Salivary cortisol: a better measure of adrenal cortical function than serum cortisol
Abstract
Salivary cortisol concentration was found to be directly proportional to the serum unbound cortisol concentration both in normal men and women and in women with elevated cortisol-binding globulin (CBG). The correlation was excellent in dynamic tests of adrenal function (dexamethasone suppression, ACTH stimulation), in normals and patients with adrenal insufficiency, in tests of circadian variation and randomly collected samples. Women in the third trimester of normal pregnancy exhibited elevated salivary cortisol throughout the day. The relationship between salivary and serum total cortisol concentration was markedly non-linear with a more rapid increase in salivary concentration once the serum CBG was saturated. The rate of equilibrium of cortisol between blood and saliva was very fast, being much less than 5 minutes. These data, combined with a simple, stress-free, non-invasive collection procedure, lead us to suggest that salivary cortisol is a more appropriate measure for the clinical assessment of adrenocortical function than is serum cortisol.
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Changes in circulating CBG have a significant impact on total, but not free, cortisol concentrations.
“Changes in circulating CBG have a significant impact on total, but not free, cortisol concentrations (85, 86).”
From Higher Circulating Cortisol in the Follicular vs. Luteal Phase of the Menstrual Cycle: A Meta-Analysis (2020) · cites this paper as [86]
Salivary levels of unconjugated steroids provide a measure of their free concentrations in serum.
“Their levels in saliva therefore provide a measure of their free concentrations in serum [210].”
From Human steroid biosynthesis, metabolism and excretion are differentially reflected by serum and urine steroid metabolomes: a comprehensive review (2019) · cites this paper as [210]
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- Authors
- Vining, R. F., McGinley, R. A., Maksvytis, J. J., & Ho, K. Y.
- Affiliations
- Garvan Institute of Medical Research (AU)
- Venue
- Annals of Clinical Biochemistry International Journal of Laboratory Medicine
- Publisher
- SAGE Publications
- Published
- 1983-11
- Volume
- 20
- Issue
- 6
- Pages
- 329-335
- ISSN
- 0004-5632 (ISSN-L)
- 1758-1001
- OpenAlex
- W2062000903
- Cited by
- 684
- References
- 18
- Citations by year
- 2026: 16 · 2025: 19 · 2024: 15 · 2023: 38 · 2022: 29 · 2021: 21 · 2020: 19 · 2019: 19 · 2018: 26 · 2017: 30 · 2016: 24 · 2015: 22 · 2014: 40 · 2013: 29 · 2012: 32
- FWCI
- 1.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Clinical Biochemistry International Journal of Laboratory Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Keywords
- salivary cortisol, serum cortisol, corticosteroid-binding globulin, adrenal function testing, dexamethasone suppression test, ACTH stimulation test, adrenal insufficiency, pregnancy
- MeSH terms
- Adrenal Cortex, Adrenal Cortex Function Tests, Adrenocorticotropic Hormone, Adult, Carrier Proteins, Circadian Rhythm, Dexamethasone, Female, Humans, Hydrocortisone, Male, Pregnancy, Pregnancy Trimester, Third, Saliva, Sex Factors
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