2025 · Journal of Clinical Endocrinology & Metabolism · paywalled
Utility of Salivary Cortisol and Cortisone in the Diagnostics of Adrenal Insufficiency
Kvam Hellan et al.
The finding, in our words
Patient-centric microsampling of salivary cortisol shows a 12.6 nmol/L cutoff at 60 min post cosyntropin stimulation, 89% accuracy, 85% sensitivity and 90% specificity, for adrenal insufficiency diagnosis, but reproducibility in healthy volunteers was poor.
A paraphrase to the Library’s standard, never the abstract. The source is one link away and is always the authority.
This study found that salivary 11-dehydrodexamethasone correlates strongly with serum dexamethasone, unlike salivary dexamethasone which shows poor agreement. This validation suggests patients could self-collect saliva samples at home to verify dexamethasone absorption for the overnight suppression test.
This study validated a lateral flow fluorescence assay using quantum dots for saliva and europium nanoparticles for serum to detect cortisol within physiological ranges. The test operates in 15 minutes with a handheld reader, supporting point-of-care and at-home monitoring without a cold chain.
Testosterone, androstenedione, cortisol and cortisone were measurable from 200 µL saliva, but estradiol fell below quantification and progesterone in under half of samples: only a subset of steroids is reliable in saliva, and not interchangeable with serum.
A validated LC-MS/MS assay successfully measured 13 steroid hormones and two synthetic steroids in saliva, requiring only 50 microlitres, or down to 2 to 5 microlitres for nine analytes. This shows saliva's viability for non-invasive, patient-centric microsampling and decentralised monitoring in paediatric, neonatal and adult populations.
During ACTH stimulation, salivary cortisol correlated only weakly with serum and gave modest accuracy: saliva does not reliably replace serum cortisol for adrenal insufficiency. A concrete limit.