Endocrine Abstracts

Introduction: Congenital adrenal hyperplasia (CAH) requires lifelong glucocorticoid therapy and careful biochemical monitoring. Salivary steroid measurement offers a less invasive alternative to blood sampling, but data on its correlation with plasma levels are limited. This study evaluated the correlation between salivary and plasma steroid profiles in patients with and without plasma hyperandrogenemia.

Methods: Real-world data from 2020–2023 were extracted from the routine laboratory database Opus L (Dedalus) and provided as an analyzable Excel dataset. Data were systematically filtered according to relevant CAH diagnoses, and only corresponding cases were selected for analysis. Plasma concentrations of 17-hydroxyprogesterone (17-OHP) and androstenedione were extracted and mean salivary 17-OHP values were calculated and included in the analysis. A relevant hyperandrogenemia was defined as plasma androstenedione concentrations exceeding the age- and sex-specific upper reference limit (Kulle, A E et al. 2010). Matched plasma–saliva sample pairs from the same patients with a CAH diagnosis were identified who had both a plasma and a salivary sample collected within a 30-day interval. These matches (n = 373, 165 female [f], 208 male [m]) were stratified based on hyperandrogenemia status and analyzed in two groups: hyperandrogenemia (f: n = 49; m: n = 71) vs. non-hyperandrogenemia (f: n = 108; m: n = 117). In 28 cases, plasma androstenedione data were not documented (n = 28).

Results: Plasma androstenedione showed a significant positive correlation with age across all groups (with and without hyperandrogenemia; males and females) (r = 0.68–0.76; all P < 0.05). In contrast, salivary 17-OHP was not significantly correlated with age, regardless of hyperandrogenemia status or sex (all P > 0.05). Plasma 17-OHP also showed no significant age-related correlation in most groups; only females without hyperandrogenemia demonstrated a moderate positive correlation (r = 0.48; P < 0.05). A significant positive correlation between plasma 17-OHP and mean salivary 17-OHP was observed in all groups (r = 0.43–0.60; all P < 0.05).

Conclusion: Significant sex differences were observed across all analyzed parameters. Boys showed higher plasma androstenedione, plasma 17-OHP and salivary 17-OHP levels than girls, both in the presence of hyperandrogenemia and within normal androstendione in plasma (all P < 0.05). Sex differences were most pronounced for plasma 17-OHP, both in patients with plasma hyperandrogenemia (f: 43.7 [11.9-126] vs. m: 119 [38.3-265]) and in those without (f: 3.7 [0.7-11.6] vs. m: 15.4 [6.5-41]).