Downloaded from www.medrech.

com
The correlation between salivary and serum cortisol levels in the healthy population

Medrech

ISSN No. 2394-3971

Original Research Article

THE CORRELATION BETWEEN SALIVARY AND SERUM CORTISOL LEVELS IN
THE HEALTHY POPULATION
Blertina Dyrmishi*, Taulant Olldashi, Entela Puca, Prof asc Zamira Ylli3, Elvana Rista5,
Prof Agron Ylli3

1. Endocrinologist, department of internal medicine, Hygeia Hospital, Tirana, Albania,

2.Surgen, Hygeia Hospital, Tirana, Albania,
3. Endocrinologist, Immunologist, Head of Endocrine Department, UHC Mother Teresa, Tirana,
Albania,
4. Nephrologist, department of internal medicine, Hygeia Hospital, Tirana, Albania

Abstract:
Aim: The aim of the study was to evaluate the correlation between salivary and serum cortisol
levels in the healthy population.
Methods: 30 healthy women and men, aged from 22 to 53 years old, were included in our study.
All the participants were healthy, without any known disease. Two samples of salivary and
serum cortisol were collected from all the participants in the study, in the morning and in the
afternoon, before and after work. The mean age was 33 14 SD years old. 60% (18) were
females and 40% (12) were males. All the participants were within normal weight range, the
mean BMI was 23.5 kg/m. All the subjects followed the rules of salivary sample collection.
Results: The mean age of the healthy subjects was 33 14 years old. The mean baseline
morning cortisol level of the study population was 159.6 ng/ml (SD: 41.7; normal range 55-230
ng/ml, 8:00 AM) and the mean salivary cortisol level in the morning was 3.2 g/dL (SD: 2.4
g/dL; normal range 1-11.3 g/dL). After work, at 4:00 PM, the mean baseline serum cortisol
was 100.1 ng/ml (SD: 30.7; normal range 28-140 ng/ml) and the mean salivary cortisol level
after work was 1.21 g/dl (SD: 0.59; normal range 0.2-2.7 g/dl). Baseline salivary cortisol
correlated significantly with serum salivary cortisol before and after work; at 8:00 AM and 4:00
PM; p <0.05 in the morning and p< 0.0001 after work. The Pearsons coefficients were 0.44 in
the morning and 0.7 in the afternoon.
Conclusions: In our study we found a correlation between salivary and serum cortisol levels in
both samples, in the morning and in the afternoon. The salivary cortisol levels correlated
significantly with the serum cortisol levels (r = 0.44, p< 0.05 in the morning and r = 0.7, p
<0.00.1 in the afternoon).
Keywords: salivary cortisol, serum cortisol, correlation.

Dyrmishi B. et al., Med. Res. Chron., 2015, 3 (1), 91-96

Medico Research Chronicles, 2016

Submitted on: February 2016

Accepted on: February 2016
For Correspondence
Email ID:

91

Downloaded from www.medrech.com

Introduction:
The measuring of cortisol is a very good
diagnostic test, which is used for the
diagnosing
of
the
hypoor
hypercortisolemic conditions. But because
of the variation of the secretion of cortisole
and its circadian rhythm, in practice a single
level of cortisol measured in the serum
makes it difficult to interpretate if it is or not
a normal level, therefore there rises the need
of other diagnostic methods for the
interpretation of the serum cortisol levels.
Free cortisol in serum:
Because of the expensive and not so
diffused in practice techniques, the
measuring of the free cortisol in serum is not
used frequently in practice (1, 2, and 3). The
free cortisol in serum diffuses easily in the
saliva. The concentration of the salivary
cortisol does not depend on the afflux of the
saliva (4, 5). The measuring of salivary
cortisol is a very good non-invasive
diagnostic test. The samples from the saliva
can be collected from the individual itself at
home. The measuring of salivary cortisol is
a preferable diagnostic test in the evaluation
of the hypotalamus-pituitary axis in the
conditions of endogenous hypo- or
hyperfunction. The level of the cortisol
measured at midnight (late night salivary
cortisol) has excellent sensitivity and
specificity for diagnosing Cushing syndrome
(6, 7, and 8). Salivary cortisol corresponds
with the free cortisol in serum. Since it is
difficult to measure free cortisol in serum,
this makes the use of salivary cortisol
practicable in the clinical use. The collection
of the salivary sample is done after first
rinsing the mouth, but without using a brush
to wash the teeth. The collected saliva can
be stored for some days even in room
temperature (9). The salivary cortisol is
especially important for the ambulatory

measuring of some samples and in the

evaluation of some patient, in whom the
cyclic Cushing syndrome is suspected (10,
11, and 12).
Aim of the study:
Evaluation of the correlation in serum and
saliva in the group of the healthy individuals
included in the study.
Thirty healthy healthcare workers, at the age
range of 22-53 years old (mean age 33 years
old), 60% (18) females and 40% (12) males,
were included in the study. The participants
signed their voluntary participation in the
study and the consent of the information.
The selection of the participants in the study
was done based on the verbal request. All
the participants were informed of the study
protocol and its aim. They were free to quit
the participation in the study at any moment.
All the subjects followed the rules for the
collection of the saliva. The criteria
excluding the participation in the study
were: abusive use of alcohol, psychiatric
conditions, subjects taking medications
which interfere with cortisol metabolism,
febrile conditions in the days preceding the
collection of the samples in serum and
saliva, dental infections and the females
under treatment with oral contraceptives.
The samples of saliva and serum were
collected in the morning at 8:00 AM and in
the afternoon at 4:00 PM (before work and
after work).
At the same time of the collection of the
saliva samples there were also collected the
blood samples for measuring the serum
cortisol. After the collection of the saliva,
the samples were stored in 4 Celsius for
eight hours and then they were kept frozen
in 20 Celsius until the moment of the
analysis and then they were centrifuged for
10 minutes in 3000 rpm. The samples for the
serum cortisol were obtained from the

Dyrmishi B. et al., Med. Res. Chron., 2015, 3 (1), 91-96

Medico Research Chronicles, 2016

The correlation between salivary and serum cortisol levels in the healthy population

92

Downloaded from www.medrech.com

The correlation between salivary and serum cortisol levels in the healthy population

antecubital vein. The samples were stored in

room temperature for 20 minutes, and then
they were centrifuged for 5 minutes in 3000
rpm and were kept in 20 Celsius until the
moment of the analysis.
Materials and Methods:
30 healthy individuals (males and females)
were included in the study. The blood and
saliva samples were collected in the morning
at 8:00 AM and in the afternoon at 4:00 PM
after work. All the participants in the study
respected the rules of saliva samples
collection.
Laboratory Analyses:
Serum cortisol was measured by RIA CT
AcM and salivary cortisol was determined
by Salivary Cortisol ELISA kit.
Statistical Analyses:
The data were presented as mean (SD). The
relation between variables was expressed as
correlation
coefficients

Pearsons

coefficients. P-level < 0.05 was considered

as statistically significant.
Results:
The mean age of the healthy subjects was 33
14 years old. Mean baseline morning
cortisol level of the study population was
159.6 ng/ml (SD: 41.7 normal range 55-230
ng/ml, 08:00 AM) and mean salivary
cortisol level in the morning was 3.2 g/dL
(SD: 2.4 g/dL; normal range 1-11.3
g/dL). After work, at 04:00 PM, mean
baseline serum cortisol was 100.1 ng/ml
(SD: 30.7; normal range 28-140 ng/ml) and
mean salivary cortisol level after work was
1.21 g/dl (SD: 0.59; normal range 0.2-2.7
g/dl). Baseline salivary cortisol correlated
significantly with serum salivary cortisol
before and after work; at 08:00 AM and
04:00 PM; p <0.05 in the morning and p<
0.0001 after work. Pearsons coefficients
were 0.44 in the morning and 0.7 in the
afternoon.

Mean salivary
cortisol

Mean serum
cortisol

Pearsons
coefficient

Morning (08:00
AM)

3.2 g/dl

159.6 ng/ml

0.44

p <0.05

Afternoon
(04:00 PM)

1.21g/dl

100.1 ng/ml

0.7

p< 0.0001

Dyrmishi B. et al., Med. Res. Chron., 2015, 3 (1), 91-96

Medico Research Chronicles, 2016

Table No 1: Correlation between salivary and cortisol levels.

93

Downloaded from www.medrech.com

The correlation between salivary and serum cortisol levels in the healthy population

Medico Research Chronicles, 2016

Table No 2: Summary of participants data (1-female, 0- male).

Dyrmishi B. et al., Med. Res. Chron., 2015, 3 (1), 91-96

94

Downloaded from www.medrech.com

Discussion
In our study we compared serum and
salivary cortisol levels in the healthy
persons, our group of control. Even in
previous studies other authors have
performed in selected populations, they
compared the salivary and serum cortisol
levels and studied them even during the
stimulation test (13) or during the exercises
(14).
We found a statistically significant
correlation between salivary and serum
cortisol levels, but our study had some
limitations: We needed to perform the study
in a bigger number of participants, the
samples of salivary and serum cortisol
should have been collected even in late night
hours and there should have been collected
more samples during the day. We needed to
evaluate the salivary and serum cortisol
levels in obese people without any known
disease, since our population in the study
had normal body mass index and compare
women and men levels and difference
between women using oral contraceptive
compared
to
women
not
using
contraceptives. Also our population in the
study was of young age and we needed to
evaluate our study even in other ages, as in
children and older adults.
Conclusions:
In our study we found a correlation between
salivary and serum cortisol levels in both
samples, in the morning and in the
afternoon. The salivary cortisol levels
correlated significantly with serum cortisol
levels (r = 0.44, p< 0.05 in the morning and
r = 0.7, p <0.00.1 in the afternoon).
References:
1- Ballarg PL, Carter JP, Graham BS,
Baxter JD. A radioreceptor assay for
evaluation of the plasma glucocorticoid
activity of natyral and sintetic steroids in
man. J Clin Endorinol Metab 1975;
41(2): 290-304.

2- Amir H. Hamrahian, MD; Tawakalitu S,

et al. Measurements of serum Free
Cortisol In critically ill Patient. N Engl J
Med. 2004; 350 (4): 1629-1638.
3- Huang W, Kalhorn TF, Baillie M, et al.
Determination of free and total cortisol
in plasma and urine by liquid
Chromatography-tandem
mass
spectrometry. Ther Drug Moint 2007;
29(2) :215-224.
4- Walker RF, Riad-Famhy D, Read GF.
Adrenal status assessed by direct
radioimmunoassay of cortisol in whole
saliva or parotid saliva. Clin Chem 1978;
24 (9): 1460-1463.
5- Vining RF; McGinley RA; Symons RG.
Hormones in saliva: mode of entry and
consequent implications for clinical
interpretatio. Clin Chem. 1983; 29 (10):
1752-1756.
6- Finding JW & Ralf H. Screening and
diagnosis of Cushings syndrome.
Endocrinology and Metabolism Clinic of
North America. 2005, 34; 385-402
7- Yaneva M, Mosnier-Pudar H, Dugue
MA, Grabar S, Fulla Y & Bertagna X.
Midnight salivary cortisol for the intial
diagnosis of Cushings syndrome of
various causes. Journal of Clinical
Endocrinology and Metabolism 2004, 89
( 7): 3345-3351.
8- Castro M, Elias PC, Martinelli CE, Jr,
Antonini SR, Santiago L & Moreira AC.
Salivary cortisol as a tool for
physiological studies and diagnostic
strategies. Brazilian Journal of Medical
and Biological Research 2000; 33, 11711175.
9- Chen YM, Cintron NM, Whitson Pa.
Long-term storage of salivary cortisol
samples at room temperature. Clin Chem
1992; 38 (2):304.
10- Raff H, Homar PJ, Burn Ea. Comparison
of two methods for measuring salivary
cortisol. Clin Chem 2002: 48:207-208.

Dyrmishi B. et al., Med. Res. Chron., 2015, 3 (1), 91-96

Medico Research Chronicles, 2016

The correlation between salivary and serum cortisol levels in the healthy population

95

Downloaded from www.medrech.com

The correlation between salivary and serum cortisol levels in the healthy population

13- R.K. Schindelm and al. salivary cortisol

as an alternative for serum cortisol in the
low-dose adrenocorticotropic hormone
stimulation test. J Endocrinol. Invest
2010; 33: 92-95.
14- VanBruggen MD and al. The
relationship between serum and salivary
cprtisol levels in response to different
intensities of exercise. Int J Sports
Physiol Perform, 2011; 6 (3) : 396-407

Medico Research Chronicles, 2016

11- Mosnier-Pudar, H, Thomopoulos P,

Bertagna X, et al. Long Distance and
long term followup of a patient with
intermittent Cushing disease by salivary
cortisol measurements. Eur J Endocrinol
1995; 133:313-316.
12- Papanicolaou Da, Mullen N, Kyrou I,
Nieman LK. Nightime salivary cortisol:
a usefull test for the diagnosis of
Cushings syndrome. J Clin Endocrinol
Metab 2002; 87: 4515-4521.

Dyrmishi B. et al., Med. Res. Chron., 2015, 3 (1), 91-96

96