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Interpreting salivary cortisol thresholds in ectopic ACTH syndrome
1Department of Endocrinology and Metabolism, Necmettin Erbakan University Faculty of Medicine , Konya, Türkiye.
Endocrine Connections
|June 29, 2026
Summary
Late-night salivary cortisol (LNSC) levels of ≥130 nmol/L predict mortality in ectopic ACTH syndrome. However, this threshold is assay-specific and requires further validation for clinical use.
Area of Science:
- Endocrinology
- Clinical Biochemistry
- Oncology
Background:
- Ectopic ACTH syndrome (EAS) is a rare condition causing excess cortisol production.
- Biochemical severity is crucial for predicting outcomes in EAS.
- Late-night salivary cortisol (LNSC) has emerged as a potential prognostic marker.
Purpose of the Study:
- To comment on a national cohort study identifying LNSC ≥130 nmol/L as a mortality predictor in EAS.
- To discuss the clinical implications and limitations of this biochemical threshold.
Main Methods:
- Perspective commentary on a published national cohort study.
- Analysis of the prognostic significance of LNSC in EAS.
- Discussion of assay variability and biomarker interpretation.
Main Results:
- A LNSC level of ≥130 nmol/L was identified as an independent predictor of mortality in EAS.
- The prognostic value of this threshold is dependent on the specific analytical method used.
- Absolute LNSC values may not be interchangeable across different assays.
Conclusions:
- The identified LNSC threshold is a clinically relevant signal of severe hypercortisolism in the Roche ECLIA assay context.
- Further multicenter validation is needed using harmonized assays and continuous biomarker modeling.
- Subgroup analyses considering tumor context and treatment era are recommended.
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