{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T03:05:29Z","timestamp":1783393529630,"version":"3.54.6"},"reference-count":22,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,3,21]],"date-time":"2025-03-21T00:00:00Z","timestamp":1742515200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Saliva hormone measurement is increasingly being applied in everyday clinical practice. In relation to salivary cortisone measurement, there is a particular advantage, with minimal chance of cross\u2010reaction with prescribed glucocorticoids and greater convenience. We evaluated the utility of salivary cortisone measurement in patients undergoing an overnight dexamethasone suppression test (ONDST).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Individuals undergoing an ONDST had parallel measurement of serum cortisol and salivary cortisone at 0900 following midnight dexamethasone (1\u2009mg). Salivary cortisone was measured by electrospray positive liquid chromatography tandem mass spectrometry. The threshold for adequate suppression of salivary cortisone was&lt;\u20092.7nmol\/L; serum cortisol was&lt;\u200950nmol\/L.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Results for 34 individuals which included 21% men (mean age 49.4 years) and 79% women (mean age 56.7 years) were analysed. Serum cortisol did not suppress in 22\/34 cases. Salivary cortisone did not suppress in two of the cases where cortisol did suppress. We found a strong correlation between 0900 salivary cortisone and serum cortisol after 1\u2009mg ONDST (<jats:italic>r<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090.65, <jats:italic>p<\/jats:italic>\u2009=\u20090.009). When performance of post\u2010dexamethasone salivary cortisone (&lt;\u20092.7nmol\/L) alone in relation to suppression of serum cortisol (&lt;\u200950nmol\/L) was analysed all but 2 individuals were correctly classified. They had values for post dexamethasone salivary cortisone\/serum cortisol of respectively 5.9\/23\u2009nmol\/L (presented with unexplained fatigue, case 25) and 7\/32\u2009nmol\/L (investigated for cyclical Cushing's Syndrome that was excluded, case 29). Agreement was 94.1%, kappa 0.87, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001. The sensitivity of salivary cortisone for potential Cushing's syndrome as indicated by the post\u2010dexamethasone 0900 serum cortisol was 100% (all cases of potential cortisol excess (0900 cortisol &gt;\u200950nmol\/L) were picked up) and specificity of 84.6% with a positive predictive value of 90.5% of salivary cortisone (using serum cortisol as the standard) and negative predictive value of 100% in relation to ruling out cortisol excess.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We have provided further evidence that ONDST salivary cortisone has potential to be the first\u2010line test for suspected Cushing's syndrome, not requiring venepuncture or attendance at hospital, with 100% sensitivity and reasonable specificity. Application of the salivary cortisone test has the potential for significant savings of money and time in this and other contexts.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.15233","type":"journal-article","created":{"date-parts":[[2025,3,23]],"date-time":"2025-03-23T09:51:13Z","timestamp":1742723473000},"page":"13-20","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Morning Salivary Cortisone Versus Serum Cortisol in the Overnight Dexamethasone Suppression Test (ODNST): Evaluation in a Clinical Setting"],"prefix":"10.1111","volume":"103","author":[{"given":"Mathilde","family":"Mordaunt","sequence":"first","affiliation":[{"name":"University of Manchester Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9537-4050","authenticated-orcid":false,"given":"Adrian","family":"Heald","sequence":"additional","affiliation":[{"name":"University of Manchester Manchester UK"},{"name":"Department of Endocrinology and Diabetes Salford Royal Hospital Salford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waseem","family":"Majeed","sequence":"additional","affiliation":[{"name":"University of Manchester Manchester UK"},{"name":"Department of Endocrinology and Diabetes Salford Royal Hospital Salford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupinder","family":"Kochhar","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes Salford Royal Hospital Salford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akheel","family":"Syed","sequence":"additional","affiliation":[{"name":"University of Manchester Manchester UK"},{"name":"Department of Endocrinology and Diabetes Salford Royal Hospital Salford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajshekhar N.","family":"Mudaliar","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes Salford Royal Hospital Salford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramadan","family":"Alshames","sequence":"additional","affiliation":[{"name":"Biochemistry Department, Faculty of Dentistry Tripoli University Tripoli Libya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahmy","family":"Hanna","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes University Hospital North Midlands Stoke on\u2010Trent UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Marshall","sequence":"additional","affiliation":[{"name":"University of Manchester Manchester UK"},{"name":"Department of Biochemistry Manchester University NHS Trust Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Keevil","sequence":"additional","affiliation":[{"name":"University of Manchester Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony A.","family":"Fryer","sequence":"additional","affiliation":[{"name":"Keele University Keele UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,21]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgad242"},{"issue":"10","key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"2449","DOI":"10.1007\/s40618-024-02354-x","article-title":"Development of Diagnostic Algorithm for Cushing's Syndrome: A Tertiary Centre Experience","volume":"47","author":"Efthymiadis A.","year":"2024","journal-title":"Journal of Endocrinological Investigation"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1210\/endrev\/bnae016"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchromb.2011.11.036"},{"issue":"12","key":"e_1_2_9_6_1","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1038\/nrendo.2010.192","article-title":"Salivary Cortisol or Cortisone?","volume":"6","author":"Raff H.","year":"2010","journal-title":"Nature Reviews Endocrinology"},{"key":"e_1_2_9_7_1","volume-title":"StatPearls [Internet]","author":"Dogra P.","year":"2024"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2015.09.001"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/jalm\/jfaa193"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/MED.0000000000000328"},{"key":"e_1_2_9_11_1","first-page":"3","article-title":"Electrospray Ionisation Mass Spectrometry: Principles and Clinical Applications","volume":"24","author":"Ho C. 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