21 Hidroksilaz Eksikliğine Bağlı Konjenital Adrenal Hiperplazili Olgularda Bir Takip Belirteci Olarak Tükürükte 17 OH Progesteron Düzeyinin Ölçümü

Abstract

T h e most common cause of congenital adrenal hyperplasia (CAH) is 21- hydroxylase deficiency. These patients require glucocorticoid treatment to reduce the amount of circulating adrenal sex steroids and minimize the risk of adrenal insufficiency. The effectiveness of treatment is monitored by measurement of 17-OH P. This means that the invasive procedure needs to be done every 3-6 months. S aliva which offers a noninvasive and stress-free alternative to plasma, is a widely accepted sample source for analyses of steroids. Obtainment of saliva is painless and more pleasant in serial sample collections than the use of intravenous cannules. Salivary 17-OH P also represents the free and physiologically active hormone. Therefore, its determination has been described as useful in the hormonal evaluation of patients with 21- hydroxylase deficiency. However, salivary hormone measurement presents some difficulties. Its concentrations are considerably low, resulting in the necessity of sensitive assays and tecnically trained laboratory personel. In this study, we compared 17-OH P levels obtained simultaneously in plasma and saliva in order to develop a system of monitoring steroid treatment in CAH patients using only saliva. Saliva and serum samples were collected simultaneously from 67 patients (123 samples) with CAH and 72 age and body mass index matched healthy controls from Hacettepe University Pediatric Endocrinology Department. T h e serum and salivary 17-OH P levels in patient group were significantly higher than controls. There was an excellent correlation between serum and salivary 17-OH P in both groups. The strong positive correlation also existed in serial samples. In control group, salivary 17-OH P levels were equivalent to serum levels as using this formula: Plasma 17-OH P = 0,18 + 0,08 x Salivary 17-OH P In CAH patients, upper limit of 10 ng/ml for plasma 17-OH P was defined poor controlled. ROC analyses of salivary 17-OH P provided serum 17-OH P 10 ng/ml level equivalent to salivary level of 0,155 ng/ml (p<0.001). I n conclusion, the current study demonstrates significantly positive corelation between serum ve saliva, salivary 17-OH P provides a useful alternative to measurement of this hormon in serum for monitoring the treatment of CAH. Saliva, instead of serum sampling offers some advantages, such as painless and more pleasant in serial sample collections, easy to perform on an outpatient basis, measurement of bioactive free hormone.