Cortisol, LC/MS, Saliva, 3 Samples

Test Code

92687

CPT Codes
82530 (x3)

Preferred Specimen

0.5 mL saliva collected in each of three separate Salivette® Cortisol with blue screw-cap

Minimum Volume

0.2 mL (x3)

Other Acceptable Specimens

Super SAL™ or Super SAL2™ Universal Saliva Kit

Instructions

a. Saliva collection should be done at the earliest 60 minutes after brushing teeth, a meal (liquid/solid food intake) or oral intake of medication and 10 minutes after rinsing the mouth with water in order to avoid contamination of the saliva by interfering substances.

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

Refrigerated (cold packs)

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

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

Set up: Sun-Tue, Thu-Fri; Report available: 2-6 days

Reference Range

See Laboratory Report

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.

The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.