{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T18:18:49Z","timestamp":1793470729524,"version":"4.5.0"},"reference-count":50,"publisher":"Walter de Gruyter GmbH","issue":"10","funder":[{"DOI":"10.13039\/501100002960","name":"V\u00e4sterbotten L\u00e4ns Landsting","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002960","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Private donation to Ume\u00e5 University for research on pituitary disease"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec id=\"j_cclm-2023-0141_abs_001\">\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Salivary cortisol and cortisone at late night and after dexamethasone suppression test (DST) are increasingly used for screening of Cushing\u2019s syndrome (CS). We aimed to establish reference intervals for salivary cortisol and cortisone with three liquid chromatography-tandem mass spectrometry (LC-MS\/MS) techniques and for salivary cortisol with three immunoassays (IAs), and evaluate their diagnostic accuracy for CS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_cclm-2023-0141_abs_002\">\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Salivary samples at 08:00\u00a0h, 23:00\u00a0h and 08:00\u00a0h after a 1-mg DST were collected from a reference population (n=155) and patients with CS (n=22). Sample aliquots were analyzed by three LC-MS\/MS and three IA methods. After establishing reference intervals, the upper reference limit (URL) for each method was used to calculate sensitivity and specificity for CS. Diagnostic accuracy was evaluated by comparing ROC curves.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_cclm-2023-0141_abs_003\">\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>URLs for salivary cortisol at 23:00\u00a0h were similar for the LC-MS\/MS methods (3.4\u20133.9\u00a0nmol\/L), but varied between IAs: Roche (5.8\u00a0nmol\/L), Salimetrics (4.3\u00a0nmol\/L), Cisbio (21.6\u00a0nmol\/L). Corresponding URLs after DST were 0.7\u20131.0, and 2.4, 4.0 and 5.4\u00a0nmol\/L, respectively. Salivary cortisone URLs were 13.5\u201316.6\u00a0nmol\/L at 23:00\u00a0h and 3.0\u20133.5\u00a0nmol\/L at 08:00\u00a0h after DST. All methods had ROC AUCs\u00a0\u22650.96.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_cclm-2023-0141_abs_004\">\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>We present robust reference intervals for salivary cortisol and cortisone at 08:00\u00a0h, 23:00\u00a0h and 08:00\u00a0h after DST for several clinically used methods. The similarities between LC-MS\/MS methods allows for direct comparison of absolute values. Diagnostic accuracy for CS was high for all salivary cortisol and cortisone LC-MS\/MS methods and salivary cortisol IAs evaluated.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1515\/cclm-2023-0141","type":"journal-article","created":{"date-parts":[[2023,4,4]],"date-time":"2023-04-04T05:24:43Z","timestamp":1680585883000},"page":"1780-1791","source":"Crossref","is-referenced-by-count":10,"title":["Salivary cortisol and cortisone in diagnosis of Cushing\u2019s syndrome\u00a0\u2013 a comparison of six different analytical methods"],"prefix":"10.1515","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2110-4602","authenticated-orcid":false,"given":"Nils","family":"B\u00e4cklund","sequence":"first","affiliation":[{"name":"Department of Public Health and Clinical Medicine , Ume\u00e5 University, Ume\u00e5 , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00f6ran","family":"Brattsand","sequence":"additional","affiliation":[{"name":"Department of Medical Biosciences , Ume\u00e5 University , Ume\u00e5 , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Staffan","family":"Lundstedt","sequence":"additional","affiliation":[{"name":"Department of Medical Biosciences , Ume\u00e5 University , Ume\u00e5 , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Aardal","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry , Link\u00f6ping University , Link\u00f6ping , Sweden"},{"name":"Department of Biomedical and Clinical Sciences , Link\u00f6ping University , Link\u00f6ping , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inga","family":"Bartuseviciene","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry , Karolinska University Hospital , Stockholm , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarina","family":"Berinder","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Surgery, Karolinska Institute , Karolinska University Hospital , Stockholm , Sweden"},{"name":"Department of Endocrinology , Karolinska University Hospital , Stockholm , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"H\u00f6ybye","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Surgery, Karolinska Institute , Karolinska University Hospital , Stockholm , Sweden"},{"name":"Department of Endocrinology , Karolinska University Hospital , Stockholm , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pia","family":"Burman","sequence":"additional","affiliation":[{"name":"Department of Endocrinology , Sk\u00e5ne University Hospital , Malm\u00f6 , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Britt","family":"Ed\u00e9n Engstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Endocrinology and Mineral Metabolism , Uppsala University , Uppsala , Sweden"},{"name":"Department of Endocrinology and Diabetes , Uppsala University Hospital , Uppsala , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Isaksson","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry and Pharmacology , Lund University , Lund , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Blomgren","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry and Pharmacology , Lund University , Lund , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oskar","family":"Ragnarsson","sequence":"additional","affiliation":[{"name":"Institute of Medicine, Sahlgrenska Academy , University of Gothenburg , Gothenburg , Sweden"},{"name":"Wallenberg Center for Molecular and Translational Medicine , University of Gothenburg , Gothenburg , Sweden"},{"name":"Department of Endocrinology , Sahlgrenska University Hospital , G\u00f6teborg , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrika","family":"R\u00fcetschi","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry , Sahlgrenska University Hospital , Gothenburg , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanette","family":"Wahlberg","sequence":"additional","affiliation":[{"name":"School of Medical Sciences, Faculty of Medicine and Health , \u00d6rebro University , \u00d6rebro , Sweden"},{"name":"Department of Medicine , \u00d6rebro University Hospital , \u00d6rebro , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommy","family":"Olsson","sequence":"additional","affiliation":[{"name":"Department of Public Health and Clinical Medicine , Ume\u00e5 University , Ume\u00e5 , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"Dahlqvist","sequence":"additional","affiliation":[{"name":"Department of Public Health and Clinical Medicine , Ume\u00e5 University , Ume\u00e5 , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2023,4,4]]},"reference":[{"key":"2025071623155211236_j_cclm-2023-0141_ref_001","doi-asserted-by":"crossref","unstructured":"Fleseriu, M, Auchus, R, Bancos, I, Ben-Shlomo, A, Bertherat, J, Biermasz, NR, et al.. Consensus on diagnosis and management of Cushing\u2019s disease: a guideline update. Lancet Diabetes Endocrinol 2021;9:847\u201375. https:\/\/doi.org\/10.1016\/s2213-8587(21)00235-7.","DOI":"10.1016\/S2213-8587(21)00235-7"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_002","doi-asserted-by":"crossref","unstructured":"B\u00e4cklund, N, Brattsand, G, Israelsson, M, Ragnarsson, O, Burman, P, Ed\u00e9n Engstr\u00f6m, B, et al.. Reference intervals of salivary cortisol and cortisone and their diagnostic accuracy in Cushing\u2019s syndrome. Eur J Endocrinol 2020;182:569\u201382. https:\/\/doi.org\/10.1530\/eje-19-0872.","DOI":"10.1530\/EJE-19-0872"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_003","doi-asserted-by":"crossref","unstructured":"Ueland, G\u00c5, Methlie, P, Kellmann, R, Bj\u00f8rgaas, M, \u00c5svold, BO, Thorstensen, K, et al.. Simultaneous assay of cortisol and dexamethasone improved diagnostic accuracy of the dexamethasone suppression test. Eur J Endocrinol 2017;176:705\u201313. https:\/\/doi.org\/10.1530\/eje-17-0078.","DOI":"10.1530\/EJE-17-0078"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_004","doi-asserted-by":"crossref","unstructured":"Ng, CM, Lam, TK, Au Yeung, YC, Choi, CH, Iu, YP, Shek, CC, et al.. Clinical utility of late-night and post-overnight dexamethasone suppression salivary cortisone for the investigation of Cushing\u2019s syndrome. Hong Kong Med J 2017;23:570\u20138. https:\/\/doi.org\/10.12809\/hkmj176240.","DOI":"10.12809\/hkmj176240"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_005","doi-asserted-by":"crossref","unstructured":"Manetti, L, Rossi, G, Grasso, L, Raffaelli, V, Scattina, I, Del Sarto, S, et al.. Usefulness of salivary cortisol in the diagnosis of hypercortisolism: comparison with serum and urinary cortisol. Eur J Endocrinol 2013;168:315\u201321. https:\/\/doi.org\/10.1530\/eje-12-0685.","DOI":"10.1530\/EJE-12-0685"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_006","doi-asserted-by":"crossref","unstructured":"Garde, AH, Hansen, \u00c5M, Nikolajsen, TB. An inter-laboratory comparison for determination of cortisol in saliva. Accred Qual Assur 2003;8:16\u201320. https:\/\/doi.org\/10.1007\/s00769-002-0548-x.","DOI":"10.1007\/s00769-002-0548-x"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_007","doi-asserted-by":"crossref","unstructured":"Dodd, AJ, Ducroq, DH, Neale, SM, Wise, MP, Mitchem, KL, Armston, A, et al.. The effect of serum matrix and gender on cortisol measurement by commonly used immunoassays. Ann Clin Biochem 2014;51:379\u201385. https:\/\/doi.org\/10.1177\/0004563213514567.","DOI":"10.1177\/0004563213514567"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_008","doi-asserted-by":"crossref","unstructured":"Taylor, AE, Keevil, B, Huhtaniemi, IT. Mass spectrometry and immunoassay: how to measure steroid hormones today and tomorrow. Eur J Endocrinol 2015;173:D1\u201312. https:\/\/doi.org\/10.1530\/eje-15-0338.","DOI":"10.1530\/EJE-15-0338"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_009","doi-asserted-by":"crossref","unstructured":"Raff, H, Homar, PJ, Burns, EA. Comparison of two methods for measuring salivary cortisol. Clin Chem 2002;48:207\u20138. https:\/\/doi.org\/10.1093\/clinchem\/48.1.207.","DOI":"10.1093\/clinchem\/48.1.207"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_010","doi-asserted-by":"crossref","unstructured":"Smith, RE, Maguire, JA, Stein-Oakley, AN, Sasano, H, Takahashi, K, Fukushima, K, et al.. Localization of 11\u03b2-hydroxysteroid dehydrogenase type II in human epithelial tissues. J Clin Endocrinol Metab 1996;81:3244\u20138. https:\/\/doi.org\/10.1210\/jc.81.9.3244.","DOI":"10.1210\/jcem.81.9.8784076"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_011","doi-asserted-by":"crossref","unstructured":"Bocchi, B, Fagart, J, Cluzeaud, F, Fay, M, Rafestin-Oblin, ME, Farman, N. Glucocorticoid metabolism by 11-\u03b2 hydroxysteroid dehydrogenase type 2 modulates human mineralocorticoid receptor transactivation activity. J Steroid Biochem Mol Biol 2003;84:239\u201344. https:\/\/doi.org\/10.1016\/s0960-0760(03)00036-0.","DOI":"10.1016\/S0960-0760(03)00036-0"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_012","doi-asserted-by":"crossref","unstructured":"Perogamvros, I, Owen, LJ, Newell-Price, J, Ray, DW, Trainer, PJ, Keevil, BG. Simultaneous measurement of cortisol and cortisone in human saliva using liquid chromatography-tandem mass spectrometry: application in basal and stimulated conditions. J Chromatogr, B: Anal Technol Biomed Life Sci 2009;877:3771\u20135. https:\/\/doi.org\/10.1016\/j.jchromb.2009.09.014.","DOI":"10.1016\/j.jchromb.2009.09.014"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_013","doi-asserted-by":"crossref","unstructured":"Antonelli, G, Ceccato, F, Artusi, C, Marinova, M, Plebani, M. Salivary cortisol and cortisone by LC-MS\/MS: validation, reference intervals and diagnostic accuracy in Cushing\u2019s syndrome. Clin Chim Acta 2015;451:247\u201351. https:\/\/doi.org\/10.1016\/j.cca.2015.10.004.","DOI":"10.1016\/j.cca.2015.10.004"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_014","doi-asserted-by":"crossref","unstructured":"Ray, JA, Kushnir, MM, Rockwood, AL, Meikle, AW. Analysis of cortisol, cortisone and dexamethasone in human serum using liquid chromatography tandem mass spectrometry and assessment of cortisol: cortisone ratios in patients with impaired kidney function. Clin Chim Acta 2011;412:1221\u20138. https:\/\/doi.org\/10.1016\/j.cca.2011.03.016.","DOI":"10.1016\/j.cca.2011.03.016"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_015","doi-asserted-by":"crossref","unstructured":"Raff, H. Cushing\u2019s syndrome: diagnosis and surveillance using salivary cortisol. Pituitary 2012;15:64\u201370. https:\/\/doi.org\/10.1007\/s11102-011-0333-0.","DOI":"10.1007\/s11102-011-0333-0"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_016","doi-asserted-by":"crossref","unstructured":"Ueland, G\u00c5, Kellmann, R, J\u00f8rstad Davidsen, M, Viste, K, Husebye, ES, Alm\u00e5s, B, et al.. Bedtime salivary cortisol as a screening test for Cushing syndrome in children. J Endocr Soc 2021;5:bvab033. https:\/\/doi.org\/10.1210\/jendso\/bvab033.","DOI":"10.1210\/jendso\/bvab033"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_017","doi-asserted-by":"crossref","unstructured":"Imamovic, M, B\u00e4cklund, N, Lundstedt, S, Brattsand, G, Aardal, E, Olsson, T, et al.. Confounding effects of liquorice, hydrocortisone, and blood contamination on salivary cortisol but not cortisone. Endocr Connect 2022;12:e220324. https:\/\/doi.org\/10.1530\/ec-22-0324.","DOI":"10.1530\/EC-22-0324"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_018","doi-asserted-by":"crossref","unstructured":"Debono, M, Harrison, RF, Whitaker, MJ, Eckland, D, Arlt, W, Keevil, BG, et al.. Salivary cortisone reflects cortisol exposure under physiological conditions and after hydrocortisone. J Clin Endocrinol Metab 2016;101:1469\u201377. https:\/\/doi.org\/10.1210\/jc.2015-3694.","DOI":"10.1210\/jc.2015-3694"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_019","doi-asserted-by":"crossref","unstructured":"Perogamvros, I, Keevil, BG, Ray, DW, Trainer, PJ. Salivary cortisone is a potential biomarker for serum free cortisol. J Clin Endocrinol Metab 2010;95:4951\u20138. https:\/\/doi.org\/10.1210\/jc.2010-1215.","DOI":"10.1210\/jc.2010-1215"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_020","doi-asserted-by":"crossref","unstructured":"Kot\u0142owska, A, Puzyn, T, Sworczak, K, Stepnowski, P, Szefer, P. Metabolomic biomarkers in urine of Cushing\u2019s syndrome patients. Int J Mol Sci 2017;18:294. https:\/\/doi.org\/10.3390\/ijms18020294.","DOI":"10.3390\/ijms18020294"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_021","doi-asserted-by":"crossref","unstructured":"Brossaud, J, Ducint, D, Corcuff, JB. Urinary glucocorticoid metabolites: biomarkers to classify adrenal incidentalomas? Clin Endocrinol 2016;84:236\u201343. https:\/\/doi.org\/10.1111\/cen.12717.","DOI":"10.1111\/cen.12717"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_022","doi-asserted-by":"crossref","unstructured":"El-Farhan, N, Rees, DA, Evans, C. Measuring cortisol in serum, urine and saliva: are our assays good enough? Ann Clin Biochem 2017;54:308\u201322. https:\/\/doi.org\/10.1177\/0004563216687335.","DOI":"10.1177\/0004563216687335"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_023","doi-asserted-by":"crossref","unstructured":"Gomez-Gomez, A, Miranda, J, Feixas, G, Arranz Betegon, A, Crispi, F, Gratac\u00f3s, E, et al.. Determination of the steroid profile in alternative matrices by liquid chromatography tandem mass spectrometry. J Steroid Biochem Mol Biol 2020;197:105520. https:\/\/doi.org\/10.1016\/j.jsbmb.2019.105520.","DOI":"10.1016\/j.jsbmb.2019.105520"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_024","doi-asserted-by":"crossref","unstructured":"Casals, G, Hanzu, FA. Cortisol measurements in Cushing\u2019s Syndrome: immunoassay or mass spectrometry? Ann Lab Med 2020;40:285\u201396. https:\/\/doi.org\/10.3343\/alm.2020.40.4.285.","DOI":"10.3343\/alm.2020.40.4.285"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_025","doi-asserted-by":"crossref","unstructured":"Baid, SK, Sinaii, N, Wade, M, Rubino, D, Nieman, LK. Radioimmunoassay and tandem mass spectrometry measurement of bedtime salivary cortisol levels: a comparison of assays to establish hypercortisolism. J Clin Endocrinol Metab 2007;92:3102\u20137. https:\/\/doi.org\/10.1210\/jc.2006-2861.","DOI":"10.1210\/jc.2006-2861"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_026","doi-asserted-by":"crossref","unstructured":"Beko, G, Varga, I, Glaz, E, Sereg, M, Feldman, K, Toth, M, et al.. Cutoff values of midnight salivary cortisol for the diagnosis of overt hypercortisolism are highly influenced by methods. Clin Chim Acta 2010;411:364\u20137. https:\/\/doi.org\/10.1016\/j.cca.2009.11.033.","DOI":"10.1016\/j.cca.2009.11.033"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_027","doi-asserted-by":"crossref","unstructured":"Inder, WJ, Dimeski, G, Russell, A. Measurement of salivary cortisol in 2012: laboratory techniques and clinical indications. Clin Endocrinol 2012;77:645\u201351. https:\/\/doi.org\/10.1111\/j.1365-2265.2012.04508.x.","DOI":"10.1111\/j.1365-2265.2012.04508.x"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_028","doi-asserted-by":"crossref","unstructured":"Turpeinen, U, H\u00e4m\u00e4l\u00e4inen, E. Determination of cortisol in serum, saliva and urine. Best Pract Res Clin Endocrinol Metabol 2013;27:795\u2013801. https:\/\/doi.org\/10.1016\/j.beem.2013.10.008.","DOI":"10.1016\/j.beem.2013.10.008"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_029","doi-asserted-by":"crossref","unstructured":"Petersenn, S. Biochemical diagnosis of Cushing\u2019s disease: screening and confirmatory testing. Best Pract Res Clin Endocrinol Metabol 2021;35:101519. https:\/\/doi.org\/10.1016\/j.beem.2021.101519.","DOI":"10.1016\/j.beem.2021.101519"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_030","doi-asserted-by":"crossref","unstructured":"Israelsson, M, Brattsand, R, Brattsand, G. 20\u03b1- and 20\u03b2-dihydrocortisone may interfere in LC-MS\/MS determination of cortisol in saliva and urine. Ann Clin Biochem 2018;55:341\u20137. https:\/\/doi.org\/10.1177\/0004563217724178.","DOI":"10.1177\/0004563217724178"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_031","unstructured":"Horowitz, GL, Altaie, S, Boyd, JC, Ceriotti, F, Garg, U, Horn, P, et al.. Defining, establishing, and verifying reference intervals in the clinical laboratory; approved guideline\u2013third edition. C28-A3c ed. Wayne, PA: Clinical and Laboratory Standards Institute; 2010."},{"key":"2025071623155211236_j_cclm-2023-0141_ref_032","doi-asserted-by":"crossref","unstructured":"Dixon, WJ. Processing data for outliers. Biometrics 1953;9:74\u201389. https:\/\/doi.org\/10.2307\/3001634.","DOI":"10.2307\/3001634"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_033","doi-asserted-by":"crossref","unstructured":"Sun, X, Xu, W. Fast implementation of DeLong\u2019s algorithm for comparing the areas under correlated receiver operating characteristic curves. IEEE Signal Process Lett 2014;21:1389\u201393. https:\/\/doi.org\/10.1109\/lsp.2014.2337313.","DOI":"10.1109\/LSP.2014.2337313"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_034","doi-asserted-by":"crossref","unstructured":"DeLong, ER, DeLong, DM, Clarke-Pearson, DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988;44:837\u201345. https:\/\/doi.org\/10.2307\/2531595.","DOI":"10.2307\/2531595"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_035","doi-asserted-by":"crossref","unstructured":"Erickson, D, Singh, RJ, Sathananthan, A, Vella, A, Bryant, SC. Late-night salivary cortisol for diagnosis of Cushing\u2019s syndrome by liquid chromatography\/tandem mass spectrometry assay. Clin Endocrinol 2012;76:467\u201372. https:\/\/doi.org\/10.1111\/j.1365-2265.2011.04239.x.","DOI":"10.1111\/j.1365-2265.2011.04239.x"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_036","doi-asserted-by":"crossref","unstructured":"Ceccato, F, Marcelli, G, Martino, M, Concettoni, C, Brugia, M, Trementino, L, et al.. The diagnostic accuracy of increased late night salivary cortisol for Cushing\u2019s syndrome: a real-life prospective study. J Endocrinol Invest 2019;42:327\u201335. https:\/\/doi.org\/10.1007\/s40618-018-0921-1.","DOI":"10.1007\/s40618-018-0921-1"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_037","doi-asserted-by":"crossref","unstructured":"Sturmer, LR, Dodd, D, Chao, CS, Shi, RZ. Clinical utility of an ultrasensitive late night salivary cortisol assay by tandem mass spectrometry. Steroids 2018;129:35\u201340. https:\/\/doi.org\/10.1016\/j.steroids.2017.11.014.","DOI":"10.1016\/j.steroids.2017.11.014"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_038","doi-asserted-by":"crossref","unstructured":"Ceccato, F, Boscaro, M. Cushing\u2019s syndrome: screening and diagnosis. High Blood Pres Cardiovasc Prev 2016;23:209\u201315. https:\/\/doi.org\/10.1007\/s40292-016-0153-4.","DOI":"10.1007\/s40292-016-0153-4"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_039","doi-asserted-by":"crossref","unstructured":"Roberts, RF, Roberts, WL. Performance characteristics of five automated serum cortisol immunoassays. Clin Biochem 2004;37:489\u201393. https:\/\/doi.org\/10.1016\/j.clinbiochem.2004.01.009.","DOI":"10.1016\/j.clinbiochem.2004.01.009"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_040","doi-asserted-by":"crossref","unstructured":"Brixey-McCann, R, Tennant, S, Geen, J, Armston, A, Barth, J, Keevil, B, et al.. Effect of cortisol assay bias on the overnight dexamethasone suppression test: implications for the investigation of Cushing\u2019s syndrome. Endocr Abstr 2015;38:P22. https:\/\/doi.org\/10.1530\/endoabs.38.p22.","DOI":"10.1530\/endoabs.38.P22"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_041","doi-asserted-by":"crossref","unstructured":"Laudat, MH, Cerdas, S, Fournier, C, Guiban, D, Guilhaume, B, Luton, JP. Salivary cortisol measurement: a practical approach to assess pituitary-adrenal function. J Clin Endocrinol Metab 1988;66:343\u20138. https:\/\/doi.org\/10.1210\/jcem-66-2-343.","DOI":"10.1210\/jcem-66-2-343"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_042","doi-asserted-by":"crossref","unstructured":"Berndt, V, Dahlqvist, P, de Verdier, J, Ryberg, H, Ragnarsson, O. The diagnostic value of salivary cortisol and salivary cortisone in patients with suspected hypercortisolism. Front Endocrinol 2022;13:1028804. https:\/\/doi.org\/10.3389\/fendo.2022.1028804.","DOI":"10.3389\/fendo.2022.1028804"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_043","doi-asserted-by":"crossref","unstructured":"Deutschbein, T, Broecker-Preuss, M, Flitsch, J, Jaeger, A, Althoff, R, Walz, MK, et al.. Salivary cortisol as a diagnostic tool for Cushing\u2019s syndrome and adrenal insufficiency: improved screening by an automatic immunoassay. Eur J Endocrinol 2012;166:613\u20138. https:\/\/doi.org\/10.1530\/eje-11-0945.","DOI":"10.1530\/EJE-11-0945"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_044","doi-asserted-by":"crossref","unstructured":"Raff, H, Singh, RJ. Measurement of late-night salivary cortisol and cortisone by LC-MS\/MS to assess preanalytical sample contamination with topical hydrocortisone. Clin Chem 2012;58:947\u20138. https:\/\/doi.org\/10.1373\/clinchem.2012.182717.","DOI":"10.1373\/clinchem.2012.182717"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_045","doi-asserted-by":"crossref","unstructured":"Debono, M, Elder, C, Lewis, J, Fearnside, J, Caunt, S, Dixon, S, et al.. Home waking salivary cortisone to screen for adrenal insufficiency. NEJM Evid 2022;2(2):EVIDoa2200182. https:\/\/doi.org\/10.1056\/EVIDoa2200182.","DOI":"10.1056\/EVIDoa2200182"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_046","doi-asserted-by":"crossref","unstructured":"Kannankeril, J, Carroll, T, Findling, JW, Javorsky, B, Gunsolus, IL, Phillips, J, et al.. Prospective evaluation of late-night salivary cortisol and cortisone by EIA and LC-MS\/MS in suspected Cushing syndrome. J Endocr Soc 2020;4:bvaa107. https:\/\/doi.org\/10.1210\/jendso\/bvaa107.","DOI":"10.1210\/jendso\/bvaa107"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_047","doi-asserted-by":"crossref","unstructured":"Galm, BP, Qiao, N, Klibanski, A, Biller, BMK, Tritos, NA. Accuracy of Laboratory tests for the diagnosis of Cushing syndrome. J Clin Endocrinol Metab 2020;105:dgaa105. https:\/\/doi.org\/10.1210\/clinem\/dgaa105.","DOI":"10.1210\/clinem\/dgaa105"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_048","doi-asserted-by":"crossref","unstructured":"M\u00e9sz\u00e1ros, K, Karvaly, G, M\u00e1rta, Z, Magda, B, T\u0151ke, J, Sz\u00fccs, N, et al.. Diagnostic performance of a newly developed salivary cortisol and cortisone measurement using an LC-MS\/MS method with simple and rapid sample preparation. J Endocrinol Invest 2018;41:315\u201323. https:\/\/doi.org\/10.1007\/s40618-017-0743-6.","DOI":"10.1007\/s40618-017-0743-6"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_049","doi-asserted-by":"crossref","unstructured":"Garde, AH, Hansen, AM. Long-term stability of salivary cortisol. Scand J Clin Lab Invest 2005;65:433\u20136. https:\/\/doi.org\/10.1080\/00365510510025773.","DOI":"10.1080\/00365510510025773"},{"key":"2025071623155211236_j_cclm-2023-0141_ref_050","doi-asserted-by":"crossref","unstructured":"Meyer, EJ, Nenke, MA, Rankin, W, Lewis, JG, Torpy, DJ. Corticosteroid-binding globulin: a review of basic and clinical advances. Horm Metab Res 2016;48:359\u201371. https:\/\/doi.org\/10.1055\/s-0042-108071.","DOI":"10.1055\/s-0042-108071"}],"container-title":["Clinical Chemistry and Laboratory Medicine (CCLM)"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/cclm-2023-0141\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/cclm-2023-0141\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T23:16:05Z","timestamp":1752707765000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/cclm-2023-0141\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,4]]},"references-count":50,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,4,4]]},"published-print":{"date-parts":[[2023,9,26]]}},"alternative-id":["10.1515\/cclm-2023-0141"],"URL":"https:\/\/doi.org\/10.1515\/cclm-2023-0141","relation":{},"ISSN":["1434-6621","1437-4331"],"issn-type":[{"value":"1434-6621","type":"print"},{"value":"1437-4331","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,4]]}}}