Abstract
I was surprised that Graham Read feels that salivary steroid assays are ‘still awaiting a killer application’ in his editorial 1 on my review. 2 The remit for the review from the ACB Clinical Sciences Reviews Committee was to provide an up-to-date guide to those assays that were suitable for a routine diagnostic service, and the criteria for assessment were chosen with this in mind.
The evidence base for the use of salivary cortisol in screening for Cushing's is now strong and extensive, and where sensitivities and specificities have been reported these are as good or better than those cited for the conventional screening tests of urine cortisol or plasma cortisol following dexamethasone suppression. Recently, the Endocrine Society has endorsed the use of evening salivary cortisol as a screen for Cushing's in their Clinical Practice Guideline. 3
This is the ‘killer application’, since there is now sufficient evidence to justify the introduction of salivary cortisol into routine use for Cushing's screening.
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