Late Night Salivary Cortisol

Aka: Late Night Salivary Cortisol, Late-Night Salivary Cortisol, Salivary Cortisol

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II. Indications: Cushing's Syndrome Screening

  1. Among 3 first line options for Cushing's Syndrome Screening
    1. See 24-hour Urinary Free Cortisol level
    2. See Low-Dose Dexamethasone Suppression Test

III. Technique

  1. Collect Salivary Cortisol swab at 11 pm, before bedtime
  2. Avoid chewing Tobacco, smoking or teeth brushing before collecting Salivary sample
  3. Repeat test at least twice due to variability

IV. Efficacy

  1. Often normal in adrenal hypercortisolism
  2. Perform Salivary Cortisol twice due to variability in 50% of samples
  3. Test Sensitivity: 92 to 100%
  4. Test Specificity: 93 to 100%

V. Causes: False Positives

  1. Incorrect Collection
  2. Nightshift workers
  3. Contaminated sample (blood, Oral Infection)
  4. Drug Interactions
    1. Licorice
    2. Carbenoxolone

VI. Causes: False Negatives

  1. Incorrect Collection

VII. References

  1. Elamin (2008) J Clin Endocrinol Metab 93(5):1553-62 +PMID: 18334594 [PubMed]
  2. Galm (2020) J Clin Endocrinol Metab 105(6):dgaa105 +PMID: 32133504 [PubMed]
  3. Maness (2024) Am Fam Physician 110(3): 270-80 [PubMed]

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