PURPOSE OF REVIEW: A resurgence of interest in salivary biomarkers has generated 
evidence for their value in assessing adrenal function. The advantages of 
salivary measurements include only free hormone is detected, samples can be 
collected during normal daily routines and stress-induced cortisol release is 
less likely to occur than during venepuncture. We review the use of salivary 
biomarkers to diagnose and monitor patients for conditions of cortisol excess 
and deficiency and discuss the value of measuring salivary cortisone versus 
salivary cortisol.
RECENT FINDINGS: Developments in laboratory techniques have enabled the 
measurement of salivary hormones with a high level of sensitivity and 
specificity. In states of altered cortisol binding, salivary biomarkers are more 
accurate measures of adrenal reserve than serum cortisol. Salivary cortisone is 
a superior marker of serum cortisol compared with salivary cortisol, 
specifically when serum cortisol is low and during hydrocortisone therapy when 
contamination of saliva may result in misleading salivary cortisol 
concentrations.
SUMMARY: Salivary cortisol and cortisone can be used to assess cortisol excess, 
deficiency and hydrocortisone replacement, with salivary cortisone having the 
advantage of detection when serum cortisol levels are low and there is no 
interference from oral hydrocortisone.