations in the severely burned

IntroductionHypermetabolism is universal in the severely burned and is characterized by catabolism of lean mass and body fat with associated insulin resistance. Adipokines are likely to play a role in these changes but have not been identified to date in burn patients.MethodsFrom a single burn ICU, 17 burn patients with an expected stay >14 days were studied. Study period began within 14 days of admission. Over 7 days, plasma samples were collected for measurement of leptin, adiponectin, resistin, ghrelin, insulin, and cortisol by ELISA. For comparison, samples from 15 healthy controls of similar age, BMI, and blood glucose were obtained.ResultsMean age was 33 ± 17 years and BMI 26 ± 3.4. Average burn size was 45 ± 20% TBSA and ISS 32 ± 10 with 72% having inhalation injury; in-hospital mortality was 29%. Estimated energy needs were 3626 ± 710 kcal, of which 84 ± 21% were met by enteral feeding with intensive insulin treatment (glucose 80–110 mg/ml). Using the homeostasis model assessment of insulin resistance, burned subjects were more resistant than controls (17 ± 11.3 and 8 ± 10.0). Insulin levels were elevated (57 ± 35.6 μU/ml in burned subject vs. 26 ± 31.1 μU/ml in controls), and cortisol concentrations increased (50 ± 41.2 μg/dl vs. 12 ± 3.9 μg/dl). These traditional hormone changes were associated with increased resistin (16.6 ± 5.5 ng/ml vs. 3.8 ± 0.9 ng/ml) and decreased leptin (8.8 ± 8.9 ng/ml vs. 19.4 ± 23.5 ng/ml), adiponectin (9 ± 3.5 ng/ml vs. 17 ± 10.2 ng/ml), and ghrelin (0.37 ± 0.14 ng/ml vs.0.56 ± 0.26 ng/ml).ConclusionPatients with burns, who are characteristically hypermetabolic with hypercortisolism and insulin resistant, have significant changes in adipokine levels that appear independent of the magnitude of initial injury or metabolic derangement. In addition, suppression of ghrelin in the presence of decreased leptin and adiponectin levels in combination with increased insulin and resistin levels represent unexpected changes in the metabolic milieu of the injured patient possibly due to dramatic activation of inflammatory pathways, indicating strategies for treatment.     

The interface of hypothalamic–pituitary–adrenocortical axis and circulating brain natriuretic peptide in prediction of cardiopulmonary performance during physical stress

Brain natriuretic peptide (NT-pro-BNP) was implicated in the regulation of hypothalamic–pituitary–adrenocortical (HPA) responses to psychological stressors. However, HPA axis activation in different physical stress models and its interface with NT-pro-BNP in the prediction of cardiopulmonary performance is unclear. Cardiopulmonary test on a treadmill was used to assess cardiopulmonary parameters in 16 elite male wrestlers (W), 21 water polo player (WP) and 20 sedentary age-matched subjects (C). Plasma levels of NT-pro-BNP, cortisol and adrenocorticotropic hormone (ACTH) were measured using immunoassay sandwich technique, radioimmunoassay and radioimmunometric techniques, respectively, 10 min before test (1), at beginning (2), at maximal effort (3), at 3rd min of recovery (4). In all groups, NT-pro-BNP decreased between 1 and 2; increased from 2 to 3; and remained unchanged until 4. ACTH increased from 1 to 4, whereas cortisol increased from 1 to 3 and stayed elevated at 4. In all groups together, ΔNT-pro-BNP2/1 predicted peak oxygen consumption (B = 37.40, r = 0.38, p = 0.007); cortisol at 3 predicted heart rate increase between 2 and 3 (r = −0.38,B = −0.06, p = 0.005); cortisol at 2 predicted peak carbon-dioxide output (B = 2.27, r = 0.35, p < 0.001); ΔACTH3/2 predicted peak ventilatory equivalent for carbon-dioxide (B = 0.03, r = 0.33, p = 0.003). The relation of cortisol at 1 with NT-pro-BNP at 1 and 3 was demonstrated using logistic function in all the participants together (for 1/cortisol at 1 B = 63.40, 58.52; r = 0.41, 0.34; p = 0.003, 0.013, respectively). ΔNT-pro-BNP2/1 linearly correlated with ΔACTH4/3 in WP and W (r = −0.45, −0.48; p = 0.04, 0.04, respectively). These results demonstrate for the first time that HPA axis and NT-pro-BNP interface in physical stress probably contribute to integrative regulation of cardiopulmonary performance.     

Telling facial metrics: facial width is associated with testosterone levels in men

High facial width-to-height ratio (fWHR) has been associated with a cluster of behavioural traits in men, including aggression and status-striving. This association between face structure and behaviour may be caused by testosterone. Here we investigated the relationship of both baseline and reactive testosterone levels to fWHR. In addition, we investigated the link between testosterone and three well-characterised sexually dimorphic facial metrics. Testosterone was measured in one sample of males (n = 185) before and after a speed-dating event. An additional sample provided only baseline testosterone measures (n = 92). fWHR was positively associated with testosterone reactions to potential mate exposure and marginally associated with baseline testosterone in Sample 1. We found a positive association with baseline testosterone and fWHR in Sample 2. In addition, face-width-to-lower-height ratio was positively associated with testosterone in both samples, suggesting that, in particular, facial width (scaled by two measures of facial height) is associated with testosterone. Importantly, our results also indicate that there is no association between adult testosterone and the sexual dimorphism of face shape. Thus, while our findings question the status of sexual dimorphism as a proxy measure of testosterone, they do provide evidence that testosterone is linked to fWHR and might underlie the relationship between fWHR and behaviour.     

Plasma copeptin concentration and outcome after pediatric traumatic brain injury

Higher plasma copeptin level has been associated with poor outcomes of critical illness. The present study was undertaken to investigate the plasma copeptin concentrations in children with traumatic brain injury (TBI) and to analyze the correlation of copeptin with disease outcome. Plasma copeptin concentrations of 126 healthy children and 126 children with acute severe TBI were measured by enzyme-linked immunosorbent assay. Twenty-one patients (16.7%) died and 38 patients (30.2%) had an unfavorable outcome (Glasgow Outcome Scale score of 1–3) at 6 months. Plasma copeptin level was obviously higher in patients than in healthy children (46.2 ± 20.8 pmol/L vs. 9.6 ± 3.0 pmol/L, P < 0.001). Plasma copeptin level was identified as an independent predictor for 6-month mortality [odds ratio (OR) 1.261, 95% confidence interval (CI) 1.112–1.538, P = 0.005] and unfavorable outcome (OR 1.313, 95% CI 1.146–1.659, P = 0.003). The predictive value of copeptin was similar to that of Glasgow Coma Scale (GCS) score for 6-month mortality [area under curve (AUC) 0.832, 95% CI 0.755–0.892 vs. AUC 0.873, 95% CI 0.802–0.926, P = 0.412] and unfavorable outcome (AUC 0.863, 95% CI 0.790–0.918 vs. AUC 0.885, 95% CI 0.816–0.935, P = 0.596). Copeptin improved the AUC of GCS score for 6-month unfavorable outcome (AUC 0.929, 95% CI 0.869–0.967, P = 0.013), but not for 6-month mortality (AUC 0.887, 95% CI 0.818–0.936, P = 0.600). Thus, plasma copeptin level represents a novel biomarker for predicting 6-month clinical outcome in children with TBI.     

Age-independent increases in male salivary testosterone during horticultural activity among Tsimane forager-farmers

Testosterone plays an important role in mediating male reproductive trade-offs in many vertebrate species, augmenting muscle and influencing behavior necessary for male–male competition and mating-effort. Among humans, testosterone may also play a key role in facilitating male provisioning of offspring as muscular and neuromuscular performance is deeply influenced by acute changes in testosterone. This study examines acute changes in salivary testosterone among 63 Tsimane men ranging in age from 16 to 80 (mean 38.2) years during one-hour bouts of tree-chopping while clearing horticultural plots. The Tsimane forager-horticulturalists living in the Bolivian Amazon experience high energy expenditure associated with food production, have high levels of parasites and pathogens, and display significantly lower baseline salivary testosterone than age-matched US males. Mixed-effects models controlling for BMI and time of specimen collection reveal increased salivary testosterone (p < 0.001) equivalent to a 48.6% rise, after one hour of tree chopping. Age had no effect on baseline (p = 0.656) or change in testosterone (p = 0.530); self-reported illness did not modify testosterone change (p = 0.488). A comparison of these results to the relative change in testosterone during a competitive soccer tournament in the same population reveals larger relative changes in testosterone following resource production (tree chopping), compared to competition (soccer). These findings highlight the importance of moving beyond a unidimensional focus on changes in testosterone and male–male aggression to investigate the importance of testosterone–behavior interactions across additional male fitness-related activities. Acutely increased testosterone during muscularly intensive horticultural food production may facilitate male productivity and provisioning.     

Preliminary evidence that acute stress moderates basal testosterone's association with retaliatory behavior

A contribution to a special issue on Hormones and Human Competition.Testosterone is theorized to increase retaliation after social provocation. However, empirical evidence in support of these theories is mixed. The present research investigated whether acute stress causally suppresses testosterone's association with retaliation. We also explored sex differences in behavioral responses to acute stress. Thirty-nine participants (51.28% male) were randomly assigned to a high- or low-stress condition. Then participants engaged in 20 one-shot rounds of the ultimatum game, which was used to assess retaliatory behavioral responses to unfair treatment. Participants provided two saliva samples to measure testosterone and cortisol concentrations - one sample before the stress manipulation, and the second after the ultimatum game (20 minutes post-stressor). Results revealed a positive association between basal testosterone and retaliation in the low-stress condition, but not in the high-stress condition. Further, cortisol concentrations increased in the high- compared to the low-stress condition, and these cortisol changes moderated the association between basal testosterone and retaliation. The associations between basal testosterone and retaliation under varying levels of stress were similar in men and women. However, there was a sex difference in behavioral responses to the stress manipulation that was independent of testosterone. In women, the high-stress condition reduced retaliation compared to the low-stress condition, whereas in men the opposite pattern emerged. Collectively, this study (i) provides preliminary evidence that experimentally manipulated stress blocks basal testosterone's association with retaliation, and (ii) reveals a sex difference in retaliation under varying levels of stress. Discussion focuses on mechanisms, limitations, and the need for follow-up studies with larger sample sizes.     

A microsphere-based duplex competitive immunoassay for the simultaneous measurements of aldosterone and testosterone in small sample volumes: Validation in human and mouse plasma

BackgroundThe small blood volumes available in rodent studies often limit adequate quantification of all hormones of interest. We report here the development of two new assays combining an extraction step with multiplex immunoassay (MIA) technology for the simultaneous determination of aldosterone and testosterone in 50 μl sample volume.MethodsFollowing solvent extraction, aldosterone and testosterone competitive immunoassays are performed incorporating biotinylated tracers and antibody-coated beads each having a unique fluorescence. Quantification is via addition of streptavidin–R–phycoerythrin (SA–PE). The assays were validated and compared to established methods. Baseline hormone levels in mice from four different strains, and changes after ACTH and HCG stimulation in CD-1 mice are shown.ResultsThe assays are sensitive (aldosterone 15 pg/ml, testosterone 12 pg/ml), reproducible (intra-/inter-assay imprecision aldosterone 5.1–15.6%/9.9–15.8% and testosterone 9.7–10.9%/7.7–11.4%) and correlate significantly to established assays (r = 0.94–0.95). Baseline aldosterone levels varied between strains, but not between the genders. Testosterone was significantly higher in male of all strains except in C57BL/6× NMRI mice. After ACTH injection, aldosterone (median, interquartile range) rose from 354 (261–396) pg/ml to 2008 (875–2467) in male and from 260 (210–576) to 1120 (734–1528) in female CD-1 mice. HCG injection in the same strain increased testosterone in male mice only (3.5 (0.4–8.3) ng/ml to 31.8 (30.4–33.9) ng/ml, P < 0.01).ConclusionsWe describe a MIA for the simultaneous measurement of aldosterone and testosterone in small volumes after extraction. In addition to presenting a new tool for steroid research in rodent models, our data show strain-dependent differences in steroid hormone metabolism in rodents.     

Biomarkers in critically ill patients with systemic inflammatory response syndrome or sepsis supplemented with high-dose selenium

ObjectiveLow levels of selenium (Se) and glutathione peroxidase (GSHPx), a key selenoenzyme, were documented in systemic inflammatory response syndrome (SIRS) and sepsis, both associated with high mortality. Se supplementation had mixed effects on outcome. We hypothesized that Se supplementation could have a different impact on biomarkers and 28-day mortality in patients with SIRS vs. sepsis.MethodsAdult patients with SIRS or sepsis were randomized to either high-dose (Se+, n = 75) or standard-dose (Se−, n = 75) Se supplementation. Plasma Se, whole blood GSHPx activity, C-reactive protein (CRP), procalcitonin (PCT), prealbumin, albumin and cholesterol levels were measured serially up to day 14.ResultsThere was no difference in mortality between Se− (24/75) vs. Se+ group (19/75; p = 0.367) or between SIRS and septic patients (8/26 vs. 35/124; p = 0.794). There was a trend to reduced mortality in SIRS patients in the Se+ vs. Se− group (p = 0.084). Plasma Se levels increased in the Se+ group only in patients with sepsis but not in patients with SIRS. Plasma Se levels correlated with GSHPx. In SIRS/Se+ group, Se correlated only with GSHPx. In SIRS/Se− group, Se correlated with cholesterol but not with other biomarkers. In sepsis patients, Se levels correlated with cholesterol, GSHPx and prealbumin. Cholesterol levels were higher in survivors in the Se− group.ConclusionsSe levels correlated with GSHPx activity and other nutritional biomarkers with significant differences between SIRS and sepsis groups. High-dose Se supplementation did not affect mortality but a strong trend to decreased mortality in SIRS patients warrants further studies in this population.     

Diagnostic performance of salivary cortisol and serum osteocalcin measurements in patients with overt and subclinical Cushing's syndrome

ObjectiveThe cut-off value for salivary cortisol measurement for the diagnosis of Cushing's syndrome (CS) may depend both on the severity of the disease and the composition of control group. Therefore, we examined the utility of midnight salivary cortisol measurements in patients who were evaluated for signs and symptoms of CS or because they had adrenal incidentalomas. Because serum osteocalcin (OC) is considered as a sensitive marker of hypercortisolism, we also investigated whether OC could have a role in the diagnosis of CS.Patients and methodsEach of the 151 patients was included into one of the following groups: (A) overt CS (n = 23), (B) subclinical CS (n = 18), (C) inactive adrenal adenomas (n = 40), (D) patients without HPA disturbances (n = 70). Patients (C + D) were used as controls. Serum, salivary and urinary cortisol, and OC were measured by electrochemiluminescence immunoassay.ResultsGroup A had suppressed OC as compared to both group B and group (C + D). Serum and salivary cortisol concentrations showed strong negative correlations with OC in patients with overt CS. The areas under the curves of salivary and serum cortisol at 24:00 h (0.9790 and 0.9940, respectively) serum cortisol after low dose dexamethasone test (0.9930) and OC (0.9220) obtained from ROC aanalysis for the diagnosis of overt CS were not statistically different.ConclusionThis study confirms the usefulness of midnight salivary cortisol measurements in the diagnosis of overt CS in the everyday endocrinological praxis. Our results suggest that OC may have a role in the diagnosis of overt CS.