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Also known as: Cortisol SalivaLCMSMS

Cortisol, Saliva,LC/MS/MS

*Important Information on Lab Test Processing Times: Ulta Lab Tests is committed to informing you about the processing times for your lab tests processed through Quest Diagnostics. Please note that the estimated processing time for each test, indicated in business days, is based on data from the past 30 days across the 13 Quest Diagnostics laboratories for each test. These estimates are intended to serve as a guide and are not guarantees. Factors such as laboratory workload, weather conditions, holidays, and the need for additional testing or maintenance can influence actual processing times. We aim to offer estimates to help you plan accordingly. Please understand that these times may vary, and processing times are not guaranteed. Thank you for choosing Ulta Lab Tests for your laboratory needs.

The CORTISOL, SALIVA test contains 1 test with 1 biomarker.

Brief Description: The Cortisol Saliva test is a valuable diagnostic tool that measures the levels of cortisol, a hormone produced by the adrenal glands, in the saliva. This test provides insights into the body's stress response and circadian rhythm, aiding in the assessment of various medical conditions and guiding treatment plans.

Also Known As: Cortisol Total Test, Cortisol Saliva Test, Cortisol 1 Specimen Test, 1 Specimen Cortisol Test, Cortisol Free Test

Collection Method: Saliva Collection Kit

Specimen Type: Saliva

Test Preparation: Cortisol, LC/MS/MS, Saliva Collection Kit (Instructions Below)

This test is for 1 specimen only (Single tube)

  1. Pick up the Cortisol, LC/MS/MS, Saliva Collection Kit from the Patient Service Center that is selected when placing the order.
  2. Provide the Patient Requisition to obtain your Kit

Patient Preparation

  1. 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.
  2. Do not use this kit on children under 3 years of age or any patient with increased risk of swallowing or choking.

Collection Instructions

  1. Remove the swab from the Salivette.
  2. 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.
  3. Return the swab with the absorbed saliva to the Salivette.
  4. Replace the stopper.
  5. Label the Salivette® as it is collected with the following:
    1. patient name
    2. date of birth (DOB)
    3. date and time of collection
    4. (Note: tube must be labeled as it is collected)
  6. Refrigerate the Salivette immediately

Return Collected Sample & Patient Requisition Directly to Patient Service Center

  • Return to the Patient Service Center where the test kit was obtained, within 48 hours of the specimen being first collected, the  Salivette® with the specimen collected. 
  • Important, please also include the Ulta Lab Tests Patient Requisition for the Cortisol, LC/MS/MS, Saliva, sample when returning the specimen.

Storage instructions

Specimen should be stored at refrigerated temperature prior to returning to the Patient Service Center . Return specimen within 48hrs of collection.

When is a Cortisol Saliva test ordered?

When a person has symptoms that point to a high level of cortisol and Cushing syndrome, a cortisol test may be recommended.

Women with irregular menstrual periods and increased facial hair may be tested, and children with delayed development and small stature may also be tested.

When someone exhibits symptoms that point to a low cortisol level, adrenal insufficiency, or Addison disease, this test may be ordered.

What does a Cortisol Saliva test check for?

Cortisol is a hormone that plays a function in protein, lipid, and carbohydrate metabolism. It has an effect on blood glucose levels, blood pressure, and immune system regulation. Only a small fraction of cortisol in the blood is "free" and biologically active; the majority is attached to a protein. Cortisol is a hormone that is produced into the urine and found in the saliva. This test determines how much cortisol is present in the blood, urine, or saliva.

Cortisol levels in the blood usually rise and fall in a pattern known as "diurnal variation." It reaches its highest point early in the morning, then gradually decreases over the day, reaching its lowest point around midnight. When a person works irregular shifts and sleeps at different times of the day, this rhythm might fluctuate, and it can be disrupted when a disease or condition inhibits or stimulates cortisol production.

The adrenal glands, two triangle organs that sit on top of the kidneys, generate and emit cortisol. The hypothalamus in the brain and the pituitary gland, a small organ below the brain, control the hormone's production. The hypothalamus produces corticotropin-releasing hormone when blood cortisol levels drop, which tells the pituitary gland to create ACTH. The adrenal glands are stimulated by ACTH to generate and release cortisol. The brain, pituitary, and adrenal glands must all be operating properly in order to produce enough levels of cortisol.

Cushing syndrome is a collection of signs and symptoms associated with an unusually high cortisol level. Cortisol production may be increased as a result of:

  • Large doses of glucocorticosteroid hormones are given to treat a range of ailments, including autoimmune illness and certain cancers.
  • Tumors that produce ACTH in the pituitary gland and/or other regions of the body.
  • Cortisol production by the adrenal glands is increased as a result of a tumor or abnormal expansion of adrenal tissues.

Rarely, CRH-producing malignancies in various regions of the body.

Cortisol production may be reduced as a result of:

  • Secondary adrenal insufficiency is caused by an underactive pituitary gland or a pituitary gland tumor that prevents ACTH production.
  • Primary adrenal insufficiency, often known as Addison disease, is characterized by underactive or injured adrenal glands that limit cortisol production.

After quitting glucocorticosteroid hormone medication, especially if it was abruptly stopped after a long time of use.

Lab tests often ordered with a Cortisol Saliva test:

When a Cortisol Saliva test is ordered, it's often part of a broader evaluation of adrenal gland function and hormonal balance. Here are some tests commonly ordered alongside it:

  1. 24-Hour Urinary Free Cortisol:

    • Purpose: To measure cortisol excretion in urine over a 24-hour period.
    • Why Is It Ordered: To assess cortisol production over an extended period. It's particularly useful in diagnosing Cushing's syndrome.
  2. ACTH (Adrenocorticotropic Hormone) Test:

    • Purpose: To measure the level of ACTH, a hormone produced by the pituitary gland that stimulates the adrenal glands to release cortisol.
    • Why Is It Ordered: To determine whether abnormal cortisol levels are due to a problem with the adrenal glands or the pituitary gland.
  3. Dexamethasone Suppression Test:

    • Purpose: To assess the ability of dexamethasone (a synthetic glucocorticoid) to suppress cortisol production.
    • Why Is It Ordered: To help diagnose Cushing's syndrome and differentiate between various causes of excess cortisol production.
  4. Blood Serum Cortisol Test:

    • Purpose: To measure the level of cortisol in the blood.
    • Why Is It Ordered: To provide additional information on cortisol levels throughout the day and to complement the findings of the saliva test.
  5. Renin and Aldosterone Tests:

    • Purpose: To measure levels of renin and aldosterone, hormones involved in blood pressure regulation.
    • Why Is It Ordered: To assess for conditions like Addison’s disease or other forms of adrenal insufficiency, where aldosterone production can also be affected.
  6. Electrolyte Panel:

    • Purpose: To measure key electrolytes in the blood.
    • Why Is It Ordered: To evaluate for electrolyte imbalances that can occur with adrenal disorders, such as hypernatremia or hyperkalemia.
  7. Complete Blood Count (CBC):

    • Purpose: To evaluate overall blood health.
    • Why Is It Ordered: To check for signs of infection or other hematological conditions that might affect adrenal function.
  8. Thyroid Function Test:

    • Purpose: To assess thyroid function.
    • Why Is It Ordered: Because thyroid and adrenal disorders can sometimes coexist or have similar symptoms.

These tests, when ordered alongside a Cortisol Saliva test, provide a comprehensive evaluation of adrenal gland function and can help in diagnosing conditions like Cushing's syndrome or Addison’s disease. They are crucial for understanding the underlying cause of cortisol abnormalities and for guiding appropriate treatment. The specific combination of tests will depend on the individual’s symptoms, clinical presentation, and medical history.

Conditions where Cortisol Saliva test is recommended:

The Cortisol Saliva test is ordered to assess and diagnose various conditions, including:

  • Cushing's Syndrome: This disorder is characterized by excessive cortisol production, leading to symptoms such as weight gain, high blood pressure, and diabetes.

  • Adrenal Insufficiency: Also known as Addison's disease, this condition involves inadequate cortisol production, causing fatigue, muscle weakness, and low blood pressure.

  • Stress-Related Conditions: The test can help assess the impact of chronic stress on cortisol levels, aiding in the management of stress-related disorders.

How does my health care provider use a Cortisol Saliva test?

A cortisol test can be used to detect Cushing syndrome, which is characterized by an excess of cortisol, as well as adrenal insufficiency or Addison disease, which are characterized by a deficiency of cortisol. Cortisol is a hormone that regulates protein, lipid, and carbohydrate metabolism, among other functions. Cortisol levels in the blood normally increase and fall in a "diurnal variation" pattern, rising early in the morning, dropping during the day, and reaching their lowest point around midnight.

The adrenal glands generate and excrete cortisol. The hypothalamus in the brain and the pituitary gland, a small organ below the brain, control the hormone's production. The hypothalamus produces corticotropin-releasing hormone when blood cortisol levels drop, which tells the pituitary gland to create ACTH. The adrenal glands are stimulated by ACTH to generate and release cortisol. The brain, pituitary, and adrenal glands must all be operating properly in order to produce enough levels of cortisol.

Only a small fraction of cortisol in the blood is "free" and biologically active; the majority is attached to a protein. Blood cortisol testing assesses both protein-bound and free cortisol, but urine and saliva cortisol testing assesses only free cortisol, which should be in line with blood cortisol levels. Multiple blood and/or saliva cortisol levels collected at various times, such as 8 a.m. and 4 p.m., can be used to assess cortisol levels and diurnal variation. A 24-hour urine cortisol sample will not reveal diurnal variations; instead, it will assess the total quantity of unbound cortisol voided over the course of 24 hours.

If an elevated amount of cortisol is found, a health professional will conduct additional tests to confirm the results and discover the cause.

If a person's blood cortisol level is abnormally high, a doctor may order additional tests to be sure the high cortisol is indeed abnormal. Additional testing could involve monitoring 24-hour urinary cortisol, doing an overnight dexamethasone suppression test, and/or obtaining a salivary sample before sleep to detect cortisol at its lowest level. Urinary cortisol testing necessitates collecting urine over a set length of time, usually 24 hours. Because ACTH is released in pulses by the pituitary gland, this test can assist evaluate whether a raised blood cortisol level is a true rise.

An ACTH stimulation test may be ordered if a health practitioner feels that the adrenal glands are not releasing enough cortisol or if initial blood tests reveal insufficient cortisol production.

ACTH stimulation is a test that measures the amount of cortisol in a person's blood before and after a synthetic ACTH injection. Cortisol levels will rise in response to ACTH stimulation if the adrenal glands are functioning normally. Cortisol levels will be low if they are damaged or not working properly. To distinguish between adrenal and pituitary insufficiency, a lengthier variant of this test can be used.

What do my Cortisol test results mean?

Cortisol levels are typically lowest before bedtime and highest shortly after awakening, though this pattern can be disrupted if a person works rotating shifts and sleeps at various times on separate days.

Excess cortisol and Cushing syndrome are indicated by an increased or normal cortisol level shortly after awakening, as well as a level that does not diminish by bedtime. If the excess cortisol is not suppressed after an overnight dexamethasone suppression test, the 24-hour urine cortisol is elevated, or the late-night salivary cortisol level is elevated, the excess cortisol is likely due to abnormal increased ACTH production by the pituitary or a tumor outside of the pituitary, or abnormal production by the adrenal glands. Additional tests will aid in determining the root of the problem.

If the person examined responds to an ACTH stimulation test and has insufficient cortisol, the problem is most likely due to insufficient ACTH production by the pituitary. If the person does not respond to the ACTH stimulation test, the problem is most likely to be with the adrenal glands. Secondary adrenal insufficiency occurs when the adrenal glands are underactive as a result of pituitary dysfunction and/or insufficient ACTH synthesis. Adrenal injury causes decreased cortisol production, which is referred to as primary adrenal insufficiency or Addison disease.

Once an irregularity has been found and linked to the pituitary gland, adrenal glands, or another source, the health practitioner may utilize additional testing, such as a CT scan, to determine the extent of any gland damage.

Most Common Questions About the Cortisol Saliva test:

Purpose and Applications

Why is the Cortisol Saliva test ordered?

The Cortisol Saliva test is primarily ordered to evaluate the cortisol levels in the body, specifically the adrenal function. It helps in diagnosing conditions such as Cushing's disease, Addison's disease, and other disorders related to the adrenal gland.

Who might need the Cortisol Saliva test?

Individuals who display symptoms of adrenal gland disorders, like unexplained weight changes, muscle weakness, fatigue, or skin changes, might be recommended to undergo this test. The test is also useful for those undergoing evaluation for adrenal tumors or nodules.

Clinical Significance

What do abnormal results indicate in the Cortisol Saliva test?

High cortisol levels in the saliva might indicate conditions like Cushing's disease, stress, or tumors in the adrenal or pituitary gland. On the other hand, low cortisol levels can suggest Addison's disease, adrenal insufficiency, or pituitary gland dysfunction.

How does the Cortisol Saliva test compare to blood or urine cortisol tests?

The Cortisol Saliva test has the advantage of being non-invasive and can be collected multiple times during the day to assess cortisol's diurnal variation. While blood tests measure total cortisol, saliva tests measure the free, biologically active fraction. Urine tests evaluate the cumulative cortisol excretion over 24 hours.


How is the diurnal variation considered in interpreting the Cortisol Saliva test results?

Cortisol secretion follows a diurnal pattern, being highest in the morning and tapering off through the day. Therefore, multiple samples may be collected at specified intervals, typically upon waking, noon, evening, and bedtime. The results need to be interpreted considering the time of sample collection.

Clinical Limitations

Are there conditions or factors that might influence the results of the Cortisol Saliva test?

Yes, stress, physical exertion, illness, certain medications, and even some dietary components can influence cortisol levels. It's essential to discuss any recent stresses or medications with the healthcare provider before the test.

Additional Considerations

If my Cortisol Saliva test results are abnormal, what are the next steps?

If your results are abnormal, further evaluation and tests may be needed to pinpoint the exact cause. This could include imaging tests of the adrenal or pituitary gland, additional hormone tests, or a dexamethasone suppression test. Your healthcare provider will guide you on the next steps based on your results and clinical presentation.

How can I ensure accurate results for the Cortisol Saliva test?

For accurate results, it's essential to follow the test instructions carefully. This might include avoiding specific foods or drinks, not brushing or flossing teeth shortly before the test, and ensuring a relaxed environment during the sample collection. It's also crucial to collect the sample at the specified times if multiple samples are required for assessing diurnal variation.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.

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