ESPE Abstracts

Background: Pubertal assessment is based on patient history, physical examination, bone age, blood tests, and in some cases, endocrine “stimulation tests”. Sex hormones are present in saliva and may serve as a cost-effective, simple, and painless alternative for invasive blood or stimulation tests performed at day care units. Previous studies showed correlation between saliva-and-blood levels of sex hormones; However, it is not in routine clinical use due to lack of standardization and calibration.

Research Objective: Calibration of salivary compared with blood sex hormone levels in children, in order to utilize salivary sex-hormone tests for pubertal assessment.

Methods: Prospective clinical cohort at a hospitals’ pediatric day-care ward. Patients under 18 years old, undergoing an endocrine test, were recruited to the study. Routine blood samples, including sex hormones, were drawn as well as saliva samples. Saliva samples were processed using Liquid Chromatography coupled to tandem Mass-Spectrometry (LC-MS/MS) for estradiol and DHEAS extraction. Saliva-to-blood hormones levels were calibrated and analyzed.

Results: 71 children were recruited to the study. 38/71(53.5%) females. Among the female group, 12/38 (31.6%) were prepubertal with a median age of 7.44 years [Q1-Q3 5.8-9.49] and 26/38 (68.4%) were during puberty with a median age of 8.9 years [Q1-Q3 8.2-13.9]. 12/26 (46.2%) of pubertal females were defined as precocious puberty. Within the female group there was a significant lower salivary DHEAS levels in the prepuberal group compared with the “during puberty” group (median 495.8 pg/ml [Q1-Q3 87.8-1944] vs. 1479.2 pg/ml [Q1-Q3 466-4823.3] respectively, P = 0.038). A similar trend of lower salivary estradiol in the prepubertal vs. during puberty was found (median 0.19 pg/ml [Q1-Q3 0-1.04] vs. 1.45 pg/ml [Q1-Q3 0.004-2.79] respectively, P = 0.05). Among the male group 13/33 (39.4%) were prepubertal with a median age of 8.02 years [Q1-Q3 7.5-9.2] and 20/33 (60.6%) were during puberty with a median age of 12.2 years [Q1-Q3 11.3-12.8]. Median salivary DHEAS level was significantly lower in the prepubertal male group compared with the “during puberty” group (median 554.2 pg/ml [Q1-Q3 187.2-1125.9] vs. 1083.3 pg/ml [Q1-Q3 592.2-1805.1] respectively, P = 0.048). 35/46 (76.1%) of pubertal children would have been detected as “during puberty” with salivary DHEAS empiric threshold of 500 pg/ml.

Conclusion: Salivary DHEAS and estradiol levels correlate with the stage of puberty and serum hormone levels, and may therefore be used as a simple, noninvasive, and readily available screening method for beginning of puberty. Further research is required.