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Salivary cortisol--an alternative to serum cortisol determinations in dynamic function tests

E Aardal-Eriksson1, B E Karlberg, A C Holm

  • 1Department of Biomedicine and Surgery, Faculty of Health Sciences, Linköping University, Sweden.

Clinical Chemistry and Laboratory Medicine
|June 25, 1998
PubMed
Summary

Salivary cortisol effectively mirrors serum cortisol in assessing adrenocortical function during dynamic endocrine tests. This non-invasive method offers a comparable and potentially advantageous alternative for evaluating hypothalamic-pituitary-adrenocortical axis function.

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Area of Science:

  • Endocrinology
  • Clinical Chemistry

Background:

  • Adrenocortical function is typically assessed using serum cortisol levels.
  • Dynamic endocrine tests are crucial for diagnosing hypothalamic-pituitary-adrenocortical axis (HPAA) disorders.
  • Salivary cortisol offers a potential non-invasive alternative to serum cortisol measurements.

Purpose of the Study:

  • To evaluate salivary cortisol as a reliable alternative to serum cortisol for assessing adrenocortical function.
  • To compare salivary and serum cortisol responses during insulin tolerance test (ITT), corticotropin-releasing hormone (CRH) stimulation, and adrenocorticotropic hormone (ACTH) stimulation.
  • To investigate the correlation between plasma ACTH and cortisol levels in both serum and saliva.

Main Methods:

  • Measurements of salivary and serum cortisol were performed following ITT, CRH stimulation, and ACTH stimulation in healthy controls and patients with suspected HPAA disturbances.

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  • Plasma ACTH was also measured during ITT and CRH stimulation.
  • Patients were classified as good or poor responders based on serum cortisol criteria.

    • Main Results:

    • Salivary and serum cortisol analyses yielded concordant results in 42 out of 45 tests.
    • Healthy subjects and good responders showed a significantly greater mean cortisol increase in saliva compared to serum across all tests (p < 0.05).
    • Salivary cortisol exhibited a delayed peak and an initial decrease not observed in serum during ITT, with stronger correlations to plasma ACTH (r = 0.76–0.85) compared to serum cortisol (r = 0.54–0.64).

    Conclusions:

    • Salivary cortisol measurement is a viable alternative to serum cortisol in dynamic endocrine testing for HPAA function.
    • The enhanced cortisol response and closer correlation with ACTH in saliva suggest potential advantages over serum measurements.
    • Salivary cortisol offers a non-invasive and reliable method for assessing adrenocortical function.