Test Catalog

Test Id : SALCT

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Cortisol, Saliva

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Overview

Test Catalog

Useful For
Suggests clinical disorders or settings where the test may be helpful

Screening for Cushing syndrome

 

Diagnosis of Cushing syndrome in patients presenting with symptoms or signs suggestive of the disease

Method Name
A short description of the method used to perform the test

Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Cortisol, Saliva

Aliases
Lists additional common names for a test, as an aid in searching

Nighttime Salivary Cortisol

Salivary Cortisol

Salivary Cushings

Salivary Hydrocortisone

Specimen Type
Describes the specimen type validated for testing

Saliva

Necessary Information

Collection time is required.

ORDER QUESTIONS AND ANSWERS

Question ID Description Answers
COLT3 Collection Time in Military Time

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Patient Preparation:

1. Do not brush teeth before collecting specimen.

2. Do not eat or drink for 15 minutes prior to specimen collection.

Supplies: Cortisol, Saliva Collection Kit (T514)

Container/Tube: SARSTEDT Salivette

Specimen Volume: 1.5 mL

Collection Instructions:

1. Provide patient with a Saliva Collection Kit (Salivette) containing the Cortisol - Saliva Collection Instructions and ask them to follow the instructions as written.

2. Instruct patient to collect specimen between 11 p.m. and midnight and record collection time on the Cortisol - Saliva Collection Instructions sheet.

3. Instruct patient to return Cortisol - Saliva Collection Instructions with the appropriately labeled Salivette to the laboratory.

Additional Information:

1. Reference values are also available for an 8 a.m. (7 a.m.-9 a.m.) or a 4 p.m. (3 p.m.-5 p.m.) collection, however, the 11 p.m. to midnight collection is preferred.

2. If multiple specimens are collected, submit each vial under a separate order.

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Forms

If not ordering electronically, complete, print, and send General Request (T239)

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.

0.6 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

  All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Saliva Refrigerated (preferred) 28 days
Frozen 60 days
Ambient 28 days

Useful For
Suggests clinical disorders or settings where the test may be helpful

Screening for Cushing syndrome

 

Diagnosis of Cushing syndrome in patients presenting with symptoms or signs suggestive of the disease

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Cortisol levels are regulated by corticotropin (previously adrenocorticotropic hormone: ACTH), which is synthesized by the pituitary in response to corticotropin-releasing hormone (CRH). Cushing syndrome results from overproduction of glucocorticoids because of either primary adrenal disease (adenoma, carcinoma, or nodular hyperplasia) or an excess of ACTH (from a pituitary tumor or an ectopic source). ACTH-dependent Cushing syndrome due to a pituitary corticotroph adenoma is the most frequently diagnosed subtype; commonly seen in women in the third through fifth decades of life.

 

Corticotropin-releasing hormone is released in a cyclic fashion by the hypothalamus, resulting in diurnal peaks (elevated in the morning) and troughs (low in the evening) for plasma ACTH and cortisol levels. The diurnal variation is lost in patients with Cushing syndrome and these patients have elevated levels of evening plasma cortisol. The measurement of late-night salivary cortisol is an effective and convenient screening test for Cushing syndrome.(1) In a recent study from the National Institute of Health, nighttime salivary cortisol measurement was superior to plasma and urine free cortisol assessments in detecting patients with mild Cushing syndrome.(2) The sensitivity of nighttime salivary cortisol measurements remained superior to all other measures. The distinction between Cushing syndrome and pseudo-Cushing states is most difficult in the setting of mild-to-moderate hypercortisolism. Subtle increases in salivary cortisol collected at midnight (cortisol of nadir) appear to be one of the earliest abnormalities in Cushing syndrome.

Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

7 a.m.-9 a.m.: 100-750 ng/dL

3 p.m.-5 p.m.: <401 ng/dL

11 p.m.-midnight: <100 ng/dL

Interpretation
Provides information to assist in interpretation of the test results

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 syndrome. It is standard practice to confirm elevated results at least once. This can be done by repeat late-night salivary cortisol measurements, midnight blood sampling for cortisol (CORT / Cortisol, Serum), 24-hour urinary free cortisol collection (CORTU / Cortisol, Free, 24 Hour, Urine), or overnight dexamethasone suppression testing. 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.

Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

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.

Supportive Data

Using this assay, it was determined that late-night salivary cortisol is in the range of 100 ng/mL to 6000 ng/dL (2.76-166 nmol/L) for clinically confirmed Cushing patients (N=11).

 

Normal values are based on 36 donors (ages 0-8 years), 46 donors (ages 9-17 years), and 102 donors (age >17 years).

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Raff H, Raff JL, Findling JW. Late-night salivary cortisol as a screening test for Cushing's syndrome. J Clin Endocrinol Metab. 1998;83:2681-2686

2. Papanicolaou DA, Mullen N, Kyrou I, Nieman LK. Nighttime salivary cortisol: a useful test for the diagnosis of Cushing's syndrome. J Clin Endocrinol Metab. 2002;87:4515-4521

3. Lin CL, Wu TJ, Machacek DA, Jiang NS, Kao PC. Urinary free cortisol and cortisone determined by High Performance Liquid Chromatography in the Diagnosis of Cushing’s Syndrome. J Clin Endo Metab. 1997;82:151-155

4. Mohamed RS, Abuelgasim B, Barker S, et al. Late-night salivary cortisol and cortisone should be the initial screening test for Cushing's syndrome. Endocr Connect. 2022;11(7):e220050. doi:10.1530/EC-22-0050

Method Description
Describes how the test is performed and provides a method-specific reference

Isotopically labeled cortisol and cortisone are added to the sample as internal standards. Cortisol, cortisone, and coinciding internal standards are extracted from the specimens using online turbulent flow chromatography, which is followed by liquid chromatography tandem mass spectrometry analysis. Although cortisone is not reported, it is used to verify the cortisol value and screen for possible contamination from exogenous sources.(Unpublished Mayo method)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Friday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

2 to 5 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

2 weeks

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees :
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their account representative. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

82533

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
SALCT Cortisol, Saliva 2142-8
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
84225 Cortisol, Saliva 2142-8
23612 AM Cortisol 58674-3
23613 PM Cortisol 58668-5
23614 Midnight Cortisol 58642-0

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports