Radioimmunoassay and Tandem Mass Spectrometry Measurement of Bedtime Salivary Cortisol Levels: A Comparison of Assays to Establish Hypercortisolism

Context: Although bedtime salivary cortisol measurement has been proposed as the optimal screening test for the diagnosis of Cushing’s syndrome, its performance using commercially available assays has not been widely evaluated. Objective: Our objective was to compare RIA and tandem mass spectrometry (LC-MS/MS) measurement of salivary cortisol in obese subjects and healthy volunteers. Design and Setting: We conducted a cross-sectional prospective study of outpatients. Subjects and Methods: We studied 261 obese subjects (186 female) with at least two additional features of Cushing’s syndrome and 60 healthy volunteers (30 female). Subjects provided split bedtime salivary samples for cortisol measurement by commercially available RIA and LC-MS/MS. Results were considered normal or abnormal based on the laboratory reference range. Subjects with abnormal results underwent evaluation for Cushing’s syndrome. Results: In paired samples, RIA gave a lower specificity than LC-MS/MS in obese subjects (86 vs. 94%, P = ...