The clinical applications of salivary cortisol measurements were evaluated by radioimmunoassay of time-matched saliva and plasma samples. Salivary cortisol levels of normal subjects exhibited a significant (p less than 0.001) diurnal variation with a mean (+/- SD) concentration of 8.7 +/- 4.8 nmol/L at 0800-1000 h and 2.4 +/- 1.1 nmol/l at 1500-1700 h. After an overnight dexamethasone suppression test, morning salivary cortisol levels decrease to 2.7 +/- 0.7 nmol/L (p less than 0.001 vs normal). An excellent correlation (r = 0.805) of cortisol measurements with time-matched saliva and plasma samples was obtained (y = 0.03x + 0.88, p less than 0.001, n = 91). Hypercortisolism was confirmed by raised salivary cortisols in only half of patients with elevated total plasma levels, thereby indicating that salivary cortisol measurements is a better index of adrenal status.
The concentrations of calcium, phosphate, protein and nitrite in whole unstimulated saliva, and the salivary flow rate under fasting conditions (saliva collected at least after 6 h without food and water) were compared with those under control conditions (saliva collected within 30 min to 1 h after food). The flow rate of fasting saliva was half that of control (0.098 ml/min vs 0.208 ml/min) and no significant differences in the flow rate were observed between sexes. The concentration of nitrite under fasting conditions was 50% higher than that in control saliva (p less than 0.05). The protein concentration was decreased, but not significantly, under fasting conditions. The composition of fasting saliva with regard to calcium and phosphate concentrations was comparable to that of the control. No significant variations in these components between sexes were observed under either condition.