A B C D E F G H I J K L M N O P Q R S T U V W X Y Z # |
Cortisol, LC/MS, Saliva
Test CodeAlias/See Also
LAB3758
CPT Codes
<p>82530</p>
Preferred Specimen
Patient Preparation:
- Do not brush teeth before collecting specimen (wait at least 60 minutes after brushing teeth).
- Saliva collection should be done at least 60 minutes after a meal or oral intake of medication.
- Wait 10 minutes after rinsing the moith with water in order to avoid contamination of the saliva by interfering substances.
Specimen Type: Saliva
Collection Container/Type
Preferred: Salivette Cortisol (blue screw-cap)
Acceptable: Super SAL or Super SAL2 Universal Saliva kit
Submission Container/Tube: Salivette
Specimen Volume: 0.5 mL
Collection Instructions:
- Remove the swab from the Salivette.
- Place the swab in the mouth, e.g. in your cheek, where it should remain for 2 minutes 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.
Minimum Volume
0.2 mL
Other Acceptable Specimens
Instructions
b. Remove the swab from the Salivette.
c. Place the swab in the mouth, e.g. in your cheek, where it should remain for 2 minutes without chewing. If an extremely small amount of saliva is produced, leave the swab in the mouth for longer.
d. Return the swab with the absorbed saliva to the Salivette.
e. Replace the stopper.
f. Refrigerate the Salivette immediately.
Transport Temperature
Specimen Stability
Room temperature: 72 hours
Refrigerated: 21 days
Frozen: 6 months
Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
Hemolysis • White-top Salivette collection devices
Methodology
Chromatography/Mass Spectrometry
This test was developed and its analytical performance characteristics have been determined by Quest Diagnostics. It has not been cleared or approved by the U.S. Food and Drug Administration. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.
FDA Status
This test was developed and its analytical performance characteristics have been determined by Quest Diagnostics. It has not been cleared or approved by the U.S. Food and Drug Administration. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.
Setup Schedule
Report Available
2-6 days
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 |
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.
Performing Laboratory
Quest Diagnostics Nichols Institute-San Juan Capistrano, CA
33608 Ortega Highway
San Juan Capistrano, CA 92675-2042
Last Updated: February 17, 2023