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Cortisol, Saliva

Cortisol measured in saliva at a set time of day. It reflects the free, active cortisol and shows how levels rise and fall across the day.

AI-verified against cited sources. Awaiting expert reviewLOINC 2142-8

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What it is

Cortisol is a hormone made by the adrenal glands. It helps the body respond to stress and keeps blood sugar and blood pressure steady. Levels are highest soon after you wake and fall through the day to their lowest point around bedtime. Saliva holds the free, active part of the cortisol in blood, and you can collect it at home with a cotton swab. Because levels change so much through the day, every result has to be read against the time it was collected. Some panels collect several samples in one day to show a daily curve.

Why it matters

Clinicians mainly use saliva cortisol at night, as one of several tests when they are looking at whether the body makes too much cortisol over a long time (Cushing syndrome). Daytime and multi-sample saliva profiles are also offered by some labs. Each lab sets its own ranges for each time of day, and different methods give different numbers. A result outside a range doesn't mean something is wrong. Stress, sleep, illness, steroid creams and collection mistakes can all move it. A clinician can put the numbers in context.

If it’s low

A result below your lab's range for the time of day means cortisol was lower than usual at that moment. A common reason is a sample collected later in the day than the range assumes, when levels are normally lower. Steroid medicines can also lower the body's own cortisol production. A low daytime saliva result can't show on its own whether the adrenal or pituitary glands make too little cortisol. Clinicians use blood tests, such as morning cortisol and ACTH, and stimulation tests for that question.

Common causes

  • A sample collected later in the day than the range assumes, when levels are normally lower
  • Taking, or recently stopping, steroid medicines, which quiet the body's own cortisol production
  • Adrenal or pituitary conditions that lower cortisol (uncommon)

What can help

  • Check that the collection time matches the range printed on your report
  • Bring a list of any steroid medicines you take or recently stopped
  • If you have ongoing weakness, tiredness, dizziness or weight loss, talk with a clinician about which tests fit

If it’s high

A result above your lab's range for the time of day means cortisol was higher than usual at that moment. This often has an everyday explanation, such as stress, poor sleep, an early or late collection time, or contamination from a steroid cream or tablet. Conditions linked to higher cortisol include depression, alcohol use disorder, obesity and polycystic ovary syndrome. Less often, high cortisol is linked to Cushing syndrome. One result can't tell these apart, so clinicians usually repeat the test or add other tests.

Common causes

  • Physical or emotional stress, short or broken sleep, illness or a hospital stay
  • A sample taken at a different time than the range assumes
  • A collection problem, such as eating, brushing teeth, mouthwash, alcohol, tobacco or bleeding gums before the sample
  • Contamination from hydrocortisone or other steroid creams, ointments, oral gels or tablets
  • Depression, alcohol use disorder, obesity or polycystic ovary syndrome
  • Pregnancy
  • Cushing syndrome (uncommon)

What can help

  • Follow the collection steps and the timing on your kit exactly
  • Tell your clinician about any cream, gel, tablet or injection that contains a steroid, and about shift work or an unusual sleep schedule
  • Ask whether the type of test (saliva, blood or 24-hour urine) and the collection times fit your question

Usual ranges

What labs print as the reference range, by who was tested. Ranges differ a little between labs, so the range on your own report is the one your result is judged against.

What can affect your result

  • Time of day: levels peak soon after waking and fall through the day, so each time has its own range
  • Stress, sleep, shift work and illness
  • Mouth contamination: food, drink, brushing, mouthwash, lip products, tobacco and bleeding gums
  • Steroid creams, gels, tablets and injections
  • Depression, alcohol use disorder, obesity and polycystic ovary syndrome
  • Pregnancy
  • Assay method: LC-MS/MS and immunoassay results and ranges differ
  • Collection steps matter: Quest asks you to wait at least 60 minutes after brushing teeth, eating or taking oral medicine, and to rinse with water 10 minutes before the sample. ARUP also asks for no alcohol for 12 hours and no mouthwash or lip products.
  • Bleeding gums can add blood to the sample and raise the result.
  • Hydrocortisone creams, ointments, oral gels and tablets, and other steroid products, can contaminate the sample or raise cortisol.
  • Smoking has been linked to higher late-night results, and licorice or chewing tobacco may raise them (Endocrine Society 2008).
  • Stress, poor sleep, shift work, illness, depression, alcohol use disorder and some medicines can change the daily cortisol curve (Mayo).
  • Immunoassays and LC-MS/MS give different numbers, so compare results from the same method.

Use the exact times on your kit, because each lab prints a different range for each time of day. Common windows are 8 to 10 a.m. (Quest), noon to 2 p.m., 4 to 6 p.m. and about 11 p.m. Some wellness panels collect 4 or 5 samples across one day, for example on waking, 30 minutes later, around noon, in the evening and at bedtime. A single sample is a snapshot of that moment. Cortisol is released in pulses and shifts with sleep, stress and meals, so one day's curve can look different from another's.

When to talk to a clinician

There is no emergency threshold for saliva cortisol, and a result outside your lab's range is not urgent on its own. Talk with the clinician who ordered it about what to do next. Let a clinician know about symptoms that can go with high cortisol, such as weight gain around the middle, easy bruising, wide purple stretch marks, new high blood pressure or high blood sugar. Seek urgent care for severe weakness, fainting, severe belly pain, vomiting or confusion, especially if you take or recently stopped steroid medicines. Call 911 or your local emergency number if you feel very unwell.

Questions you could ask

  • What times of day should I collect samples for my question?
  • Should follow-up tests use the same lab and method?
  • Could stress, my sleep, a steroid cream or medicine, or the way I collected the sample have affected this result?
  • Was my sample collected at a time that fits this range?
  • Should we repeat it or try a different type of cortisol test?
  • Was my sample collected later than the range assumes?

Questions people ask

Why does my report give a different range for each time of day?

Cortisol follows a daily rhythm. It peaks soon after you wake, falls through the day, and is lowest around bedtime. Labs print a separate range for each collection window, so the time you collected matters.

Why does another lab show very different numbers?

Labs use different methods. Mass spectrometry (LC-MS/MS) and immunoassays measure cortisol differently, and immunoassays tend to read higher. Each lab also builds its own ranges. Compare results only with the range on the same lab's report.

How do I convert the units?

Multiply µg/dL by 10 to get ng/mL, by 1,000 to get ng/dL, or by 27.6 to get nmol/L. For example, 0.2 µg/dL is 2 ng/mL, 200 ng/dL or about 5.5 nmol/L.

Show the science and sources

Units

  • 1 µg/dL = 1 µg/dL
  • 1 µg/dL = 27.59 nmol/L
  • 1 µg/dL = 10 ng/mL
  • 1 µg/dL = 1000 ng/dL

Open the Salivary cortisol unit converter

For clinicians and researchers

Salivary cortisol reflects the free (unbound) fraction in blood and is in equilibrium with it within minutes, regardless of saliva flow (Endocrine Society 2008). Serum cortisol peaks around 7-9 a.m. and falls to a nadir near midnight in people with a regular sleep-wake cycle. Reference intervals depend on collection time and method. By LC-MS/MS the morning intervals are 0.04-0.56 µg/dL at Quest (8-10 a.m.), 0.025-0.600 µg/dL at Labcorp (8 a.m.) and 0.10-0.75 µg/dL at Mayo and ARUP (7-9 a.m.) and Michigan Medicine (7-8 a.m.); the late-afternoon upper limits are 0.15-0.20 µg/dL at Quest and Labcorp and below 0.401 µg/dL at Mayo, ARUP and Michigan Medicine; and the late-night upper limit is 0.09-0.10 µg/dL. ZRT's enzyme immunoassay intervals are in ng/mL (morning 3.7-9.5, noon 1.2-3.0, evening 0.6-1.9, bedtime 0.4-1.0), and a 2020 comparison found immunoassay reading about 52% higher than LC-MS/MS for late-night samples (Ponzetto). The salivary glands express 11-beta-HSD2, which turns cortisol into cortisone, so licorice and chewing tobacco may, in theory, raise results; LC-MS/MS that also measures cortisone, as Mayo's does, can help flag contamination from topical hydrocortisone. Passive drool reads higher than Salivette cotton samples, and samples are stable for weeks at room or refrigerator temperature (Endocrine Society 2008). The guideline use of salivary cortisol is late-night sampling as one of the initial tests for Cushing syndrome (Endocrine Society 2008; 2021 consensus). Mayo notes its midnight salivary assay can't be used to evaluate low cortisol.

LOINC 2142-8 (primary), 58674-3, 58644-6, 58668-5, 51844-9. Specimen: saliva.

Sources

  1. Cortisol, LC/MS, Saliva (test code 19897), Quest Diagnostics
  2. Salivary Cortisol, LC/MS-MS (test 500179), Labcorp (Endocrine Sciences)
  3. SALCT: Cortisol, Saliva, Mayo Clinic Laboratories
  4. Cortisol by LC-MS/MS, Salivary (ARUP test 3016866), ARUP Laboratories
  5. Cortisol, Saliva (SCOR), Michigan Medicine Laboratories (MLabs)
  6. Saliva Test Specifications: Cortisol, ZRT Laboratory
  7. The Diagnosis of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline, Journal of Clinical Endocrinology & Metabolism (2008)
  8. Consensus on Diagnosis and Management of Cushing's Disease: A Guideline Update, The Lancet Diabetes & Endocrinology (2021)
  9. Reference ranges of late-night salivary cortisol and cortisone measured by LC-MS/MS and accuracy for the diagnosis of Cushing's syndrome, Journal of Endocrinological Investigation (2020)
  10. Cortisol (PubChem CID 5754), PubChem (NIH)

AI-verified against cited sources. Awaiting expert review. Last reviewed 2026-10-03. How we build and check these pages.

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