Salivary Cortisol Assessment of Response Following TVAM

Salivary Cortisol Assessment of Response Following TVAM

Authors: Arata M., Debarge P.


The autonomic nervous system interacts with the hypothalamic-pituitary-adrenal axis (HPA axis). Autonomic dysfunction can lead dysfunction of the HPA axis. Here we describe the effect of TVAM therapy on the HPA axis as assessed by salivary cortisol levels.


Ninety-six patients with symptomatic autonomic dysfunction. Salivary cortisol tested pre procedure, 2 weeks and 3 months post procedure. Bowker test used to examine change from pre to post. Mixed effect model used assuming an autocorrelation covariance structure.


The data shows normalization pattern following TVAM. Abnormally low awakening cortisol increased following TVAM p<0.01. The response was bimodal with low salivary cortisol pre procedure increases after. Similarly high cortisol decreases post procedure. Normal cortisol values tend to stay normal.


TVAM appears to impact HPA axis beyond periprocedural period. Low salivary cortisol preprocedure response statistically significant. This response has potential implications for cortisol awakening response effect on disease states.

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