Morning Salivary Cortisone Matches Serum Cortisol for Adrenal Insufficiency Screening

A retrospective cross-sectional study of 517 ACTH stimulation tests in 449 patients at a UK tertiary center found that baseline morning salivary cortisone predicted confirmed adrenal insufficiency with an AUC of 0.93, statistically similar to serum cortisol (0.93) and superior to salivary cortisol (0.87). The study proposed three thresholds for salivary cortisone: a rule-out level ("e265;703 ng/dL) with 0.97 sensitivity, a rule-in level (<180 ng/dL) with 0.97 specificity, and an intermediate level (<389 ng/dL) suggested for identifying patients to consider for glucocorticoid cover while awaiting confirmatory testing.

Most relevant for: Patients undergoing evaluation for suspected adrenal insufficiency via ACTH stimulation testing.

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