As an additional measure of tissue cortisol the three saliva samples, awakening, post awakening, and bedtime, will also be assayed for cortisone.
All of these effects of cortisol affect the entire organism, suggesting that measuring circulating cortisol, rather than tissue cortisol, may be more relevant and useful from a clinical point of view.
Adipose tissue cortisol is strongly correlated with serum total and free cortisol, suggesting that serum cortisol reflects tissue cortisol availability.
The authors hypothesized that tissue cortisol levels are more relevant as this is what binds to cellular cortisol receptors and leads to cortisol-associated physiological changes seen.
Plasma estimations of cortisol do not correlate with the microdialysis levels, raising the possibility that plasma cortisol may be an unreliable guide to tissue cortisol activity.
The main outcome measure was description of the ACTH-cortisol response by calculating serum free cortisol and measuring total cortisol and ACTH concentrations.
Further studies, measuring cortisol during other time points, might reveal whether the cortisol level is affected in this patient group.
Measurement of cortisol in scalp hair is a recently developed method of measuring long-term cortisol levels [ 7– 11].
First, we did not routinely measure cortisol metabolism or tissue effects in our patients because this requires elaborate techniques [ 8].
