Clinical Use
Monitoring corticosteroid replacement therapy in children with congenital adrenal hyperplasia due to 21-hydroxylase deficiency.
The use of saliva permits collection of multiple samples in a non-invasive manner in a stress-free (home) environment. Corticosteroid dose can be adjusted until salivary concentrations throughout the day fall within defined limits.
Patient Preparation
None, but saliva must be collected in the following manner:
- Rinse mouth thoroughly with water to remove food debris;
- After 5 – 10 min, allow saliva to collect in floor of mouth;
- Gently express saliva into the collecting vial;
- Repeat 2 & 3 until at least l mL saliva (excluding froth) has been collected.
Saliva may be obtained from a very young child by gentle suction.
Collect saliva at the following times:
| First sample | Before taking early morning dose of steroid |
| Second sample | Between 11.00h and 13.00h |
| Third sample | Between 15.00h and 17.00h |
| Fourth sample | Before taking late night dose of steroid |
Sample Preparation
During collection of saliva at home, store the samples at 4C. Store samples in the laboratory at -20C before despatch. Send saliva samples (minimum of 1 mL) to the SAS laboratory.
Reference Ranges
The following concentrations are associated with treatment judged to be adequate by accepted criteria: