Abstract
BACKGROUND: The diagnosis and management of childhood adrenal disorders is challenging. Clinical markers of hormone excess or deficiency may take months to manifest, and traditional biomarkers correlate only partially with clinical outcomes. Recent work has indicated that 11 oxygenated 19-carbon (11oxC19) steroids may be useful in the assessment of adrenal function. 11oxC19 steroids, testosterone (T) and androstenedione (A4), can be measured in saliva, but very little is known about these hormones in healthy children. METHODS: Participants collected saliva samples 30 min after waking and every 2 h until bedtime. Samples were analysed for T, A4, 11 ketotestosterone (11KT) and 11βhydroxyandrostenedione (11OHA4) by liquid chromatography tandem mass spectrometry. RESULTS: Fifty-two (30 male) healthy children aged 10.4 ± 3.9 (5.0-17.5) participated. Median height SDS was 0.4 (IQR -0.3 to 1.01) and median BMI SDS was 0.3 (IQR -0.2 to 1.3). All steroids showed a diurnal rhythm, with all hormones decreasing in measured concentration at time points that are 30 min after waking. Salivary T was higher in postpubertal children, particularly boys (p < 0.001). Salivary A4 was lower in boys compared to girls (p = 0.009) and did not differ with pubertal development. 11KT increased with age (p < 0.001) and concentrations were similar between boys and girls. 11OHA4 reduced in concentration with age (p = 0.03) and was below detectable limits after the early morning peak in both sexes. CONCLUSION: For the first time we describe the physiological profile of 11KT and 11OHA4 in children. Further data are required to establish reference ranges, which should consider age, sex, pubertal status and time of sampling.