Quantitative determination of cortisol and cortisone from saliva by LC-MS/MS. Non-invasive assessment of adrenal function and HPA axis activity.
2 analytes
3–5 working days
This method provides non-invasive measurement of salivary cortisol and cortisone for evaluation of adrenal function, circadian rhythm assessment, and diagnosis of Cushing's syndrome and adrenal insufficiency.
Clinical indications include:
| Analyte / Group | Components | Clinical Significance |
|---|---|---|
| Cortisol | Hydrocortisone | Primary glucocorticoid; regulates metabolism, immune response, and stress adaptation |
| Cortisone | 11-Dehydrocortisol | Inactive metabolite of cortisol; reflects local tissue cortisol inactivation by 11β-HSD2 |
The cortisol:cortisone ratio provides additional information about 11β-hydroxysteroid dehydrogenase (11β-HSD) enzyme activity.
Cortisol is the primary glucocorticoid hormone produced by the adrenal cortex, regulated by the hypothalamic-pituitary-adrenal (HPA) axis. It follows a pronounced circadian rhythm, peaking in the early morning and reaching its nadir around midnight.
Low late-night salivary cortisol helps exclude Cushing's syndrome
Cortisol follows a predictable diurnal pattern
Saliva collection avoids venepuncture stress artefacts
Salivary cortisol measurement offers a significant advantage over serum cortisol: saliva collection is non-invasive and stress-free, avoiding the cortisol elevation that venepuncture itself can cause. Salivary cortisol reflects the free (unbound) fraction of circulating cortisol, which is the biologically active form.
Late-night salivary cortisol has become a first-line screening test for Cushing's syndrome, as the loss of normal circadian nadir is one of the earliest biochemical abnormalities in this condition.
Cortisol varies by time of day due to its diurnal (circadian) rhythm. Interpretation must always account for the time of sample collection.
| Time of Day | Serum Cortisol | SI Units (nmol/L) |
|---|---|---|
| Morning (6–8 AM) | 6–23 μg/dL | 166–635 nmol/L |
| Evening | 2–10 μg/dL | 55–276 nmol/L |
| Late night / Midnight | <5 μg/dL | <138 nmol/L |
Salivary cortisol has different reference ranges than serum cortisol. Elevated cortisol may indicate Cushing's syndrome or chronic stress. Low cortisol may indicate adrenal insufficiency.
Cortisol follows a circadian pattern — levels are highest in the early morning and lowest at midnight. Sample timing is critical for accurate interpretation.
Cortisol testing may be beneficial for individuals experiencing:
Evidence-based strategies for cortisol regulation:
Re-test cortisol after 8–12 weeks. If using salivary cortisol, a 4-point diurnal curve gives the most complete picture.
Both analytes are measured simultaneously by isotope-dilution LC-MS/MS, providing superior specificity compared to immunoassay methods. LC-MS/MS eliminates cross-reactivity with synthetic corticosteroids and other steroid metabolites that can cause false results in immunoassays.
Saliva samples are collected using a Salivette device at specified times (typically morning and late-night). The non-invasive collection method enables home sampling and is particularly valuable for paediatric patients and circadian rhythm studies.
From enquiry to results in a few simple steps — no clinic visit required.
This test is available to healthcare professionals, wellness brands, clinics, and research institutions worldwide. We currently serve partners in:
Whether you need testing services for your patients, white-label kits for your brand, or method transfer to your own laboratory — get in touch to discuss how we can work together.
This test simultaneously measures cortisol and cortisone from saliva by LC-MS/MS. The cortisol:cortisone ratio provides additional insight into 11β-HSD enzyme activity.
Salivary cortisol reflects the free (biologically active) fraction, not total cortisol. It's non-invasive, easy to collect at specific times of day, and is the recommended method for screening Cushing's syndrome.
Collect saliva into a provided tube — no eating, drinking, or brushing teeth for 30 minutes beforehand. Collection can be done at home.
Results are typically delivered within 3 to 5 working days from the time your sample arrives at our laboratory. The analysis is performed by LC-MS/MS.
Depends on the clinical question. Late-night salivary cortisol (around 11 PM) is used to screen for Cushing's syndrome. Morning cortisol assesses adrenal function. Your clinician will advise the best collection time.
Masdiag's cortisol test is available worldwide through our partner network. We currently serve healthcare professionals, wellness brands, and clinics in Europe, the United Kingdom, Asia, Australia, New Zealand, and the United States. Contact us to discuss testing services, white-label kits, or method transfer to your laboratory.
Whether you need testing services, method transfer, or white-label kit development — we'd love to hear from you.