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. Author manuscript; available in PMC: 2015 Apr 1.
Published in final edited form as: Compr Physiol. 2014 Apr;4(2):739–769. doi: 10.1002/cphy.c130035

Figure 3.

Figure 3

The use of late-night salivary cortisol (LNSC) for screening patients with suspected Cushing’s syndrome. Note that because Cushing’s syndrome is relatively rare and its phenotype very common, most patients screened will have normal LNSCs and Cushing’s syndrome will be ruled out. Conversely, most patients with true Cushing’s syndrome will have consistently increased LNSCs. Even so, the diagnosis is usually confirmed with urine free cortisol (UFC) measurements and/or the overnight low-dose dexamethasone suppression test (oDST). Occasionally, the LNSCs are discordant as shown or the samples are suspicious for contamination with over-the-counter hydrocortisone creams. In that case, measurement of cortisol and cortisone by liquid chromatography/tandem mass spectrometry (LC-MS/MS) will resolve the problem. Adapted from (211) with kind permission from Springer.