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.
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|
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.
The following concentrations are associated with treatment judged to be adequate by accepted criteria: