MSACL 2025 Abstract

The Growing Utility of Salivary Testing in Routine Clinical Practice

Brian Keevil, PhD (Presenter) University Hospital of South Manchester

Relevant Financial Disclosures (within past 24 months, reported on Apr 16, 2025) Other Potential Conflicts Roche / Consultant / Ended Conflict mitigation NOT REQUIRED.

BACKGROUND:
The adrenal gland secretes multiple hormones including cortisol, which is essential for survival and affects multiple organs. Abnormalities of cortisol secretion include over-secretion (hypercortisolism) or under-secretion (hypocortisolism) with a myriad of clinical presentations for both conditions.

This makes the diagnosis of adrenal disorders clinically challenging and expensive because of the need for the patient to attend hospital for testing. Cortisol dysfunction is therefore included in the differential diagnosis of many common presentations and can be assessed on its own (static testing) or as part of a stimulation or suppression test (dynamic function testing). In reality, several tests are used together to assess different aspects of the hypophyseal pituitary adrenal axis. Stimulation tests are used to assess adrenal reserve (hypocortisolism) and are designed to predict the ability of a patient to survive trauma. Historically, the main cause of adrenal insufficiency was tuberculosis or autoimmune disease; however, in the develop world use of glucocorticoid medication now predominates. Suppression tests are used to assess overt hypercortisolism (Cushing syndrome) but also mild autonomous cortisol excretion (MACE) by incidentally detected adrenal tumours. MACE is now recognised as a significant cause of cardiovascular morbidity

SUMMARY:
Serum, saliva and urine are used for static testing whilst serum samples are used for dynamic function testing. The requirement for serum samples ensures that patients must attend the hospital, which is expensive and inconvenient for the patient. Alternative strategies are therefore required to safeguard patients, improve the patient journey and also reduce costs. This presentation will focus on the strengths and weaknesses of current testing regimes and propose saliva testing as a good alternative to dynamic function testing that can be performed in the patient’s home. This approach is gaining traction in the UK and has been adopted in one major centre already.