What is the procedure for performing a saliva cortisol test and what is its clinical significance?

From the Guidelines

To perform a saliva cortisol test, it is essential to follow a standardized protocol, such as scheduling appointments between 9 and 11 a.m., avoiding food intake for at least 1 hour before collection, and refraining from smoking, alcohol consumption, and vigorous physical exercise for specified periods before sampling, as recommended by the most recent guidelines 1. The test typically involves collecting saliva in a sterile tube by spitting or using an absorbent swab placed in your mouth for 1-2 minutes. Multiple samples may be needed throughout the day to track your cortisol rhythm, and samples should be stored according to the kit instructions, usually refrigerated until delivery to the lab. The test is valuable because cortisol follows a diurnal pattern, with highest levels in the morning and lowest at night, and abnormal patterns can indicate various conditions, such as Cushing's syndrome or adrenal insufficiency, as supported by recent studies 1. Some key points to consider when performing a saliva cortisol test include:

• Avoiding eating, drinking, or using tobacco for at least 1 hour before collection, as recommended by recent guidelines 1
• Refraining from smoking for at least 4 hours and alcohol consumption for at least 12 hours before sampling, as suggested by recent studies 1
• Avoiding vigorous physical exercise for at least 24 hours before sampling, as recommended by recent guidelines 1
• Collecting saliva samples at standardized times, such as between 9 and 11 a.m., to minimize diurnal variation, as suggested by recent studies 1
• Using a sterile tube or absorbent swab to collect saliva samples, as recommended by recent guidelines 1
• Storing samples according to the kit instructions, usually refrigerated until delivery to the lab, as recommended by recent guidelines 1 It is crucial to interpret the results of the saliva cortisol test in the context of your symptoms and medical history, and to consult with a healthcare provider for proper diagnosis and management, as emphasized by recent studies 1. The advantages of saliva testing over blood tests include its non-invasive nature, the ability to measure free (active) cortisol, and the possibility of collecting multiple samples at home to establish your cortisol rhythm, as supported by recent studies 1. However, it is essential to note that the evidence demonstrating the benefit of using salivary cortisol over serum cortisol is limited, and the practicality and feasibility of using salivary cortisol may be questionable, as highlighted by recent studies 1. Therefore, it is essential to follow a standardized protocol and consult with a healthcare provider to ensure accurate and reliable results, as recommended by the most recent guidelines 1.

From the Research

Saliva Cortisol Test Procedure

• The test involves collecting a saliva sample, which can be done at home or in a clinical setting 2, 3, 4, 5, 6.
• The sample is typically collected at a specific time, such as in the morning or late at night, to assess the levels of cortisol in the saliva 2, 3, 4, 5, 6.
• The saliva sample is then sent to a laboratory for analysis, where the levels of cortisol are measured using an enzyme immunoassay kit or other methods 2, 5.

Significance of Saliva Cortisol Test

• The saliva cortisol test is used to diagnose and monitor various adrenal disorders, such as Cushing's syndrome and adrenal insufficiency 2, 3, 4, 5, 6.
• The test can help identify patients with endogenous hypercortisolism, which is characterized by elevated levels of cortisol in the saliva 4, 6.
• The test can also be used to monitor patients with adrenal insufficiency, who may have low levels of cortisol in their saliva 2, 6.
• The advantages of the saliva cortisol test include its non-invasiveness, reliability, and ease of use in ambulatory patients 5.

Interpretation of Results

• The results of the saliva cortisol test are interpreted based on the levels of cortisol in the saliva, which can vary depending on the time of day and the individual's condition 2, 3, 4, 5, 6.
• Elevated levels of cortisol in the saliva may indicate Cushing's syndrome or other adrenal disorders, while low levels may indicate adrenal insufficiency 2, 4, 6.
• The test can be used in combination with other diagnostic tests, such as the short Synacthen test, to confirm the diagnosis of adrenal insufficiency 2.