Cortisol
Order Code: SALCT
Epic Lab Code: LAB2929
Order Form: A-1a Miscellaneous Request or Epic Req
Commercial Mail-out Laboratory
6240 RCP
356-3527
Specimen:
Saliva
Collection Medium:
Miscellaneous container; contact laboratory
Minimum:
1.5 mL freshly collected saliva (use Salivette provided)
Delivery Instructions:
Deliver to laboratory immediately after collection.
Specimen Instructions:
1. Do not brush teeth before collecting specimen. 2. Do not eat or drink for 15 minutes prior to specimen collection. 3. Collect specimen between 11 p.m. and midnight, and record collection time. 4. To use the Salivette: A. Remove top cap of container to expose swab. B. Place swab directly into mouth by tipping container so swab falls into mouth. Do not touch swab with fingers. C. Keep swab in mouth for approximately 2 minutes. Roll swab in mouth, do not chew swab. D. Place swab back into its container without touching, and replace the cap. E. Record collection time, and send appropriately labeled Salivette to laboratory. Note: 1. 11 p.m. to midnight collection is preferred. 2. Indicate collection time. 3. If multiple specimens are collected, submit each vial under a separate order.
Analytic Time:
4 working days upon receipt at reference laboratory
Reference Range:
11 p.m.-midnight: <100 ng/dL
Interpretive Data:
Cushing syndrome is characterized by increased salivary cortisol levels, and late-night saliva cortisol measurements may be the optimum test for the diagnosis of Cushing. It is standard practice to confirm elevated results at least once. Upon confirmation of the diagnosis, the cause of hypercortisolism, adrenal versus pituitary versus ectopic adrenocorticotropic hormone production, needs to be established. This is typically a complex undertaking, requiring dynamic testing of the pituitary adrenal axis and imaging procedures. Referral to specialized centers or in-depth consultation with experts is strongly recommended.
Comments:
Cautions:
Acute stress (including hospitalization and surgery), alcoholism, depression, and many drugs (eg, exogenous glucocorticoids, anticonvulsants) can obliterate normal diurnal variation, affect response to suppression/stimulation tests, and cause elevated cortisol levels.

Cortisol levels may be increased in pregnancy and with exogenous estrogens.

Midnight salivary cortisol assay cannot diagnose hypocortisolism or Addison disease because of the limited sensitivity of the assay method.
Test Limitations:
Samples are viable for seven days at room temperature; they must be received and frozen for stability within the seven days after collection.
Methodology:
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
CPT Code:
82530
 
See Additional Information:
Specimens Requiring Immediate Delivery