Diagnostic Accuracy Study of Morning Salivary Cortisone for Screening Adrenal Insufficiency in a Real-World Cohort.

Authors

Constantinos Televantos, Phillip J Monaghan, Maria Michaelidou, Lillian Ruiheng Chen, Mohammed Ahmed, Jan Hoong Ho, Shaishav Dhage, Claire Higham, Brian Keevil, Safwaan Adam

Published in

The Journal of clinical endocrinology and metabolism. Sep 29, 2026. Epub Sep 29, 2026.

Abstract

Morning serum cortisol is used to screen for adrenal insufficiency, but requires venepuncture, early morning clinic attendance, and may be affected by altered corticosteroid-binding globulin (CBG) levels. Salivary cortisone is a non-invasive, home-based alternative.
To assess the diagnostic accuracy of morning salivary cortisone for screening adrenal insufficiency and establish clinically relevant thresholds.
Retrospective cross-sectional diagnostic accuracy study (2017 to 2024).
Single tertiary oncology and endocrinology center in the United Kingdom.
Consecutive patients undergoing adrenocorticotropin hormone (ACTH) stimulation test for suspected adrenal insufficiency.
Salivary sampling for cortisone and cortisol.
Sensitivity and specificity of baseline salivary cortisone.
A total of 517 ACTH stimulation tests in 449 participants were included; adrenal insufficiency was confirmed in 104 tests (20.1%). Baseline salivary cortisone accurately predicted adrenal insufficiency (area under the receiver operating characteristic curve [AUC] 0.93, 95% CI [0.91-0.95]), similar to serum cortisol (0.93, 0.90-0.95; p = 0.67) and superior to salivary cortisol (0.87, 0.82-0.91; p = 0.00063). A baseline salivary cortisone rule-out threshold ≥703 ng/dL (19.5 nmol/L) (sensitivity 0.97 [95% CI 0.92-0.99]; specificity 0.59 [0.54-0.63]) and a rule-in threshold <180 ng/dL (5.0 nmol/L) (sensitivity 0.58 [0.48-0.67]; specificity 0.97 [0.95-0.98]) provided the highest net benefit. An intermediate threshold <389 ng/dL (10.8 nmol/L) (sensitivity 0.83 [0.74-0.89]; specificity 0.87 [0.83-0.90]) identified patients for whom glucocorticoid cover should be considered while awaiting confirmatory testing.
Baseline morning salivary cortisone performs at least as well as serum cortisol for adrenal insufficiency screening.

PMID:
42806822
Bibliographic data and abstract were imported from PubMed on 29 Sep 2026.

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