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Aardal-Eriksson, Elisabeth
Alternative names
Publications (10 of 14) Show all publications
Imamovic, M., Backlund, N., Lundstedt, S., Brattsand, G., Aardal-Eriksson, E., Olsson, T. & Dahlqvist, P. (2023). Confounding effects of liquorice, hydrocortisone, and blood contamination on salivary cortisol but not cortisone. Endocrine Connections, 12(1), Article ID e220324.
Open this publication in new window or tab >>Confounding effects of liquorice, hydrocortisone, and blood contamination on salivary cortisol but not cortisone
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2023 (English)In: Endocrine Connections, E-ISSN 2049-3614, Vol. 12, no 1, article id e220324Article in journal (Refereed) Published
Abstract [en]

Objective: To determine the effects of liquorice consumption, topical hydro cortisone, and blood contamination on salivary cortisol and cortisone concentrations. Design and methods: Thirty healthy volunteers were randomized to a low, medium, or high dose of liquorice. Late-night saliva samples were collected using a Salivette (R) collection device at baseline, during 1 week of daily liquorice consumption, and during 4 weeks washout. Saliva sampling was also performed before and after the application of topical hydrocortisone on the skin. Furthermore, in a subgroup (n = 16), saliva and venous blood were collected from each individual and mixed to achieve graded blood contamination in saliva. Salivary cortisol and cortisone were a nalyzed with liquid chromatography-tandem mass spectrometry. Results: Significant increases in salivary cortisol concentrations were observed during medium- (+49%) and high-dose (+97%) liquorice intake, which returned to baseline 4 days after liquorice withdrawal. Topical hydrocortisone on fingers holding the collection swab increased salivary cortisol concentrations >1000-fold with concomitant pronounced elevation of the cortisol:cortisone ratio. Salivary cortisol in creased significantly after contamination with blood >= 0.5%. Visual examination could safely detect these samples. Salivary cortisone concentrations were unaffected by liquorice consumption and blood contamination, and only marginally affected by topical hydrocortisone. Conclusion: Liquorice, topical hydrocortisone, and blood contamination may all cause elevated salivary cortisol concentrations. Improved sampling instructions and visual examination of the sample may minimize these risks. Salivary cortisone is essentially unaffected by the different preanalytical confounders and may be used as a first-line screening test for Cushings syndrome.

Place, publisher, year, edition, pages
BIOSCIENTIFICA LTD, 2023
Keywords
Cushings syndrome; salivary cortisol; salivary cortisone; liquorice; sample contamination
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:liu:diva-194206 (URN)10.1530/EC-22-0324 (DOI)000971893300001 ()36383173 (PubMedID)
Available from: 2023-06-01 Created: 2023-06-01 Last updated: 2024-05-07
Backlund, N., Brattsand, G., Lundstedt, S., Aardal-Eriksson, E., Bartuseviciene, I., Berinder, K., . . . Dahlqvist, P. (2023). Salivary cortisol and cortisone in diagnosis of Cushings syndrome - a comparison of six different analytical methods. Clinical Chemistry and Laboratory Medicine, 61(10), 1780-1791
Open this publication in new window or tab >>Salivary cortisol and cortisone in diagnosis of Cushings syndrome - a comparison of six different analytical methods
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2023 (English)In: Clinical Chemistry and Laboratory Medicine, ISSN 1434-6621, E-ISSN 1437-4331, Vol. 61, no 10, p. 1780-1791Article in journal (Refereed) Published
Abstract [en]

Objectives: Salivary cortisol and cortisone at late night and after dexamethasone suppression test (DST) are increasingly used for screening of Cushings syndrome (CS). We aimed to establish reference intervals for salivary cortisol and cortisone with three liquid chromatography-tandem mass spectrometry (LC-MS/MS) techniques and for salivary cortisol with three immunoassays (IAs), and evaluate their diagnostic accuracy for CS.Methods: Salivary samples at 08:00 h, 23:00 h and 08:00 h after a 1-mg DST were collected from a reference population (n=155) and patients with CS (n=22). Sample aliquots were analyzed by three LC-MS/MS and three IA methods. After establishing reference intervals, the upper reference limit (URL) for each method was used to calculate sensitivity and specificity for CS. Diagnostic accuracy was evaluated by comparing ROC curves.Results: URLs for salivary cortisol at 23:00 h were similar for the LC-MS/MS methods (3.4-3.9 nmol/L), but varied between IAs: Roche (5.8 nmol/L), Salimetrics (4.3 nmol/L), Cisbio (21.6 nmol/L). Corresponding URLs after DST were 0.7-1.0, and 2.4, 4.0 and 5.4 nmol/L, respectively. Salivary cortisone URLs were 13.5-16.6 nmol/L at 23:00 h and 3.0-3.5 nmol/L at 08:00 h after DST. All methods had ROC AUCs =0.96.Conclusions: We present robust reference intervals for salivary cortisol and cortisone at 08:00 h, 23:00 h and 08:00 h after DST for several clinically used methods. The similarities between LC-MS/MS methods allows for direct comparison of absolute values. Diagnostic accuracy for CS was high for all salivary cortisol and cortisone LC-MS/MS methods and salivary cortisol IAs evaluated.

Place, publisher, year, edition, pages
WALTER DE GRUYTER GMBH, 2023
Keywords
Cushings syndrome; immunoassay; LC-MS/MS; method comparison; salivary cortisol; salivary cortisone
National Category
Clinical Laboratory Medicine
Identifiers
urn:nbn:se:liu:diva-194187 (URN)10.1515/cclm-2023-0141 (DOI)000964106600001 ()37013440 (PubMedID)
Note

Funding Agencies|Vasterbotten County Council

Available from: 2023-05-31 Created: 2023-05-31 Last updated: 2024-04-11Bibliographically approved
Lood, Y., Aardal, E., Ahlner, J., Ärlemalm, A., Carlsson, B., Ekman, B., . . . Josefsson, M. (2021). Determination of testosterone in serum and saliva by liquid chromatography-tandem mass spectrometry: An accurate and sensitive method applied on clinical and forensic samples. Journal of Pharmaceutical and Biomedical Analysis, 195, Article ID 113823.
Open this publication in new window or tab >>Determination of testosterone in serum and saliva by liquid chromatography-tandem mass spectrometry: An accurate and sensitive method applied on clinical and forensic samples
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2021 (English)In: Journal of Pharmaceutical and Biomedical Analysis, ISSN 0731-7085, E-ISSN 1873-264X, Vol. 195, article id 113823Article in journal (Refereed) Published
Abstract [en]

A highly sensitive and accurate electrospray liquid chromatography tandem-mass spectrometry (ESI-LC–MS/MS) method for determination of testosterone in human serum and saliva was developed and validated. Accurate quantification of testosterone in human matrices is essential in diagnosis and management of androgen status in men, women and children, and in forensic investigations of suspected abuse of anabolic androgenic steroids. Chromatography was performed on an HSS-T3 C18 column with a total run-time of 5.5 min. The tandem mass spectrometry was operated in positive electrospray ionization mode with multiple reaction monitoring. Serum and saliva samples of 200 μL, were prepared by solid-phase extraction using a 96-well plate following precipitation with 200 μL methanol. 13C labeled testosterone was used as internal standard for quantification. The standard curve was linear within the range of 4−1000 pg/mL and the limit of quantification of both serum and salivary testosterone was 4 pg/mL. Accuracy were 99–101 % and 93–95 % with between-run imprecision in serum and saliva, respectively, and inter- and intra-assay coefficients of variation were less than 9.2 %. The method proved to be applicable for determination of testosterone over a wide range of concentrations in serum and saliva samples from clinical patients with various androgen disorders, healthy male and female adults as well as from forensic cases.

Place, publisher, year, edition, pages
Elsevier, 2021
Keywords
Testosterone, Serum, Saliva, LC–MS/MS
National Category
Analytical Chemistry
Identifiers
urn:nbn:se:liu:diva-173145 (URN)10.1016/j.jpba.2020.113823 (DOI)000610841900007 ()113823 (Local ID)113823 (Archive number)113823 (OAI)
Note

Funding:Strategic Area in Forensic Science; Forskningsradet i Sydostra Sverige (FORSS) [713391]

Available from: 2021-02-04 Created: 2021-02-04 Last updated: 2022-05-23Bibliographically approved
Lood, Y., Aardal, E., Gustavsson, S., Prasolov, I., Josefsson, M. & Ahlner, J. (2021). False negative results in testosterone doping in forensic cases: Sensitivity of the urinary detection criteria T/E and T/LH. Paper presented at 2021/08/17. Drug Testing and Analysis, n/a(n/a)
Open this publication in new window or tab >>False negative results in testosterone doping in forensic cases: Sensitivity of the urinary detection criteria T/E and T/LH
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2021 (English)In: Drug Testing and Analysis, ISSN 1942-7603, E-ISSN 1942-7611, Vol. n/a, no n/aArticle in journal (Refereed) Published
Abstract [en]

At the Swedish national forensic toxicology laboratory, a measured testosterone/epitestosterone (T/E) ratio?≥?12 together with testosterone/luteinizing hormone (T/LH) in urine?>?400?nmol/IU is considered as a proof of exogenous testosterone administration. However, according to the rules of the World Anti-Doping Agency (WADA), samples with T/E ratio?>?4 are considered suspicious and shall be further analysed by gas chromatography?combustion?isotope ratio mass spectrometry (GC-C-IRMS) to confirm the origin of testosterone and its metabolites. The aim of this study was to investigate the possibility of false negative results and to estimate the frequency of negative results using the current criteria for detection of abuse of testosterone in forensic investigations. Urine and serum samples were collected by the police at suspected infringement of the doping law in Sweden. Fifty-eight male subjects were included in the study. Urinary testosterone was determined by gas chromatography?mass spectrometry (GC?MS), serum testosterone and LH?by immunoassay. The origin of testosterone and its metabolites was confirmed by means of GC-C-IRMS. Twenty-six of the 57 analysed subjects tested positive for exogenous testosterone using the criteria T/E?≥?12 combined with T/LH?>?400?nmol/IU. The IRMS analyses confirmed 47 positives; thus, 21 were considered false negatives. Negative predictive value was 32% (95% confidence interval [CI]: 16%?50%) and sensitivity 55%. No false positive subjects were found. The number of false negative cases using the current criteria for the detection of testosterone abuse and hence the low sensitivity indicates a need to discuss introduction of new strategies in forensic doping investigations.

Place, publisher, year, edition, pages
John Wiley & Sons, Ltd, 2021
Keywords
doping, GC-C-IRMS, LH, T/E, testosterone
National Category
Forensic Science
Identifiers
urn:nbn:se:liu:diva-178310 (URN)10.1002/dta.3125 (DOI)000674047600001 ()
Conference
2021/08/17
Note

Funding agencies: Strategic Research Area in Forensic Science (2019), Sweden

Available from: 2021-08-17 Created: 2021-08-17 Last updated: 2022-06-17Bibliographically approved
Aardal-Eriksson, E., Mobäck, C., Jakobsson, S. & Hoffmann, J. J. M. (2015). Iron depletion in blood donors - Have extended erythrocyte and reticulocyte parameters diagnostic utility?. Transfusion and apheresis science, 53(1), 76-81
Open this publication in new window or tab >>Iron depletion in blood donors - Have extended erythrocyte and reticulocyte parameters diagnostic utility?
2015 (English)In: Transfusion and apheresis science, ISSN 1473-0502, E-ISSN 1878-1683, Vol. 53, no 1, p. 76-81Article in journal (Refereed) Published
Abstract [en]

Background: Blood donation is associated with iron depletion, but donor iron status is not usually investigated, as such tests are cumbersome and costly. It would therefore be desirable to have simple, fast and inexpensive tests that give information on a donors risk of developing iron depletion. In a pilot study we investigated whether novel erythrocyte and reticulocyte parameters can serve this goal. Methods: In regular blood donors extended red cell parameters were measured using the Abbott CELL-DYN Sapphire hematology analyzer and conventional biochemical tests of iron status. Donors were compared with a regionally matched group of non-donating controls. Results: In the controls, the reference ranges of extended RBC parameters were well comparable to published data. Donors had significantly more microcytic RBC than controls (median 0.9 vs 0.6%), lower serum ferritin concentration (median 43 vs 91 mg/L) and higher soluble transferrin receptor/ferritin index (median 1.60 vs 1.27). Overall 18-28% of the donors were iron depleted. Moreover, 3.3% of donors had iron-restricted erythropoiesis. Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with 70% and 64% sensitivities and specificities of 72% and 78%, respectively. When combined these two parameters increased the sensitivity to 82%. Conclusions: Our results in Swedish blood donors confirm a high prevalence of iron depletion, despite iron supplementation used by about half of the donors. Microcytic RBC and MCHr appeared to be helpful in identifying iron-depleted donors, who might benefit from iron supplementation. We recommend larger prospective investigations in order to confirm and extend the findings of this pilot study. (C) 2015 Elsevier Ltd. All rights reserved.

Place, publisher, year, edition, pages
PERGAMON-ELSEVIER SCIENCE LTD, 2015
Keywords
Blood donor; Cellular hemoglobin; Erythrocyte; Iron stores; Reticulocyte
National Category
Hematology
Identifiers
urn:nbn:se:liu:diva-122544 (URN)10.1016/j.transci.2015.03.011 (DOI)000362859600016 ()25824704 (PubMedID)
Available from: 2015-11-06 Created: 2015-11-06 Last updated: 2017-12-01
Walter, S. A., Aardal-Eriksson, E., Thorell, L.-H., Bodemar, G. & Hallböök, O. (2006). Pre-experimental stress in patients with irritable bowel syndrome: high cortisol values already before symptom provocation with rectal distensions. Neurogastroenterology and Motility, 18(12), 1069-1077
Open this publication in new window or tab >>Pre-experimental stress in patients with irritable bowel syndrome: high cortisol values already before symptom provocation with rectal distensions
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2006 (English)In: Neurogastroenterology and Motility, ISSN 1350-1925, Vol. 18, no 12, p. 1069-1077Article in journal (Refereed) Published
Abstract [en]

Stress is known to affect symptoms of irritable bowel syndrome (IBS) probably by an alteration of visceral sensitivity. We studied the impact of maximal tolerable rectal distensions on cortisol levels in patients with IBS, chronic constipation and controls, and evaluated the effect of the experimental situation per se. In twenty-four IBS patients, eight patients with chronic constipation and 15 controls salivary cortisol was measured before and after repetitive maximal tolerable rectal balloon distensions and at similar times in their usual environment. Rectal sensitivity thresholds were determined. IBS patients but not controls and constipation patients had higher cortisol levels both before and after the experiment compared with similar times on an ordinary day in their usual environment (P = 0.0034 and 0.0002). There was no difference in salivary cortisol level before compared with after rectal distensions. The IBS patients had significantly lower thresholds for first sensation, urge and maximal tolerable distension than controls (P = 0.0247, 0.0001 and <0.0001) and for urge and maximal tolerable distension than patients with constipation (P = 0.006 and 0.013). IBS patients may be more sensitive to expectancy stress than controls and patients with constipation according to salivary cortisol. Rectal distensions were not associated with a further significant increase in cortisol levels.

Keywords
constipation, cortisol, hypersensitivity, IBS, rectaldistensions, stress
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14182 (URN)10.1111/j.1365-2982.2006.00833.x (DOI)
Available from: 2006-12-07 Created: 2006-12-07 Last updated: 2024-01-10
Aardal-Eriksson, E. (2002). Salivary cortisol and posttraumatic stress reactions: methodological and applied studies before and after trauma. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Salivary cortisol and posttraumatic stress reactions: methodological and applied studies before and after trauma
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The field of psychotraumatology has its roots in ancient history. During the past decades, the surveillance of the psychobiological background of reactions to and consequences of traumatic stress has made great progress and the complexity of the human stress response system stands out. The hypothalamic-pituitary-adrenocortical axis activity, modulated by various neuroimmunological substances, seems to play a major role in the stress response. However, there are still inconsistencies in explanations of relationships between biological and psychological changes following traumatic stress. Moreover, the matter of predictive factors for the development of posttraumatic morbidity is still in a speculative phase.

The aims of the present thesis were to further develop a commercial serum cortisol radioimmunoassay (RIA) for determination of cortisol in saliva and to test its reliability, specificity and sensitivity as a biochemical assay. The saliva sampling procedures and sample storage stability were also to be tested. Further issues were to investigate determinations of salivary cortisol and serum prolactin in relation to selfratings of posttraumatic psychological distress and general psychological health. Possible predictive and concurrent validity of salivary cortisol as a biochemical marker for posttraumatic psychological distress were to be tested.

Cortisol is present in saliva mainly in non-protein form, representing the free, biologically active fraction of the total plasma cortisol concentration. In a first phase of the present thesis, the commercial serum cortisol RIA was modified for determination of cortisol in saliva. The relation between salivary and serum cortisol concentrations was tested. Reference ranges at 8 AM and 10 PM for the salivary cortisol assay were established from 195 healthy subjects. Salivary cortisol concentrations were tested in relation to serum cortisol in estimating adrenocortical function during endocrine dynamic function tests in 37 patients and 13 healthy controls. In testing salivary cortisol as a marker for stress for fieldwork use, a screening study was performed on 66 male rescue workers. Salivary cortisol at 8 AM and 10 PM and serum prolactin were determined and general psychological health and posttraumatic psychological distress were estimated with the self-rating scales General Health Questionnaire, Impact of Event Scale and Posttraumatic Symptom Scale. These scales were used in the second phase of the thesis. Three applied follow-up studies were performed with sampling of salivary cortisol and self-ratings: (a) a study of 31 UN-soldiers five days, two and nine months after a mine accident; (b) a study of 145 UN-soldiers before, at return, and two and six month after a six month mission. (c) a study of 101 UN-soldiers six and twelve months after a six month mission with severe combat exposure.

The results from the present thesis indicate that the modified method of salivary cortisol determination possesses sufficient precision, accuracy, sample storage stability and procedural advantages for laboratory, clinical and field application. Moreover, it possesses moderate predictive information and moderate to high concurrent validity as a biochemical marker for posttraumatic psychological distress.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2002. p. 106
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 705
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-25539 (URN)9986 (Local ID)91-7373-139-0 (ISBN)9986 (Archive number)9986 (OAI)
Public defence
2002-02-15, Berzeliussalen, Universitetssjukhuset, Linköping, 09:30 (Swedish)
Opponent
Supervisors
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2012-10-22Bibliographically approved
Aardal-Eriksson, E., Holm, A., Eriksson, T., Lundin, T. & Thorell, L.-H. (2002). Salivary cortisol and posttraumatic stress reactions methodological and applied studies before and after trauma. International Journal of Psychophysiology, 45(1-2)
Open this publication in new window or tab >>Salivary cortisol and posttraumatic stress reactions methodological and applied studies before and after trauma
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2002 (English)In: International Journal of Psychophysiology, ISSN 0167-8760, E-ISSN 1872-7697, Vol. 45, no 1-2, p. 89-89Conference paper, Published paper (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-48843 (URN)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-12
Aardal-Eriksson, E., Eriksson, T. E. & Thorell, L.-H. (2001). Salivary cortisol, posttraumatic stress symptoms, and general health in the acute phase and during 9-month follow-up. Biological Psychiatry, 50(12), 986-993
Open this publication in new window or tab >>Salivary cortisol, posttraumatic stress symptoms, and general health in the acute phase and during 9-month follow-up
2001 (English)In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 50, no 12, p. 986-993Article in journal (Refereed) Published
Abstract [en]

Background: Because traumatic events are unpredictable, there are few studies of psychobiological states immediately following such events. Our study aimed to determine the relation of salivary cortisol to psychologic distress immediately after a traumatic event and then during follow-up.

Methods: Measurement of morning and evening salivary cortisol and ratings of psychologic distress (using the Impact of Events Scale [IES], the Post Traumatic Symptom Scale, and the General Health Questionnaire) were performed with 31 United Nations soldiers at three time points—5 days and 2 and 9 months—following a mine accident in Lebanon.

Results: Five days after the accident, 15 subjects reported substantial posttraumatic distress according to the IES, as well as significantly lower morning and higher evening cortisol levels compared with the low-impact group. Within 9 months, the posttraumatic distress of the high-impact group was reduced, accompanied by an increase in morning and a decrease in evening cortisol levels. There were significant relationships between evening cortisol and all rating scales at the first and third time points.

Conclusions: Subclinical posttraumatic stress following an adverse event can be measured biologically via salivary cortisol levels soon after the event.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24817 (URN)10.1016/S0006-3223(01)01253-7 (DOI)9215 (Local ID)9215 (Archive number)9215 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
Aardal-Eriksson, E., Eriksson, T., Holm, A.-C. & Lundin, T. (1999). Salivary cortisol and serum prolactin in relation to stress rating scales in a group of rescue workers. Biological Psychiatry, 46(6), 850-855
Open this publication in new window or tab >>Salivary cortisol and serum prolactin in relation to stress rating scales in a group of rescue workers
1999 (English)In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 46, no 6, p. 850-855Article in journal (Refereed) Published
Abstract [en]

Background: Rescue service personnel are often exposed to traumatic events as part of their occupation, and higher prevalence rates of psychiatric illness have been found among this group.

Methods: In 65 rescue workers, salivary cortisol at 8 am and 10 pm and serum prolactin at 8 am were related to the psychiatric self-rating scale General Health Questionnaire (GHQ-28) measuring psychiatric health, and the Impact of Events Scale (IES) and Post Traumatic Symptom Scale (PTSS) measuring posttraumatic symptoms.

Results: Seventeen percent of the study population scored above the GHQ-28 cut-off limit but none scored beyond the cut-off limit in the IES and PTSS questionnaires. Salivary cortisol concentration at 10 pm correlated with statistical significance to anxiety (p < .005) and depressive symptoms (p < .01) measured with GHQ-28, as well as to posttraumatic symptoms, with avoidance behavior measured with IES (p < .01) and PTSS (p < .005). Two of the rescue workers were followed over time with the same sampling procedure after a major rescue commission.

Conclusions: The correlation between evening salivary cortisol and anxiety, depressiveness, and posttraumatic avoidance symptoms indicates that these parameters can be used in screening and follow-up after traumatic stress events.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24816 (URN)10.1016/S0006-3223(98)00381-3 (DOI)9214 (Local ID)9214 (Archive number)9214 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
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