A re-investigation of saliva collection procedures that highlights the risk of potential positive interference in cortisol immunoassay

Kidd, Susan; Midgley, Paula; Lone, Nazir; Wallace, Andrew M.; Nicol, M.Z.; Smith, John A.; McIntosh, Neil

doi:10.1016/j.steroids.2009.02.009

Cited by 30 publications

(29 citation statements)

References 18 publications

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“…The measurement of SC carried out after storage at room temperature was comparable with that performed pre-storage (PZ0.8). The cross-reactivity of the method with dexamethasone was !0.5% and therefore not significant (17,18,19,20).…”

Section: Sc Collection and Assaymentioning

confidence: 85%

“…The main limitation in the use of SC measured by RIA or other immunoassay method is cross-reactivity by other steroids, exogenous glucocorticoids, and endogenous cortisol precursor and metabolites (17,18,19,20). This is partly responsible for the variable cutoffs for MSC reported by various authors, so that each laboratory should identify their normal range in a large series of subjects.…”

Section: Discussionmentioning

confidence: 99%

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Usefulness of salivary cortisol in the diagnosis of hypercortisolism: comparison with serum and urinary cortisol

Manetti¹,

Rossi²,

Grasso³

et al. 2013

European Journal of Endocrinology

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Objective: Several tests have been proposed to diagnose patients with Cushing's syndrome (CS). The aims of the study were: i) to evaluate the performance of salivary cortisol (SC) in hypercortisolism and ii) to compare SC with serum cortisol (SeC) and urinary cortisol. Design and patients: This was a diagnostic study. Twenty-seven patients with untreated Cushing's disease (CD untr), 21 women consuming oral contraceptive pill (OCP), 18 pregnant women, and 89 healthy subjects (controls) were enrolled. Methods: SC and SeC at baseline and after the low-dose dexamethasone suppression test (LDDST) and urinary free cortisol (UFC) were measured. Results: Midnight SC had a sensitivity of 100% in the CD untr group and a specificity of 97.7% in the controls. Specificity remained high (95.2%) in women taking OCP, while in pregnant women, it decreased to 83.3%. SC after the LDDST showed a sensitivity of 96.3% in the CD untr group; specificity was 97.7% in the controls and 90.5% in OCP women. Midnight SeC had a sensitivity of 100% in the CD untr group. SeC after the LDDST had a sensitivity of 100% in the CD untr group while specificity was 97.7% in the controls and 61.9% in women taking OCP. For UFC, sensitivity was 92.6% in the CD untr group while specificity was 97.7% in the controls and 100% in the OCP group. Conclusions: SC is a reliable parameter for the diagnosis of severe hypercortisolism, with high sensitivity and specificity. In women during pregnancy or taking OCP, the measurement of SC, identifying the free fraction, could be helpful to exclude CS.

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Section: Sc Collection and Assaymentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Usefulness of salivary cortisol in the diagnosis of hypercortisolism: comparison with serum and urinary cortisol

Manetti¹,

Rossi²,

Grasso³

et al. 2013

European Journal of Endocrinology

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“…In terms of the method of saliva collection, the use of salivette devices results in lower cortisol concentrations than those collected from passive expectoration, but are better correlated with total cortisol and FC levels [60,61]. Furthermore, since salivary glands express 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) [62], it is theoretically possible that liquorice or chewing tobacco (both of which contain the inhibitor glycyrrhizic acid, an inhibitor of 11β-HSD2) may have produced a falsely elevated NSC.…”

Section: Pitfalls In Salivary Cortisol Assessmentmentioning

confidence: 99%

Novel Insights in the Diagnosis of Cushing’s Syndrome

Alexandraki

Grossman

2010

Neuroendocrinology

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Cushing’s syndrome (CS) results from sustained pathologic hypercortisolism. Increased identification of cyclical CS and the similarities between the metabolic syndrome and mild CS has resulted in an increased prevalence of CS, necessitating more accurate diagnostic tests to screen and diagnose CS in its earliest stages. Many studies have examined the utility of resistance to steroid feedback by the dexamethasone suppression tests and increases in secretion assessing 24-hour urinary free cortisol; however, the most sensitive indicator is the loss of circadian rhythmicity. Therefore, midnight sleeping cortisol is undoubtedly an extremely sensitive indicator of CS but impractical for screening purposes. In this situation assessment late-night salivary cortisol (NSC) is being increasingly investigated as a simple and convenient outpatient procedure. Salivary cortisol has also been used in stimulation or suppression tests because of the detection of rapid changes in cortisol concentration. This paper discusses the effectiveness of SC as a putative accurate, stress-free, and non-invasive sampling procedure. Some studies have shown no difference between tests while others demonstrated a higher sensitivity of SC, while the combination of tests seems to increase their diagnostic value. However, the different assays used for SC estimation and the variable types of control groups in the published studies render a comparison of studies difficult. In conclusion, NSC measurement is increasingly being used as a first-line test for CS, but we recommend that local centres establish their own normative ranges, and there is still a place for the more traditional tests to confirm the diagnosis.

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“…This indicated that different absorbent devices are not equally robust to interference. Kidd et al [30] also reported variable and significant over-estimation of cortisol in saliva collected using cotton and polyester swabs when compared to that of plain saliva.…”

Section: Introductionmentioning

confidence: 98%

Comparison of Saliva Collection Methods in Children with High-Functioning Autism Spectrum Disorders: Acceptability and Recovery of Cortisol

Putnam

Lopata

Fox

et al. 2012

Child Psychiatry Hum Dev

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This study compared cortisol concentrations yielded using three saliva collection methods (passive drool, salivette, and sorbette) in both in vitro and in vivo conditions, as well as method acceptability for a sample of children (n = 39) with High Functioning Autism Spectrum Disorders. No cortisol concentration differences were observed between passive and sorbette samples obtained in vitro or in vivo. The salivette derived concentration was lower than the other two methods for the in vitro derived comparisons but did not differ from the other methods when collected in vivo. Cross-day comparison for the salivettes was also found to differ significantly, whereas the cross-day comparisons did not differ for the passive method or the sorbette method. Overall, passive drool and sorbettes were found to produce similar and stable readings of cortisol, whereas the salivette yielded unstable and variable concentrations. Ratings suggested that the children generally perceived all methods as acceptable.

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A re-investigation of saliva collection procedures that highlights the risk of potential positive interference in cortisol immunoassay

Cited by 30 publications

References 18 publications

Usefulness of salivary cortisol in the diagnosis of hypercortisolism: comparison with serum and urinary cortisol

Usefulness of salivary cortisol in the diagnosis of hypercortisolism: comparison with serum and urinary cortisol

Novel Insights in the Diagnosis of Cushing’s Syndrome

Comparison of Saliva Collection Methods in Children with High-Functioning Autism Spectrum Disorders: Acceptability and Recovery of Cortisol

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