salivary cortisol

Overview

Salivary cortisol is the fraction of the steroid hormone cortisol measured in saliva, and it is widely used as a non-invasive biomarker of hypothalamic-pituitary-adrenal (HPA) axis activity. Because salivary cortisol reflects the biologically active, unbound portion of circulating cortisol, it is commonly used in research and clinical settings to assess stress responses, adrenal function, and endocrine dysregulation.

In biomedical research, salivary cortisol is especially useful for monitoring dynamic changes over time, such as responses to acute stress, surgery, pain, exercise, or endocrine interventions. It is frequently paired with other markers of autonomic or endocrine activity, including salivary alpha-amylase, plasma hormone profiling, and targeted metabolomics, to characterize stress physiology more comprehensively.

Focus of Latest Publications

Recent publications involving salivary cortisol have focused on its use as a biomarker in cortisol-monitoring and stress-related assay development, rather than on salivary cortisol as a therapeutic target. Several studies evaluated new sensing platforms intended to measure cortisol in biological samples with greater sensitivity or practicality. These included a wearable electrochemical sweat sensor based on molecularly imprinted polymer nanoparticles and a conductive aerogel, a time-gated fluorescent aptamer system designed to suppress autofluorescence in complex matrices, and a triple-mode SERS-LFIA point-of-care platform for ultrasensitive cortisol detection. Together, these reports emphasize the need for rapid, non-invasive, and highly sensitive cortisol measurement methods.

The analytical studies generally aimed to improve detection in physiologically relevant or clinically useful settings. The time-gated aptamer sensors were reported to detect cortisol across physiologically relevant concentration ranges, with reversible responses and minute-scale temporal resolution, and were demonstrated in undiluted human serum. The wearable sweat sensor showed a wide detection range from 10 pM to 100 μM, a low detection limit, and selectivity against interfering substances, with screen-printing used to support wearable fabrication and potential mass production. The SERS-LFIA platform was presented as a point-of-care approach intended to overcome the limited sensitivity of conventional colloidal gold-based lateral flow assays for low-abundance small-molecule hormones such as cortisol.

Other recent publications addressed clinical contexts in which cortisol assessment is relevant to adrenal insufficiency and critical illness. Protocol papers described trials of hydrocortisone and fludrocortisone for critical illness-related corticosteroid insufficiency and supplemental hydrocortisone during stress in patients with prednisolone-induced adrenal insufficiency, both using biomarker-based approaches to guide or evaluate treatment. A case report of refractory hyponatremia after traumatic brain injury highlighted the diagnostic importance of reassessing adrenal function when cortisol deficiency is suspected, while another report on delayed postoperative hyponatremia after pituitary surgery examined the relationship between postoperative cortisol and sodium dynamics. Collectively, these studies show salivary cortisol being used within broader efforts to refine diagnosis, monitoring, and treatment of adrenal and stress-related disorders.

Key Publications

NEWJun HydrOcortisone and fludRocortisoNe for critical ILLness-related corticosteroid insufficiency (HORNbILL): study protocol for a multicentre randomised placebo-controlled trial. (BMJ open, 2026, PMID 42309657): "This trial aims to determine whether, through biomarker enrichment using CIRCI criteria, hydrocortisone and fludrocortisone, compared with placebo, improve organ dysfunction-free survival in critically ill patients."
NEWJun Refractory hyponatremia after traumatic brain injury unmasks adrenal insufficiency in a patient with remote steroid use. (CEN case reports, 2026, PMID 42301338): "Initiation of hydrocortisone therapy led to sustained normalization of serum sodium."
NEWJun The Limited Role of Hypocortisolism in the Development of Delayed Postoperative Hyponatremia After Pituitary Surgery. (Pituitary, 2026, PMID 42301545): "This study aimed to elucidate the relationship between postoperative cortisol and sodium dynamics, identify independent predictors of DPH and assess potential protective factors."
NEWJun Effect of supplemental hydrocortisone during stress in prednisolone-induced adrenal insufficiency: a study protocol for a multicentre, randomised, double-blinded, placebo-controlled clinical trial on health-related quality of life in patients with polymyalgia rheumatica/giant cell arteritis on low-dose prednisolone treatment (the RESCUE study). (BMJ open, 2026, PMID 42276802): "This study examines whether supplemental hydrocortisone during mild to moderate stress improves HRQoL in patients with polymyalgia rheumatica/giant cell arteritis (PMR/GCA) with adrenal insufficiency on low-dose prednisolone."
May A wearable electrochemical sensor for sweat cortisol detection based on molecularly imprinted polymer nanoparticles and cellulose nanofiber/carbon nanotube conductive aerogel. (Mikrochimica acta, 2026, PMID 42133086): "Sensitive, non-invasive detection of the steroid hormone cortisol aids in preventing chronic diseases such as depression and anxiety caused by stress."
Apr Time-Gated Fluorescent Aptamer Sensors Eliminate Autofluorescence during Continuous Molecular Detection in Complex Biological Matrices. (ACS sensors, 2026, PMID 42017428): "we present a generalizable framework for designing time-gated fluorescence aptamer switches and apply it to three clinically relevant biomarkers: glucose, lactate, and cortisol."
Mar A triple-mode SERS-LFIA platform based on Au@4-MBA@Ag core-shell nanorods for ultrasensitive point-of-care detection of cortisol. (Analytica chimica acta, 2026, PMID 42009419): "Accurate monitoring of cortisol is therefore important for both clinical assessment and disease management."
May A Rare Presentation of 17α-Hydroxylase/17,20-Lyase Deficiency in a Patient with Non-Hodgkin’s Lymphoma: A Case Report. (Journal of clinical research in pediatric endocrinology, 2026, PMID 38912718): "...causes decreased cortisol and sex steroid levels and leads to high production of adrenocorticotropic hormone."