Diagnostic accuracy study of morning salivary cortisone for screening adrenal insufficiency in a real-world cohort
Authors' conclusion
Baseline morning salivary cortisone performs at least as well as serum cortisol for adrenal insufficiency screening.
Study context
- Population
- Consecutive patients undergoing adrenocorticotropin hormone (ACTH) stimulation test for suspected adrenal insufficiency, single tertiary oncology and endocrinology center, UK, 2017–2024517 ACTH stimulation tests
- Participants
- 449 patients
- Comparison
- Morning salivary cortisone vs serum cortisol vs salivary cortisol for AI screening
- Outcome
- Sensitivity and specificity of baseline salivary cortisone
Methodological detailsretrospective, cross-sectional, single-centre
- Retrospective
- Cross-sectional
- Single-centre
Performance
As reported in the abstract
Prediction of adrenal insufficiency (AUC)
| Test or model | AUC | Rule-out threshold ≥703 ng/dL (19.5 nmol/L): sensitivity | Rule-in threshold <180 ng/dL (5.0 nmol/L): sensitivity | Intermediate threshold <389 ng/dL (10.8 nmol/L): sensitivity | Rule-out threshold ≥703 ng/dL (19.5 nmol/L): specificity | Rule-in threshold <180 ng/dL (5.0 nmol/L): specificity | Intermediate threshold <389 ng/dL (10.8 nmol/L): specificity |
|---|---|---|---|---|---|---|---|
| Salivary cortisone | 0.93 (95% CI 0.91-0.95) | 0.97 (95% CI 0.92-0.99) | 0.58 (0.48-0.67) | 0.83 (0.74-0.89) | 0.59 (0.54-0.63) | 0.97 (0.95-0.98) | 0.87 (0.83-0.90) |
| Serum cortisol | 0.93 (0.90-0.95) | — not stated in the abstract | — not stated in the abstract | — not stated in the abstract | — not stated in the abstract | — not stated in the abstract | — not stated in the abstract |
| Salivary cortisol | 0.87 (0.82-0.91) | — not stated in the abstract | — not stated in the abstract | — not stated in the abstract | — not stated in the abstract | — not stated in the abstract | — not stated in the abstract |
AUC
Salivary cortisone0.93 (95% CI 0.91-0.95)
Serum cortisol0.93 (0.90-0.95)
Salivary cortisol0.87 (0.82-0.91)
Rule-out threshold ≥703 ng/dL (19.5 nmol/L): sensitivity
Salivary cortisone0.97 (95% CI 0.92-0.99)
Serum cortisol— not stated in the abstract
Salivary cortisol— not stated in the abstract
Rule-in threshold <180 ng/dL (5.0 nmol/L): sensitivity
Salivary cortisone0.58 (0.48-0.67)
Serum cortisol— not stated in the abstract
Salivary cortisol— not stated in the abstract
Intermediate threshold <389 ng/dL (10.8 nmol/L): sensitivity
Salivary cortisone0.83 (0.74-0.89)
Serum cortisol— not stated in the abstract
Salivary cortisol— not stated in the abstract
Rule-out threshold ≥703 ng/dL (19.5 nmol/L): specificity
Salivary cortisone0.59 (0.54-0.63)
Serum cortisol— not stated in the abstract
Salivary cortisol— not stated in the abstract
Rule-in threshold <180 ng/dL (5.0 nmol/L): specificity
Salivary cortisone0.97 (0.95-0.98)
Serum cortisol— not stated in the abstract
Salivary cortisol— not stated in the abstract
Intermediate threshold <389 ng/dL (10.8 nmol/L): specificity
Salivary cortisone0.87 (0.83-0.90)
Serum cortisol— not stated in the abstract
Salivary cortisol— not stated in the abstract
— not stated in the abstract
- Salivary cortisone vs Serum cortisol: P = 0.67 — similar
- Salivary cortisone vs Salivary cortisol: P = 0.00063 — salivary cortisone superior
Further findings
- Tests with adrenal insufficiency confirmed
- 104 (20.1%)
Original publication
Diagnostic accuracy study of morning salivary cortisone for screening adrenal insufficiency in a real-world cohort. J Clin Endocrinol Metab. Published 29 September 2026. doi:10.
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