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Marcus Imamovic Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

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Nils Bäcklund Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

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Staffan Lundstedt Department of Medical Biosciences, Umeå University, Umeå, Sweden

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Göran Brattsand Department of Medical Biosciences, Umeå University, Umeå, Sweden

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Elisabeth Aardal Department of Clinical Chemistry and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden

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Tommy Olsson Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

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Per Dahlqvist Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

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). However, salivary cortisol may be falsely elevated due to preanalytical errors including liquorice consumption and contamination with dermal hydrocortisone or blood in the saliva sample ( 11 , 12 , 13 ). Salivary cortisone might be less sensitive to

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Ramjan Sanas Mohamed Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK

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Biyaser Abuelgasim Imperial College School of Medicine, Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK

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Sally Barker Imperial College School of Medicine, Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK

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Hemanth Prabhudev Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK

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Niamh M Martin Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK

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Karim Meeran Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK

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Emma L Williams Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK

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Sarah Darch Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK

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Whitlock Matthew Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK

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Tricia Tan Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK

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Florian Wernig Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK

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-hydroxysteroid dehydrogenase (11B-HSD2) which converts salivary cortisol to cortisone. The amount of salivary cortisone is significantly greater than salivary cortisol and an increased cortisol/cortisone ratio reflects exposure to both endogenous and exogenous cortisol

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Marloes L P Langelaan Clinical Laboratory, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
Department of Clinical Chemistry and Haematology, Zuyderland Medical Centre, Heerlen, The Netherlands

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Jérôme M H Kisters Department of Internal Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands

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Mirjam M Oosterwerff Department of Internal Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands

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Arjen-Kars Boer Clinical Laboratory, Catharina Hospital Eindhoven, Eindhoven, The Netherlands

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and cortisone in one run. Possible interference of 11β-hydroxysteroid dehydrogenase-modulating agents can thus be evaluated. We investigated whether early morning salivary cortisol determined by LC–MS/MS could be used in the diagnosis of AI. In our

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Filippo Ceccato Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Padova, Italy

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Elisa Selmin Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Padova, Italy

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Chiara Sabbadin Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Padova, Italy

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Miriam Dalla Costa Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Padova, Italy

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Giorgia Antonelli Laboratory Medicine, Department of Medicine DIMED, University-Hospital of Padova, Padova, Italy

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Mario Plebani Laboratory Medicine, Department of Medicine DIMED, University-Hospital of Padova, Padova, Italy

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Mattia Barbot Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Padova, Italy

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Corrado Betterle Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Padova, Italy

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Marco Boscaro Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Padova, Italy

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Carla Scaroni Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Padova, Italy

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-HC and 85–130% with DR-HC and for E 70–91% with conv-HC and 66–88% with DR-HC (both similar to controls: F 66–84%, E 32–62%). Table 1 Salivary cortisol (F), cortisone (E), cortisol-to-cortisone ratio (FEratio) levels and daily cortisol exposure

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Sarah Ying Tse Tan Department of Endocrinology, Singapore General Hospital, Singapore

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Hong Chang Tan Department of Endocrinology, Singapore General Hospital, Singapore

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Ling Zhu Department of Endocrinology, Singapore General Hospital, Singapore

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Lih Ming Loh Department of Endocrinology, Singapore General Hospital, Singapore

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Dawn Shao Ting Lim Department of Endocrinology, Singapore General Hospital, Singapore

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Du Soon Swee Department of Endocrinology, Singapore General Hospital, Singapore

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Yoke Ling Chan Department of Speciality Nursing, Singapore General Hospital, Singapore

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Huee Boon Lim Department of Speciality Nursing, Singapore General Hospital, Singapore

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Shiau Lee Ling Department of Speciality Nursing, Singapore General Hospital, Singapore

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En Jun Ou Department of Speciality Nursing, Singapore General Hospital, Singapore

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Wynn Ee Teo Department of Speciality Nursing, Singapore General Hospital, Singapore

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Xiao Ping Zhang Department of Speciality Nursing, Singapore General Hospital, Singapore

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Hui Fen Goh Department of Speciality Nursing, Singapore General Hospital, Singapore

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Peng Chin Kek Department of Endocrinology, Singapore General Hospital, Singapore

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this study was smaller compared to other existing studies. Lastly, salivary cortisone was not measured in this study. Salivary cortisol is converted to salivary cortisone by the 11β-hydroxysteroid dehydrogenase 2 enzyme that is present in high levels

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Filippo Ceccato Department of Medicine DIMED, University of Padova, Padova, Italy
Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy
Department of Neuroscience DNS, University of Padova, Padova, Italy

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Elisa Selmin Department of Medicine DIMED, University of Padova, Padova, Italy

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Giorgia Antonelli Department of Medicine DIMED, University of Padova, Padova, Italy
Laboratory Medicine, University-Hospital of Padova, Padova, Italy

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Mattia Barbot Department of Medicine DIMED, University of Padova, Padova, Italy
Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy
Department of Neuroscience DNS, University of Padova, Padova, Italy

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Andrea Daniele Department of Medicine DIMED, University of Padova, Padova, Italy

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Marco Boscaro Department of Medicine DIMED, University of Padova, Padova, Italy

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Mario Plebani Department of Medicine DIMED, University of Padova, Padova, Italy
Laboratory Medicine, University-Hospital of Padova, Padova, Italy

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Carla Scaroni Department of Medicine DIMED, University of Padova, Padova, Italy
Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy

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. Table 1 Basal and post-synacthen serum or salivary cortisol (F) and cortisone (E) levels. Data are expressed as means and s.e. Adrenal sufficient patients, n = 137 Central AI, n = 37 Normal HPA axis, n = 106 RAS, n

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Hershel Raff Division of Endocrinology, Division of Nephrology, Endocrine Research Laboratory, Department of Medicine
Division of Endocrinology, Division of Nephrology, Endocrine Research Laboratory, Department of Medicine
Division of Endocrinology, Division of Nephrology, Endocrine Research Laboratory, Department of Medicine
Division of Endocrinology, Division of Nephrology, Endocrine Research Laboratory, Department of Medicine

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Hariprasad Trivedi Division of Endocrinology, Division of Nephrology, Endocrine Research Laboratory, Department of Medicine

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. Journal of Clinical Endocrinology and Metabolism 1998 83 1163 – 1167 . ( doi:10.1210/jc.83.4.1163 ). 17 Raff H Singh RJ . Measurement of late night salivary cortisol and cortisone by liquid chromatography–tandem mass

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Jonneke J Hollanders Department of Pediatric Endocrinology, VU University Medical Center, Amsterdam, The Netherlands

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Bibian van der Voorn Department of Pediatric Endocrinology, VU University Medical Center, Amsterdam, The Netherlands

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Noera Kieviet Department of Pediatrics, Psychiatry Obstetrics Pediatrics Expert Center, OLVG West, Amsterdam, The Netherlands

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Koert M Dolman Department of Pediatrics, Psychiatry Obstetrics Pediatrics Expert Center, OLVG West, Amsterdam, The Netherlands

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Yolanda B de Rijke Department of Clinical Chemistry, Erasmus MC, University Medical Center, Rotterdam, The Netherlands

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Erica L T van den Akker Department of Pediatric Endocrinology, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands

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Joost Rotteveel Department of Pediatric Endocrinology, VU University Medical Center, Amsterdam, The Netherlands

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Adriaan Honig Department of Pediatrics, Psychiatry Obstetrics Pediatrics Expert Center, OLVG West, Amsterdam, The Netherlands
Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands

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Martijn J J Finken Department of Pediatric Endocrinology, VU University Medical Center, Amsterdam, The Netherlands

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estriol) and precursor GCs, since the adrenocortical enzymes are not fully matured yet ( 5 ). Subsequently, during the last 6–8 weeks of pregnancy, the more matured fetal adrenal produces increasing amounts of cortisol and cortisone under the control of

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Bjørn O Åsvold Department of Endocrinology, Department of Public Health, Department of Cancer Research and Molecular Medicine, Department of Medical Biochemistry, St Olavs Hospital, Trondheim University Hospital, P O Box 3250 Sluppen, N-7006 Trondheim, Norway
Department of Endocrinology, Department of Public Health, Department of Cancer Research and Molecular Medicine, Department of Medical Biochemistry, St Olavs Hospital, Trondheim University Hospital, P O Box 3250 Sluppen, N-7006 Trondheim, Norway

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Valdemar Grill Department of Endocrinology, Department of Public Health, Department of Cancer Research and Molecular Medicine, Department of Medical Biochemistry, St Olavs Hospital, Trondheim University Hospital, P O Box 3250 Sluppen, N-7006 Trondheim, Norway
Department of Endocrinology, Department of Public Health, Department of Cancer Research and Molecular Medicine, Department of Medical Biochemistry, St Olavs Hospital, Trondheim University Hospital, P O Box 3250 Sluppen, N-7006 Trondheim, Norway

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Ketil Thorstensen Department of Endocrinology, Department of Public Health, Department of Cancer Research and Molecular Medicine, Department of Medical Biochemistry, St Olavs Hospital, Trondheim University Hospital, P O Box 3250 Sluppen, N-7006 Trondheim, Norway

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Marit R Bjørgaas Department of Endocrinology, Department of Public Health, Department of Cancer Research and Molecular Medicine, Department of Medical Biochemistry, St Olavs Hospital, Trondheim University Hospital, P O Box 3250 Sluppen, N-7006 Trondheim, Norway
Department of Endocrinology, Department of Public Health, Department of Cancer Research and Molecular Medicine, Department of Medical Biochemistry, St Olavs Hospital, Trondheim University Hospital, P O Box 3250 Sluppen, N-7006 Trondheim, Norway

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suspicion of endogenous Cushing's syndrome between February 2008 and March 2010. Subjects were instructed to take two tablets of 0.5 mg dexamethasone at 2300 h. The following morning, before eating and tooth brushing, they collected a salivary sample by

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Soraya Puglisi Internal Medicine 1, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy

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Paola Perotti Internal Medicine 1, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy

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Mattia Barbot Endocrinology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy

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Paolo Cosio Internal Medicine 1, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy

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Carla Scaroni Endocrinology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy

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Antonio Stigliano Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital University of Rome, Rome, Italy

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Pina Lardo Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital University of Rome, Rome, Italy

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Valentina Morelli Endocrinology Unit, Department of Clinical Sciences and Community Health, University of Milan and Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy

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Elisa Polledri Department of Clinical Sciences and Community Health, Laboratory of Toxicology, University of Milan and Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy

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Iacopo Chiodini Endocrinology Unit, Department of Clinical Sciences and Community Health, University of Milan and Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy

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Giuseppe Reimondo Internal Medicine 1, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy

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Anna Pia Internal Medicine 1, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy

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Massimo Terzolo Internal Medicine 1, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy

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. Secondary objectives Time to response. Dose–response relationship. Effect of metyrapone on levels of serum cortisol, UFC, salivary cortisol, ACTH, 11-deoxycortisol, total testosterone, androstenedione, DHEAS in terms of percent variation

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