Cortisol, Saliva

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Subject: Cortisol, Saliva

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Definition

  • Serum free cortisol freely diffuses into saliva. Therefore, measurements of salivary cortisol (hydrocortisone) more accurately reflect the serum free cortisol. The salivary cortisol concentration is independent of salivary flow rate.

  • Normal range: varies diurnally, with concentrations about 5.6 ng/mL at 8:00–9:00 am and about 1 ng/mL at 11:00 pm.

Use

  • Screening for Cushing syndrome.

  • Diagnosis of Cushing syndrome in patients presenting with symptoms or signs suggestive of the disease.

  • Assessing cortisol secretion serially in ambulatory patients. Measurements are helpful in patients with cyclical Cushing syndrome.

Interpretation

  • Late evening levels are increased in Cushing syndrome.

  • Morning levels are decreased in adrenal insufficiency.

Limitations

  • Several factors influence analytical measurement and accuracy of salivary cortisol levels, including collection processes, devices, sample handling, processing and storage, and choice of analytical method.

  • Changes in cortisol-binding globulin and albumin affect total cortisol levels but not free levels in serum and saliva.

 
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