Lab Test

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Cortisol, LC/MS, Saliva

Compound F, Hydrocortisone

Test Codes

EPIC: LAB1232015, Beaker: Cortisol Sal, Quest: 19897

Department

Send Outs

Instructions

  • A special collection kit must be obtained from Send Outs Laboratory, 248-551-9045, or Outreach Client Services, 248-551-1155.
  • 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.

Specimen Collection Criteria

Collect: 0.5 mL saliva collected in a Salivette® Cortisol with blue screw-cap.

  • Remove the swab from the Salivette®.
  • 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.
  • Return the swab with the absorbed saliva to the Salivette®.
  • Replace the stopper.
  • Refrigerate the Salivette® immediately.

Physician Office/Draw Specimen Preparation

Maintain specimen refrigerated at (2-8°C or 36-46°F) prior to transport.

Preparation for Courier Transport

Transport: Provided swab, refrigerated at (2-8°C or 36-46°F).

Rejection Criteria

Specimens not collected and processed as indicated.

In-Lab Processing

Transport: Provided swab, refrigerated at (2-8°C or 36-46°F).

Laboratory

Sent to Quest Diagnostics, Wood Dale, IL.

Performed

Sunday, Tuesday, Thursday, Friday.
Results available in 2-6 days.

Reference Range

8-10 AM 0.04-0.56 mcg/dL
Noon-2 PM ≤0.21 mcg/dL
4-6 PM ≤0.15 mcg/dL
10 PM-1 AM ≤0.09 mcg/dL

Test Methodology

Chromatography/Mass Spectrometry

Clinical Utility

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.

CPT Codes

82530
LOINC:  2398-6

Contacts

Last Updated

12/17/2025

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