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The average level of salivary cortisol upon waking is roughly 15 nmol/L; 30 minutes later it may be 23 nmol/L, though there are wide variations. [3] The cortisol awakening response reaches a maximum approximately 30 minutes after awakening though it may still be heightened by 34% an hour after waking. [3]
In 2010 Sakihara, et al., evaluated the usefulness and accuracy of salivary, plasma, and urinary cortisol levels and determined salivary cortisol to be the "method of choice" for Cushing's syndrome screening. [23] In 2008 Restituto, et al., found early morning salivary cortisol to be "as good as serum" as an Addison's disease screening ...
The late-night or midnight salivary cortisol test has been gaining support due to its ease of collection and stability at room temperature, therefore it can be assigned to outpatients. [8] The test measures free circulating cortisol and have both a sensitivity and specificity of 95–98%. [8] [11] This test is especially useful for diagnosing ...
To confirm inappropriately low cortisol secretion, testing can include baseline morning cortisol level in the blood or morning cortisol level in the saliva. [2] Cortisol levels typically peak in the morning; thus, low values indicate true adrenal insufficiency. [2] Urinary free cortisol can also be measured, but are not necessary for diagnosis. [2]
Cortisol follows a circadian rhythm, and to accurately measure cortisol levels is best to test four times per day through saliva. An individual may have normal total cortisol but have a lower than normal level during a certain period of the day and a higher than normal level during a different period.
Levels of cortisol and ACTH both elevated; 24-hour urinary cortisol levels elevated; Dexamethasone suppression test [3] Late night salivary cortisol (LNSC) [4] Loss of diurnal variation in cortisol levels (seen only in true Cushing's Syndrome) High mean corpuscular volume and gamma-glutamyl transferase may be clues to alcoholism
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