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23248 Cortisol, Saliva (SALCT)

Cortisol, Saliva (SALCT)
Test Code: CTSALSO
Synonyms/Keywords
Nighttime Salivary Cortisol, Salivary Cortisol, Salivary Cushings, Salivary Hydrocortisone​
Useful For
Screening for Cushing syndrome
 
Diagnosis of Cushing syndrome in patients presenting with symptoms or signs suggestive of the disease
Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
Saliva​ ​SARSTEDT Salivette ​1.5 mL ​0.6 mL
Collection Processing Instructions
1. Do not brush teeth before collecting specimen.
2. Do not eat or drink for 15 minutes prior to specimen collection.
3. Collect specimen between 11 p.m. and midnight, and record collection time.
4. To use the Salivette:
a. Remove top cap of container to expose swab.
b. Place swab directly into mouth by tipping container so swab falls into mouth. Do not touch swab with fingers.
c. Keep swab in mouth for approximately 2 minutes. Roll swab in mouth, do not chew swab.
d. Place swab back into its container without touching, and replace the cap.
e. Record collection time, and send appropriately labeled Salivette to laboratory.
Additional Information:
1. Reference values are also available for 8 a.m. (7 a.m.-9 a.m.) and 4 p.m. (3 p.m.-5 p.m.) collections, however, 11 p.m. to midnight collection is preferred.
2. Indicate collection time.
3. If multiple specimens are collected, submit each vial under a separate order.
 
Return to testing laboratory promptly following collection.
Specimen Stability Information
Specimen Type Temperature Time
​Saliva ​ ​ ​Refrigerated (preferred) ​28 days
​Frozen ​60 days
​Ambient ​28 days
Rejection Criteria

​All specimens will be evaluated at Mayo Clinic Laboratories for test suitability. 

Interference

Acute stress (including hospitalization and surgery), alcoholism, depression, and many drugs (eg, exogenous glucocorticoids, anticonvulsants) can obliterate normal diurnal variation, affect response to suppression/stimulation tests, and cause elevated cortisol levels.

Cortisol levels may be increased in pregnancy and with exogenous estrogens.

Midnight salivary cortisol assay cannot diagnose hypocortisolism or Addison disease because of the limited sensitivity of the assay method.

Performing Laboratory Information
Performing Location Day(s) Test Performed Report Available Methodology/Instrumentation
​Mayo Clinic Laboratories Monday, Wednesday, Friday​ ​2 to 4 days
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)​
Reference Lab
Test Information
Cortisol levels are regulated by adrenocorticotropic hormone (ACTH), which is synthesized by the pituitary in response to corticotropin-releasing hormone (CRH). Cushing syndrome results from overproduction of glucocorticoids as a result of either primary adrenal disease (adenoma, carcinoma, or nodular hyperplasia) or an excess of ACTH (from a pituitary tumor or an ectopic source). ACTH-dependent Cushing syndrome due to a pituitary corticotroph adenoma is the most frequently diagnosed subtype; most commonly seen in women in the third through fifth decades of life.
  
CRH is released in a cyclic fashion by the hypothalamus, resulting in diurnal peaks (elevated in the morning) and nadirs (low in the evening) for plasma ACTH and cortisol levels. The diurnal variation is lost in patients with Cushing and these patients have elevated levels of evening plasma cortisol. The measurement of late-night salivary cortisol is an effective and convenient screening test for Cushing syndrome.(1) In a recent study from the National Institute of Health, nighttime salivary cortisol measurement was superior to plasma and urine free cortisol assessments in detecting patients with mild Cushing syndrome.(2) The sensitivity of nighttime salivary cortisol measurements remained superior to all other measures. The distinction between Cushing syndrome and pseudo-Cushing states is most difficult in the setting of mild to moderate hypercortisolism. Subtle increases in salivary cortisol at the midnight cortisol (cortisol of nadir) appear to be 1 of the earliest abnormalities in Cushing syndrome.
Reference Range Information
7 am - 9 am : 100-750 ng/dL
3 pm - 5 pm : <401 ng/dL
11 pm - midnight : <100 ng/dL
Interpretation
Cushing syndrome is characterized by increased salivary cortisol levels, and late-night saliva cortisol measurements may be the optimum test for the diagnosis of Cushing. It is standard practice to confirm elevated results at least once. This can be done by repeat late-night salivary cortisol measurements, midnight blood sampling for cortisol (CORT/8545 Cortisol, Serum), 24-hour urinary free cortisol collection (CORTU/8546 Cortisol, Urine), or overnight dexamethasone suppression testing. Upon confirmation of the diagnosis, the cause of hypercortisolism, adrenal versus pituitary versus ectopic adrenocorticotropic hormone production, needs to be established. This is typically a complex undertaking, requiring dynamic testing of the pituitary adrenal axis and imaging procedures. Referral to specialized centers or in-depth consultation with experts is strongly recommended.
Outreach CPTs
CPT Modifier
(if needed)
Quantity Description Comments
82533​
Synonyms/Keywords
Nighttime Salivary Cortisol, Salivary Cortisol, Salivary Cushings, Salivary Hydrocortisone​
Ordering Applications
Ordering Application Description
​Centricity ​Cortisol, Saliva SO (84225)
​Cerner ​Cortisol, Saliva SO (84225)
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
Saliva​ ​SARSTEDT Salivette ​1.5 mL ​0.6 mL
Collection Processing
1. Do not brush teeth before collecting specimen.
2. Do not eat or drink for 15 minutes prior to specimen collection.
3. Collect specimen between 11 p.m. and midnight, and record collection time.
4. To use the Salivette:
a. Remove top cap of container to expose swab.
b. Place swab directly into mouth by tipping container so swab falls into mouth. Do not touch swab with fingers.
c. Keep swab in mouth for approximately 2 minutes. Roll swab in mouth, do not chew swab.
d. Place swab back into its container without touching, and replace the cap.
e. Record collection time, and send appropriately labeled Salivette to laboratory.
Additional Information:
1. Reference values are also available for 8 a.m. (7 a.m.-9 a.m.) and 4 p.m. (3 p.m.-5 p.m.) collections, however, 11 p.m. to midnight collection is preferred.
2. Indicate collection time.
3. If multiple specimens are collected, submit each vial under a separate order.
 
Return to testing laboratory promptly following collection.
Specimen Stability Information
Specimen Type Temperature Time
​Saliva ​ ​ ​Refrigerated (preferred) ​28 days
​Frozen ​60 days
​Ambient ​28 days
Rejection Criteria

​All specimens will be evaluated at Mayo Clinic Laboratories for test suitability. 

Interference

Acute stress (including hospitalization and surgery), alcoholism, depression, and many drugs (eg, exogenous glucocorticoids, anticonvulsants) can obliterate normal diurnal variation, affect response to suppression/stimulation tests, and cause elevated cortisol levels.

Cortisol levels may be increased in pregnancy and with exogenous estrogens.

Midnight salivary cortisol assay cannot diagnose hypocortisolism or Addison disease because of the limited sensitivity of the assay method.

Useful For
Screening for Cushing syndrome
 
Diagnosis of Cushing syndrome in patients presenting with symptoms or signs suggestive of the disease
Reference Range Information
7 am - 9 am : 100-750 ng/dL
3 pm - 5 pm : <401 ng/dL
11 pm - midnight : <100 ng/dL
Interpretation
Cushing syndrome is characterized by increased salivary cortisol levels, and late-night saliva cortisol measurements may be the optimum test for the diagnosis of Cushing. It is standard practice to confirm elevated results at least once. This can be done by repeat late-night salivary cortisol measurements, midnight blood sampling for cortisol (CORT/8545 Cortisol, Serum), 24-hour urinary free cortisol collection (CORTU/8546 Cortisol, Urine), or overnight dexamethasone suppression testing. Upon confirmation of the diagnosis, the cause of hypercortisolism, adrenal versus pituitary versus ectopic adrenocorticotropic hormone production, needs to be established. This is typically a complex undertaking, requiring dynamic testing of the pituitary adrenal axis and imaging procedures. Referral to specialized centers or in-depth consultation with experts is strongly recommended.
For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Report Available Methodology/Instrumentation
​Mayo Clinic Laboratories Monday, Wednesday, Friday​ ​2 to 4 days
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)​
Reference Lab
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)
Quantity Description Comments
82533​
For most current information refer to the Marshfield Laboratory online reference manual.