The current epidemic of obesity presents an increasing number of patients with clinical features of Cushing's syndrome with the majority not having Cushing's syndrome. A simple, efficient and highly specific screening test is necessary to avoid large numbers of false-positive results with associated cost and anxiety. Since mild hypercortisolism is also associated with increased morbidity, false-negative results should also be avoided.
Salivary cortisol has been identified as a less Invasive and convenient test that offers an equivalent performance to the current invasive and less convenient conventional tests. There is a considerable body of evidence to support the use of salivary cortisol as a routine screening diagnostic test for Cushing's syndrome.