Utility of Salivary Cortisol and Cortisone in the Diagnostics of Adrenal Insufficiency
Authors' conclusion
Sa-cortisol in cosyntropin-test has high diagnostic accuracy in detecting adrenal insufficiency and is particularly useful in women on oral estrogens. An sa-cortisol ≥ 12.6 nmol/L assayed with liquid chromatography tandem mass spectrometry 60 minutes after 250 µg cosyntropin is normal.
Study context
- Population
- 128 healthy subjects (16 on oral estrogens) and 59 patients with suspected adrenal insufficiency (AI), of whom 26 were diagnosed with AI by conventional serum cortisol criteria128 healthy, 59 suspected AI
- Comparison
- Salivary cortisol, salivary cortisone and their sum after cosyntropin stimulation for diagnosing AI
- Outcome
- Cutoff level for AI (2.5th percentile in healthy subjects not receiving estrogens) and its diagnostic accuracy
- Follow-up
- 60 minutes after cosyntropin
Methodological detailsLC-MS/MS assay, 250-µg cosyntropin test
- LC-MS/MS assay
- 250-µg cosyntropin test
Performance
As reported in the abstract
| Test or model | Value | Accuracy | Sensitivity | Specificity |
|---|---|---|---|---|
| Sa-cortisol | cutoff 12.6 nmol/L | 89% | 85% | 90% |
Sa-cortisol
Valuecutoff 12.6 nmol/L
Accuracy89%
Sensitivity85%
Specificity90%
Further findings
Correlation between sa-cortisol and s-cortisol
- Model with 2 regression lines, R2
- 0.80
- Breakpoint (segmented regression), sa-cortisol
- 9.7 nmol/L
- Breakpoint (segmented regression), s-cortisol
- 482 nmol/L
- Healthy subjects on oral estrogens: linear agreement between s- and sa-cortisol through all measurements
- Breakpoint likely corresponds to saturation of cortisol binding globulin
Reproducibility (repeat test)
- Healthy subjects repeating the test; similar outcomes but poor reproducibility (intraclass coefficient and correlation)
- 17
Original publication
Utility of Salivary Cortisol and Cortisone in the Diagnostics of Adrenal Insufficiency. J Clin Endocrinol Metab. Published 12 July 2024. doi:10.
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