Overview
EPIC Code:
- LAB3060
Soft Test Code:
- CORSA
Send Out Test Code:
- 19897
Alternate Names
- Cortisol, Salivary
- Hydrocortisone, Compound F
Clinical Significance
Salivary cortisol level, particularly late-night salivary cortisol (LNSC) level, is useful in screening for endogenous Cushing syndrome. Two or more positive results of LNSC tests may be used to confirm Cushing syndrome. LNSC measurement may also be used to monitor for recurrence of Cushing disease [1].
Normally, the secretion of cortisol has a circadian rhythm. Patients with Cushing syndrome often lose the late-night circadian nadir. Therefore, an elevated LNSC level may provide initial evidence for Cushing syndrome. Two or more positive results of LNSC tests may establish the diagnosis of Cushing syndrome if non-neoplastic hypercortisolism (pseudo-Cushing syndrome) is excluded. Because saliva is convenient to collect, LNSC testing is especially useful for individuals who need to provide multiple specimens over time for the evaluation of cyclic Cushing syndrome [1].
Annual LNSC testing is recommended to monitor for the recurrence of Cushing disease after pituitary surgery. LNSC testing may also be used in assessing treatment outcomes in patients receiving medical therapy for Cushing disease [1].
Non-neoplastic hypercortisolism caused by obesity, psychiatric disorders, alcohol use disorder, and polycystic ovary syndrome may increase LNSC levels. LNSC testing should not be used to screen for Cushing syndrome in individuals without normal day and night cycles. LNSC testing has low sensitivity in patients with adrenal tumors [1].
Other tests, such as urinary free cortisol (test code 14534) and dexamethasone suppression test (test code 6921), may also be used to screen for Cushing syndrome. Choice of tests should be individualized based upon clinical scenarios [1].
The results of this test should be interpreted in the context of pertinent clinical and family history and physical examination findings.
Reference
1. Fleseriu M, et al. Lancet Diabetes Endocrinol. 2021;9(12):847-875.
Specimen Collection & Preparation
Client Notes:
Contact Client Response at 266-1500 Option 1 to request special collection kit
Test Notes:
If a single collection is desired, please use this test code CORSA. CORSB and CORSC should be ordered together.
Patient Preparation
Do not eat, drink, smoke, or use oral hygiene products for at least 30 minutes, then rinse the mouth with water and discard.
Specimen Requirements:
-OR-
0.5 mL saliva collected in a Salivette® Cortisol with blue screw-cap
Minimum Volume:
0.2 mL Saliva** This volume does not allow for repeat testing
Specimen Information:
Collection Instructions:
Saliva collection should be done at the earliest 60 min after brushing teeth, a meal (liquid/solid food intake) or oral intake of medication and 10 min after rinsing the mouth with water in order to avoid contamination of the saliva by interfering substances.
Remove the swab from the Salivette®.
Place the swab in the mouth, e.g. in your cheek, where it should remain for 2 min without chewing. If an extremely small amount of saliva is produced, leave the swab in the mouth for longer.
Return the swab with the absorbed saliva to the Salivette®.
Replace the stopper.
Refrigerate the Salivette® immediately.
Patient Printable Collection Instructions
Rejection Criteria:
Hemolysis
White-top Salivette collection kit
Transport and Storage:
-
Ambient:
72 Hours
-
Refrigerated:
21 Days
Transport (cold packs)
-
Frozen (-20 C or colder):
6 Months
Clinical Interpretation
Reference Range:
| 8-10 AM | 0.04-0.56 mcg/dL |
| noon-2 PM | ≤0.21 mcg/dL |
| 4-6 PM | ≤0.15 mcg/dL |
| 10 PM-1 AM | ≤0.09 mcg/dL |
Methodology:
- Chromatography / Mass Spectrometry
Clinical Significance
Salivary cortisol level, particularly late-night salivary cortisol (LNSC) level, is useful in screening for endogenous Cushing syndrome. Two or more positive results of LNSC tests may be used to confirm Cushing syndrome. LNSC measurement may also be used to monitor for recurrence of Cushing disease [1].
Normally, the secretion of cortisol has a circadian rhythm. Patients with Cushing syndrome often lose the late-night circadian nadir. Therefore, an elevated LNSC level may provide initial evidence for Cushing syndrome. Two or more positive results of LNSC tests may establish the diagnosis of Cushing syndrome if non-neoplastic hypercortisolism (pseudo-Cushing syndrome) is excluded. Because saliva is convenient to collect, LNSC testing is especially useful for individuals who need to provide multiple specimens over time for the evaluation of cyclic Cushing syndrome [1].
Annual LNSC testing is recommended to monitor for the recurrence of Cushing disease after pituitary surgery. LNSC testing may also be used in assessing treatment outcomes in patients receiving medical therapy for Cushing disease [1].
Non-neoplastic hypercortisolism caused by obesity, psychiatric disorders, alcohol use disorder, and polycystic ovary syndrome may increase LNSC levels. LNSC testing should not be used to screen for Cushing syndrome in individuals without normal day and night cycles. LNSC testing has low sensitivity in patients with adrenal tumors [1].
Other tests, such as urinary free cortisol (test code 14534) and dexamethasone suppression test (test code 6921), may also be used to screen for Cushing syndrome. Choice of tests should be individualized based upon clinical scenarios [1].
The results of this test should be interpreted in the context of pertinent clinical and family history and physical examination findings.
Reference
1. Fleseriu M, et al. Lancet Diabetes Endocrinol. 2021;9(12):847-875.
Production Schedule
Sites Performed
- Quest - Chantilly to San Juan Capistrano
Days Performed
Sunday
Monday
Tuesday
Thursday
Friday
Departments
- Sendouts - Clinical
Turn Around Time
3 to 7 days
Coding & Compliance
CDM
00918041
CPT Coding
82530