Cited by 186Adrenal Hormones and DisordersPituitary Gland Disorders and TreatmentsStress Responses and Cortisol

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Utility of salivary cortisol measurements in Cushing's syndrome and adrenal insufficiency

Raff, Hershel·2009·The Journal of Clinical Endocrinology & Metabolism

DOI 10.1210/jc.2009-1166

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Abstract

CONTEXT: The measurement of cortisol in saliva is a simple, reproducible, and reliable test to evaluate the normal and disordered control of the hypothalamic-pituitary-adrenal (HPA) axis. There are a variety of simple methods to obtain saliva samples without stress, making this a robust test applicable to many different experimental and clinical situations. EVIDENCE ACQUISITION: Ovid Medline and PubMed from 1950 to present were searched using the following strategies: [ and and ] and [ and and ]. The bibliographies of all relevant citations were evaluated for any additional appropriate citations. EVIDENCE SYNTHESIS: Measurement of an elevated late-night (2300 to 2400 h) salivary cortisol has a greater than 90% sensitivity and specificity for the diagnosis of endogenous Cushing's syndrome. Late-night salivary cortisol measurements are also useful to monitor patients for remission and/or recurrence after pituitary surgery for Cushing's disease. Because it is a surrogate for plasma free cortisol, the measurement of salivary cortisol may be useful during an ACTH stimulation test in patients with increased plasma binding protein concentrations due to increased estrogen, or decreased plasma binding protein concentrations during critical illness. Most reference laboratories now offer salivary cortisol testing. CONCLUSIONS: It is expected that the use of the measurement of salivary cortisol will become routine in the evaluation of patients with disorders of the HPA axis.

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Authors: Raff, H.
Affiliations: Medical College of Wisconsin (US)
Corresponding author: Raff, Hershel
ORCID: Raff, Hershel
Venue: The Journal of Clinical Endocrinology & Metabolism
Publisher: The Endocrine Society
Published: 2009-10-01
Volume: 94
Issue: 10
Pages: 3647-3655
ISSN: 0021-972X (ISSN-L)
1945-7197
DOI: 10.1210/jc.2009-1166
OpenAlex: W2026990065
Cited by: 186
References: 102
Citations by year: 2026: 5 · 2025: 6 · 2024: 6 · 2023: 6 · 2022: 5 · 2021: 3 · 2020: 15 · 2019: 17 · 2018: 6 · 2017: 9 · 2016: 12 · 2015: 10 · 2014: 16 · 2013: 16 · 2012: 20
FWCI: 2.36
Type: journal article
Language: en
Open access: closed
Locations: The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
Keywords: salivary cortisol, Cushing's syndrome, adrenal insufficiency, hypothalamic-pituitary-adrenal axis, late-night salivary cortisol, Cushing's disease, pituitary surgery, ACTH stimulation test, plasma cortisol, critical illness
MeSH terms: Adrenal Insufficiency, Circadian Rhythm, Cushing Syndrome, Humans, Hydrocortisone, Saliva, Sensitivity and Specificity, Biomarkers

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Utility of salivary cortisol measurements in Cushing's syndrome and adrenal insufficiency

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