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Updated: Jun 12, 2026

Collecting Saliva and Measuring Salivary Cortisol and Alpha-amylase in Frail Community Residing Older Adults via Family Caregivers
Published on: December 18, 2013
Salivary and free serum cortisol evaluation
Christopher Duplessis1, Dominick Rascona, Malford Cullum
1Naval Medical Center Portsmouth, Portsmouth VA, USA.
Salivary cortisol can estimate free serum cortisol in non-ICU patients. However, it is not recommended for intensive care unit (ICU) patients due to sample issues. This study highlights differences in diagnosing adrenal insufficiency using free versus total cortisol.
Area of Science:
- Endocrinology
- Clinical Chemistry
Background:
- Physiologic free serum cortisol offers a more accurate reflection of adrenal function compared to total cortisol.
- Salivary cortisol is a potential non-invasive method to estimate free serum cortisol levels.
Purpose of the Study:
- To investigate the clinical viability of salivary cortisol as a surrogate for free serum cortisol in hospitalized patients.
- To compare interpretations of adrenal insufficiency based on free versus total serum cortisol.
Main Methods:
- Free serum cortisol and salivary cortisol were measured using ELISA in both hospitalized and outpatient settings.
- Patient samples included those from intensive care units (ICUs).
Main Results:
- A strong correlation (0.914, p < 0.001) was observed between free serum cortisol and salivary cortisol.
- Satisfactory saliva samples were obtained from 37 out of 71 ICU patients.
- Disparate interpretations for adrenal insufficiency were identified when using total versus free serum cortisol.
Conclusions:
- Salivary cortisol is a viable alternative to free serum cortisol when adequate sample volumes are obtained.
- General adoption in the ICU is not recommended due to issues with sample volume and contamination.
- Discordance in interpreting adrenal insufficiency between free and total cortisol suggests a need to re-evaluate past studies.
- Widespread adoption of free serum cortisol measurement is suggested for future research.
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