Utility of salivary cortisol measurements in Cushing's syndrome and adrenal insufficiency. J Clin Endocrinol Metab 2009 Oct;94(10):3647-55
Date
07/16/2009Pubmed ID
19602555DOI
10.1210/jc.2009-1166Scopus ID
2-s2.0-70349931666 (requires institutional sign-in at Scopus site) 148 CitationsAbstract
CONTEXT: The measurement of cortisol in saliva is a simple, reproducible, and reliable test to evaluate the normal and disordered control of the hypothalamic-pituitary-adrenal (HPA) axis. There are a variety of simple methods to obtain saliva samples without stress, making this a robust test applicable to many different experimental and clinical situations.
EVIDENCE ACQUISITION: Ovid Medline and PubMed from 1950 to present were searched using the following strategies: [<saliva or salivary>and<cortisol or hydrocortisone>and<Cushing or Cushing's>] and [<saliva or salivary>and<cortisol or hydrocortisone>and<adrenal insufficiency or hypoadrenalism or hypopituitarism or Addison's disease>]. The bibliographies of all relevant citations were evaluated for any additional appropriate citations.
EVIDENCE SYNTHESIS: Measurement of an elevated late-night (2300 to 2400 h) salivary cortisol has a greater than 90% sensitivity and specificity for the diagnosis of endogenous Cushing's syndrome. Late-night salivary cortisol measurements are also useful to monitor patients for remission and/or recurrence after pituitary surgery for Cushing's disease. Because it is a surrogate for plasma free cortisol, the measurement of salivary cortisol may be useful during an ACTH stimulation test in patients with increased plasma binding protein concentrations due to increased estrogen, or decreased plasma binding protein concentrations during critical illness. Most reference laboratories now offer salivary cortisol testing.
CONCLUSIONS: It is expected that the use of the measurement of salivary cortisol will become routine in the evaluation of patients with disorders of the HPA axis.
Author List
Raff HAuthor
Hershel Raff PhD Professor in the Academic Affairs department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Adrenal InsufficiencyBiomarkers
Circadian Rhythm
Cushing Syndrome
Humans
Hydrocortisone
Saliva
Sensitivity and Specificity