Waking salivary cortisone vs the short synacthen test in screening for adrenocortical insufficiency: results of a service evaluation: evaluation of the relation of waking salivary cortisone to a 30/60minute SST

Adrian Heald; Mathilde Mordaunt; Waseem Majeed; Adam Robinson; Akheel Syed; Mike Stedman; Fahmy Hanna; Brian Keevil; Anthony Fryer

doi:10.1530/endoabs.109.OP3.1

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Endocrine Abstracts (2025) 109 OP3.1 | DOI: 10.1530/endoabs.109.OP3.1

SFEBES2025 Poster Oral Presentations Adrenal and Cardiovascular (4 abstracts)

Waking salivary cortisone vs the short synacthen test in screening for adrenocortical insufficiency: results of a service evaluation: evaluation of the relation of waking salivary cortisone to a 30/60minute SST

Adrian Heald ¹ , Mathilde Mordaunt ² , Waseem Majeed ¹ , Adam Robinson ¹ , Akheel Syed ¹ , Mike Stedman ³ , Fahmy Hanna ⁴ , Brian Keevil ² & Anthony Fryer ⁵

Author affiliations

¹Salford Royal Hospital, Salford, United Kingdom; ²University of Manchester, Manchester, United Kingdom; ³Res Consortium, Andover, United Kingdom; ⁴University Hospital North Midlands, Stoke, United Kingdom; ⁵Keele University, Keele, United Kingdom

Introduction: Saliva cortisol/cortisone measurements can be applied in every day clinical practice (minimal chance of cross reaction with prescribed glucocorticoids) and are an alternative to the Short Synacthen test (SST) (92,000 done each year in England) to evaluate adrenocortical function.

Methods: A service evaluation of waking salivary cortisone vs serum cortisol in 30/60minute SST was undertaken. We retrospectively studied patients who attended the investigation unit at a tertiary centre. They provided a waking saliva sample for measurement of salivary cortisone, by tandem mass spectrometry. Waking salivary cortisone level (pass >17nmol/l;borderline 7-17nmol/l; fail<7nmol/l) was compared with 30minute+60minute serum cortisol post 250micrograms SST (pass defined as 30 or 60 minute cortisol 450nmol/l or more).

Results: Results for 24 individuals (21% men: mean age 43 years); 79%women: mean age 45.3 years) were analysed. The reason for the test was as follows: weaning off glucocorticoids-14, low serum cortisol-10, fatigue-2, hypopituitarism-2. For the SST 86% of individuals were a pass and 14% did not reach threshold (ie a ‘fail’). Everyone deemed a pass on salivary cortisone also passed the SST. Of the 14% that failed SST, none were a pass on the salivary cortisone. Of those that were borderline/fail on salivary cortisone, 60% were a pass on SST. Positive predictive value for salivary cortisone=100%, sensitivity=75% and specificity=100%. Negative predictive value=40%.


Number of Tests	Salivary Cortisone Pass	Salivary Cortisone Borderline	Salivary Cortisone Fail
SST Pass	18	4	2
SST Fail	0	2	2

Conclusion: Waking salivary cortisone did not falsely categorise anyone as having normal adrenocortical function. Of those that passed the SST 75% also passed on the basis of salivary cortisone. Waking salivary cortisone could therefore be used as an alternative 1st line screening test (cost £16) which does not require venepuncture or attendance at hospital vs SST (cost £300+).