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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.

Fantastic review of the literature as it relates to hypocortisolism. This paper reviews the various proposed pathophysiologic mechanisms for the development of hypocortisolism. It also discusses the proper diagnostic test of choice: salivary cortisol testing.