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Salivary hormone testing again shown to gold standard.  This study looked at salivary cortisol levels in those with Cushing's disease, Cushing's syndrome, and with adrenal incidentaloma.   The results make one scratch their head.  The sensitivity and specificities of salivary cortisol were very high, exceeding at least 94% with most > 96 and 97%.  So, why the opposition?  Ignorance I guess.

Saliva is "most useful" for those suspected of Cushing's syndrome and those followed after surgery for Cushing's disease.

LC-MS/MS shown to be reliable in salivary cortisol evaluation.  Obese individuals create special challenges with regards to coritsol levels, due to peripheral cortisol to cortisone conversion.   This study points out that saliva should not be used solely in the diagnosis of Cushing's syndrome due to unreferenced norms.   That however, doesn't nullify salivary cortisol.  It requires a look at the references.  for those that are obese and being evaluated for cushing's.  There is no perfect test.  T This study is a little misleading in its conclusion.  Salivary testing is valid, but the reference ranges in the obese with suspected cushing's syndrome needs further evaluation: according to these authors.

good review of Cushing's syndrome and Cushing's disease

salivary cortisol shown to be good test to evaluate suspected Cushing's Syndrome.  Has high reproducibility and diagnostic performance.  

salivary cortisol is shown to be reliable for both Addison's and Cushing's Syndrome

this study showed salivary cortisol to be an "excellent" means to evaluate both those with adrenal disease and adrenal dysfunction.  Salivary test is a good tool to evaluate the free active cortisol.

Endocrine society clinical  practice guideline's state proves validity of salivary cortisol testing.  Statement: "the diagnostic sensitivity and specificity is said to be excellent (92-100%)" and " Measurement of salivary cortisol by ELISA and LC-MS/MS has been well validated in the United States"

Advantage of salivary cortisol measurements in the diagnosis of glucocorticoid related disorders.