Advantage of salivary cortisol measurements in the diagnosis of glucocorticoid related disorders

Objective Salivary cortisol in the assessment of glucocorticoid related disorders. Design-methods Serum and salivary cortisol were measured in 189 patients (22 Cushingʹs syndrome, 67 pseudo-Cushing, 11 Addisonʹs disease, 89 controls) at 8:00 and 24:00 h. Results Serum and salivary cortisol correlated in the whole study population (r = 0.62, p = 0.000). Morning serum and saliva cortisol in Addisonʹs disease were lower than in controls (6.74 ± 1.69 vs 22.58 ± 1.78 µg/dL, and 0.15 ± 0.25 vs 0.67 ± 0.12 µg/dL) (p < 0.001). Morning serum cortisol was similar in controls and patients with Cushingʹs syndrome or pseudo-Cushing (22.58 ± 1.78 vs 13.96 ± 6.02 vs 16.13 ± 1.69 µg/dL). Morning serum and salivary cortisol at 8:00 had the same sensitivity to distinguish patients with Addisonʹs disease from healthy controls. 24:00am serum cortisol in controls (2.61 ± 0.20 µg/dL) was lower than in the pseudo-Cushing group (6.53 ± 0.77 µg/dL, p < 0.001) and in Cushingʹs syndrome (10.90 ± 2.36 µg/dL, p = 0.003). 24:00am salivary cortisol in controls (0.0025 ± 0.001 µg/dL) was lower than in patients with Cushingʹs syndrome (0.58 ± 0.11 µg/dL, p < 0.001) and those higher than in patient with pseudo-Cushing (0.10 ± 0.06 µg/dL, p = 0.001). Both salivary cortisol and serum cortisol presented high specificity (82% and 100%) to detect Cushingʹs syndrome but salivary cortisol higher sensitivity (saliva 88% and serum 50%). Conclusion Morning salivary cortisol is as good as serum as screening test for patients with Addisonʹs disease and nighttime salivary cortisol is more adequate than serum in the screening of Cushingʹs syndrome.