Salivary Cortisol

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Abstract
One of the hallmarks of the hypothalamic-pituitary-adrenal (HPA) axis is a distinctive circadian rhythm with a peak in cortisol at 8 a.m. and a nadir around midnight. Because patients with endogenous hypercortisolism have an increase in the nadir in the circadian rhythm of cortisol, the ability to demonstrate elevated late night cortisol secretion has proved useful in the diagnosis of Cushing's syndrome. Salivary cortisol is in equilibrium with, and is an excellent reflection of, free, biologically active cortisol in the plasma. Sampling saliva is simple and can be performed by patients at home, and at ages ranging from infants to the very old. Therefore, assessment of salivary cortisol may prove useful in screening for, and the diagnosis of, endogenous hypercortisolism. Several studies have demonstrated that an elevated salivary cortisol late in the evening (e.g., 11 p.m.) suggests the presence of Cushing's syndrome. Other studies have also used salivary cortisol measurement to identify and characterize patients with intermittent Cushing's syndrome and with endogenous depression, as well as to document activity of the HPA axis in a wide array of studies in normal subjects (e.g., psychoneuroendocrinology). The simplicity of sampling salivary cortisol without the inconvenience of collecting timed urine samples and the stress of blood sampling makes it an ideal and indispensable tool in the evaluation of patients with suspected Cushing's syndrome. The Endocrinologist 2000; 10:9-17

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