, Volume 41, Issue 3, pp 487–493 | Cite as

Reproducibility and performance of one or two samples of salivary cortisol in the diagnosis of Cushing’s syndrome using an automated immunoassay system

  • C. A. Carrasco
  • M. García
  • M. Goycoolea
  • J. Cerda
  • J. Bertherat
  • O. Padilla
  • D. Meza
  • N. Wohllk
  • T. Quiroga
Original Article


The purpose of this article is to evaluate the variability and reproducibility of late night salivary cortisol (LNSC) using electrochemiluminescence immunoassay (ECLIA) and compare the accuracy of one or two samples in diagnosis of Cushing’s syndrome (CS). We prospectively included 64 healthy volunteers (HV), 35 patients with clinically suspected CS (S), and 26 patients with confirmed CS. Nine patients in the CS group had 24-h urinary free cortisol (UFC) less than two times the upper limit of normal (mild CS). UFC and two consecutive LNSC (LNSC1, LNSC2) were collected at home. All patients in the S group had normal UFC and low-dose dexamethasone suppression test. No differences were found between the HV and S groups in UFC, LNSC1, and LNSC2. Intra-individual variability between the two samples of LNSC was 22% in HV (1.6−91%), 32% in the S group (1.6−144%), and 51% (1.6−156%) in the CS group. Variability was higher in CS patients than those in the HV (P < 0.001) and S groups (P = 0.05). The AUC of LNSC1 was 0.945 (IC 95% 0.880–1.004); when considering the highest LNSC, the AUC was 0.980 (IC 95% 0.954–1.007) (P < 0.01). We found 23% of discordant LNSC in the S group and 11% in the CS group. Three patients with CS had only one elevated LNSC, all of them with mild CS. Our results suggest that LNSC is variable, and reproducibility is affected in both CS and S patients. We found significant improvements in the diagnostic accuracy of the LNSC measurement by obtaining two samples.


Salivary cortisol Cushing’s syndrome Variability Reproducibility 

List of the abbreviations


Late night salivary cortisol


Electrochemiluminescence immunoassay


Healthy volunteers


Cushing’ syndrome


24-h urinary free cortisol


Low-dose dexametasone suppression test




Area under the curve


Liquid chromatography tandem mass spectrometry



This work was supported in part by a Fellow Research scholarship of the Pontificia Universidad Católica de Chile.

Conflict of interest

There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • C. A. Carrasco
    • 1
  • M. García
    • 1
  • M. Goycoolea
    • 2
  • J. Cerda
    • 3
  • J. Bertherat
    • 4
  • O. Padilla
    • 5
  • D. Meza
    • 1
  • N. Wohllk
    • 6
  • T. Quiroga
    • 2
  1. 1.Facultad de Medicina, Department of EndocrinologyPontificia Universidad Católica de ChileSantiagoChile
  2. 2.Facultad de Medicina, Department of Clinical LaboratoryPontificia Universidad Católica de ChileSantiagoChile
  3. 3.Facultad de Medicina, Department of Public HealthPontificia Universidad Católica de ChileSantiagoChile
  4. 4.Service des Maladies Endocriniennes et Métaboliques, Centre de Référence des Maladies Rares de la SurrénaleHôpital CochinParisFrance
  5. 5.Department of Public HealthPontificia Universidad Católica de ChileSantiagoChile
  6. 6.Department of EndocrinologyHospital del Salvador Universidad de ChileSantiagoChile

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