Evaluation of the Hypothalamic-Pituitary-Adrenal Axis in Patients with Primary Sjögren's Disease

Background and Objectives: Patients with primary Sjögren's disease (pSjD) show contradictory results regarding the activity of the hypothalamic-pituitary-adrenal (HPA) axis. The aim of this study was to determine the salivary cortisol concentration to evaluate the function of the HPA axis (hypoactive/hyperactive) between patients with pSjD and control subjects. Materials and Methods: A total of 34 subjects participated in the cross-sectional study: 17 patients with pSjD and 17 control subjects. Stimulated whole saliva (SWS) was used to determine salivary cortisol concentration using an enzyme-linked immunosorbent assay (ELISA). Results: The salivary cortisol concentration showed a statistically significant difference between patients with pSjD and control subjects (4.69 ± 2.88 vs. 0.49 ± 0.37; p < 0.001; Student t-test). The area under the curve (AUC) was 100.0% in patients with pSjD (p < 0.001). The cut-off point was set to >1.454. The patients with pSjD had four times higher scores for depression and stress and six times higher scores for anxiety compared to the control subjects (p = 0.048, p < 0.001, p = 0.038; Mann-Whitney U test). The patients with pSjD had a statistically significantly higher total Oral Health Impact Profile (OHIP) score compared to the control subjects (p < 0.001, Mann-Whitney U test). Conclusions: The patients with pSjD showed short-term hyperactivity of the HPA axis compared to the control subjects.