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Cortisol, LC/MS, Saliva : 19897
Test CodeCORTSL or 19897
Alias/See Also
Hydrocortisone, Compound F
CPT Codes
82530
Instructions
Precautions:
1. Saliva should be collected at the time(s) prescribed by your doctor.
2. No food, fluids, brushing teeth, or oral inatke of medication for 60 minutes prior to collection.
3. Do not use any creams, lotions, or steroid inhalers immediately prior to collection.
4. Avoid any activity that can cause your gums to bleed, including brushing and flossing your teeth. Consult with your doctor if this is a chronic problem.
Collection Instructions
Salivette™ Cortisol with Blue screw-cap:
a. Saliva collection should be done at the earilest 60 min after brusing eeth, a meal (liquid/solid food intake) or oral inake of medication and 10 min after finsing 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 min without chewing. If an extremely smal 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. Refrigerated the Salivette™ immediately.
Super SAL™ or Super SAL2™ Universal Saliva Collection Kit:
1. Do not eat, drink, smoke, or use oral hygiene products for at least 60 minutes, then rinse the mouth with water and discard. Please wait at least 10 minutes after this rinse to start the collection procedure.
2. During this time review the detailed instructions on the Super SAL™ Saliva collection Kit insert, particularly the illustrations showing the appearance of the Sample Volume Adequacy Indicator (SVAI) before and after sample collection (Figure 3).
3. Place contents on a clean and dry surface.
4. Firmly attach the Collection Tube (E) provided to the base (D) of the Compression tube (C) (Figure 1). In preparation for saliva collection, pool saliva in the mouth. Sample collection may now begin.
5. Place the tip of the pad of the Collector (A) where saliva has pooled (Figure 2).
6. The Collector (A) may be removed from the mouth periodically to read the SVAI, but resume collection immediately afterward. Collect until the appearance of the SVAI (B) changes from white to fully red (Figure 3). The collection procedure should last approximately 2 minutes or longer.
7. Place the white absorbent pad end into the Compression Tube (C) holding the Collector (A) in an upright and vertical position and firmly push the plunger downwards to transfer saliva from the absorbent pad into the Collection Tube (E). Push and hold for 30 seconds (Figure 4).
8. Gently remove the Collection Tube (E) from the end of the Compression Tube (C). It is appropriate to remove the Collection Tube (E) during expression if necessary due to foaming. Close the lid on the tube tightly.
9. Label the collected sample immediately, include date and time of collection and store at refrigerated temperatures prior to shipment. For Technical Support, call 1-800-642-4657 ext. 2904.
1. Saliva should be collected at the time(s) prescribed by your doctor.
2. No food, fluids, brushing teeth, or oral inatke of medication for 60 minutes prior to collection.
3. Do not use any creams, lotions, or steroid inhalers immediately prior to collection.
4. Avoid any activity that can cause your gums to bleed, including brushing and flossing your teeth. Consult with your doctor if this is a chronic problem.
Collection Instructions
Salivette™ Cortisol with Blue screw-cap:
a. Saliva collection should be done at the earilest 60 min after brusing eeth, a meal (liquid/solid food intake) or oral inake of medication and 10 min after finsing 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 min without chewing. If an extremely smal 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. Refrigerated the Salivette™ immediately.
Super SAL™ or Super SAL2™ Universal Saliva Collection Kit:
1. Do not eat, drink, smoke, or use oral hygiene products for at least 60 minutes, then rinse the mouth with water and discard. Please wait at least 10 minutes after this rinse to start the collection procedure.
2. During this time review the detailed instructions on the Super SAL™ Saliva collection Kit insert, particularly the illustrations showing the appearance of the Sample Volume Adequacy Indicator (SVAI) before and after sample collection (Figure 3).
3. Place contents on a clean and dry surface.
4. Firmly attach the Collection Tube (E) provided to the base (D) of the Compression tube (C) (Figure 1). In preparation for saliva collection, pool saliva in the mouth. Sample collection may now begin.
5. Place the tip of the pad of the Collector (A) where saliva has pooled (Figure 2).
6. The Collector (A) may be removed from the mouth periodically to read the SVAI, but resume collection immediately afterward. Collect until the appearance of the SVAI (B) changes from white to fully red (Figure 3). The collection procedure should last approximately 2 minutes or longer.
7. Place the white absorbent pad end into the Compression Tube (C) holding the Collector (A) in an upright and vertical position and firmly push the plunger downwards to transfer saliva from the absorbent pad into the Collection Tube (E). Push and hold for 30 seconds (Figure 4).
8. Gently remove the Collection Tube (E) from the end of the Compression Tube (C). It is appropriate to remove the Collection Tube (E) during expression if necessary due to foaming. Close the lid on the tube tightly.
9. Label the collected sample immediately, include date and time of collection and store at refrigerated temperatures prior to shipment. For Technical Support, call 1-800-642-4657 ext. 2904.
Transport Container
Preferred Specimen
0.5 mL of saliva collected in Salivette™ Cortisol with BLUE screw-cap
Minimum Volume
0.2 mL
Acceptable
Super SAL™ or Super SAL2™ Universal Saliva Kit
0.5 mL of saliva collected in Salivette™ Cortisol with BLUE screw-cap
Minimum Volume
0.2 mL
Acceptable
Super SAL™ or Super SAL2™ Universal Saliva Kit
Transport Temperature
Refrigerated.
Specimen Stability
Room temperature: 3 days; Refrigerated: 21 days; Frozen: 6 months
Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
Hemolysis; White-top Salivette ™ collection device Saliva
Methodology
Chromatography/Mass spectrometry
Setup Schedule
Sunday - Tuesday, Thursday - Friday
Report Available
2-6 days (From receipt at performing laboratory)
Limitations
This test was developed and its analytical performance characteristics have been determined by Quest Diagnostics. It has not been cleared or approved by FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.
Reference Range
8-10 AM 0.04-0.56 mcg/dL
Noon-2 PM less than or equal to 0.21 mcg/dL
4-6 PM less than or equal to 0.15 mcg/dL
10 PM-1 AM less than or equal to 0.09 mcg/dL
Noon-2 PM less than or equal to 0.21 mcg/dL
4-6 PM less than or equal to 0.15 mcg/dL
10 PM-1 AM less than or equal to 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.
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
