Saliva Adrenal Stress Profile (Diurnal Cortisol & DHEA)
The Saliva Adrenal Stress Profile measures free cortisol at four points across the day plus salivary DHEA to characterise the diurnal cortisol rhythm and adrenal androgen output non-invasively. Late-night salivary cortisol is a validated Cushing's screen, while the broader diurnal-curve interpretation, salivary DHEA, and the cortisol-to-DHEA ratio are functional-medicine constructs not endorsed…
2
Biomarkers
Saliva
Sample
5–10 business days
Turnaround
No — but avoid eating, drinking, brushing teeth, and smoking for the specified interval before each sample
Fasting
What is the Saliva Adrenal Stress test?
The Saliva Adrenal Stress Profile measures free cortisol in saliva at four points across the day together with salivary DHEA, characterising the diurnal cortisol rhythm and adrenal androgen output from a non-invasive home collection. The pairing is intended to assess overall adrenal cortical activity and is often summarised with a cortisol-to-DHEA relationship. In the diagnostic landscape, the validated element of this profile is late-night salivary cortisol, an established screen for Cushing's syndrome. The broader 'adrenal stress' interpretation — the shape of the diurnal curve and the cortisol-to-DHEA ratio — is used predominantly in functional and integrative medicine to assess HPA-axis patterns in fatigue, stress, and sleep disturbance. It is important to note that the 'adrenal fatigue' concept commonly associated with this testing is not recognised as a diagnosis by mainstream endocrine societies, and salivary DHEA and the cortisol-to-DHEA ratio are not standardised clinical measures, with serum DHEA-S being the validated marker of adrenal androgen status. Practitioners order it to evaluate the diurnal rhythm and adrenal output non-invasively, interpreting the validated and functional components with appropriately different weight.
What does the Saliva Adrenal Stress test measure?
Salivary cortisol reflects the free, biologically active fraction of cortisol, which diffuses into saliva independent of corticosteroid-binding globulin. Cortisol follows a strong circadian rhythm — peaking after waking and falling to a nadir near midnight — which a four-point collection is designed to map.
The four-point profile characterises the shape of the diurnal cortisol curve. Late-night (bedtime) salivary cortisol specifically is a validated screen for cortisol excess (Cushing's syndrome); the broader diurnal-curve interpretation is used mainly in functional and integrative practice. # REVIEWER FLAG: Distinguish validated late-night cortisol from the functional diurnal-curve interpretation.
DHEA is an adrenal androgen precursor; its salivary measurement is taken to reflect the free fraction of adrenal androgen output. In adrenal stress profiles it is measured alongside cortisol to characterise overall adrenal cortical output, and a cortisol-to-DHEA relationship is often derived.
Salivary DHEA is used in functional practice as an index of adrenal androgen output and, via a cortisol-to-DHEA ratio, as part of an 'adrenal stress' assessment. Serum DHEA-S is the standardised, validated marker of adrenal androgen status; the salivary measure and the derived ratio are functional-medicine constructs without mainstream endorsement. # REVIEWER FLAG: Emphasise serum DHEA-S as the validated alternative; flag the ratio as non-standardised.
Why is the Saliva Adrenal Stress test ordered?
- Non-invasive assessment of the diurnal cortisol rhythm and adrenal androgen output in patients with fatigue, stress, or sleep disturbance, within a functional-medicine framework
- Screening for cortisol excess using the validated late-night (bedtime) salivary cortisol component, where Cushing's syndrome is considered
- Evaluation of the cortisol awakening response and morning peak in suspected HPA-axis dysregulation
- Assessment where a free-cortisol, time-resolved profile with adrenal androgen output is preferred to serum testing
- Monitoring of diurnal cortisol and DHEA patterns during stress-management or lifestyle interventions in integrative care
- Investigation of disrupted sleep-wake cortisol patterns, for example in shift workers, within a functional assessment
- Characterisation of overall adrenal cortical output where cortisol and DHEA are assessed together
Sample collection and turnaround
Sample type
Saliva
Fasting required
No — but avoid eating, drinking, brushing teeth, and smoking for the specified interval before each sample
Collection method
At-home collection kit
Turnaround
5–10 business days
Collection notes
Cortisol samples are collected at four points across the day (typically waking, noon, evening, bedtime) with DHEA collected per kit instructions, recording exact times. Avoid eating, drinking, brushing teeth, and smoking before each sample, and avoid topical hormone contamination. Document corticosteroid and DHEA supplementation and licorice intake. Anchor timing to actual waking and bedtime. # REVIEWER FLAG: Confirm exact collection times, DHEA sampling, pre-collection avoidance list, and shipping with ZRT before publication.
Specimen requirements
Saliva samples into kit-provided tubes at the specified time-points, plus the DHEA sample. # REVIEWER FLAG: Confirm volume, preservative, and shipping conditions with ZRT.
What can affect Saliva Adrenal Stress results?
The profile depends on samples collected at the correct times relative to waking and bedtime; mistimed collections distort the curve and undermine interpretation.
Food, drink, blood from brushing, and smoking can contaminate saliva or alter measured hormones, so an interval avoiding these before each sample is required.
Oral, inhaled, and topical corticosteroids affect cortisol, and DHEA supplementation raises measured DHEA; topical hormone creams can contaminate samples. Supplement and steroid use must be documented and contamination avoided.
Acute physical or psychological stress, illness, and altered sleep activate the HPA axis and shift the cortisol curve, so collection during a representative period is important.
An altered circadian schedule shifts the cortisol rhythm, so standard time-point reference intervals may not apply and collection should be anchored to actual waking and sleeping times.
Licorice and some substances inhibit cortisol metabolism locally and can raise measured salivary cortisol. # REVIEWER FLAG: Confirm ZRT's pre-collection avoidance list.
What do Saliva Adrenal Stress results mean?
Elevated
An elevated late-night salivary cortisol, with loss of the normal evening nadir, is the validated abnormal pattern and raises concern for Cushing's syndrome, warranting confirmatory evaluation. Elevations elsewhere in the curve, and a high cortisol-to-DHEA relationship, are interpreted within the functional framework and in the context of stress, illness, and steroid exposure.
Normal
A preserved cortisol curve with a normal late-night value argues against cortisol excess, and DHEA within the age/sex reference is reassuring. A normal profile does not exclude adrenal insufficiency, which requires serum-based dynamic assessment.
Reduced
Low values across the curve, a blunted morning peak, or a low DHEA are interpreted in functional practice as reduced or dysregulated adrenal output, though this does not correspond to a recognised mainstream diagnosis. Genuinely low cortisol suggestive of adrenal insufficiency should be evaluated with serum morning cortisol and dynamic testing, and adrenal androgen status confirmed with serum DHEA-S.
Note: Only the late-night salivary cortisol component is validated for clinical diagnosis (Cushing's screening); the diurnal-curve interpretation, salivary DHEA, and the cortisol-to-DHEA ratio are functional-medicine constructs not endorsed by mainstream endocrine societies, and the associated 'adrenal fatigue' concept is not a recognised diagnosis. Serum DHEA-S is the validated marker of adrenal androgen status, and suspected adrenal insufficiency must be assessed with serum cortisol and dynamic testing. Results depend on accurate collection timing and avoidance of contamination. # REVIEWER FLAG: Reviewer to confirm the platform's positioning on validated vs functional components.
Frequently asked questions
It measures free cortisol at four points across the day plus salivary DHEA, characterising the diurnal cortisol rhythm and adrenal androgen output from a non-invasive home collection, often summarised with a cortisol-to-DHEA relationship.
How to access the Saliva Adrenal Stress test
The Saliva Adrenal Stress reference page is free and open to all practitioners. Create a free practitioner account to see pricing, save tests to your list, and generate requisition forms. Verification takes 1–2 business days.
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Published: June 3, 2026
Last reviewed: June 3, 2026
- Nieman LK, et al. The Diagnosis of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. (2008)
- Raff H. Utility of salivary cortisol measurements in Cushing's syndrome and adrenal insufficiency. J Clin Endocrinol Metab. (2009)
- Cadegiani FA, Kater CE. Adrenal fatigue does not exist: a systematic review. BMC Endocr Disord. (2016)
- Stalder T, et al. Assessment of the cortisol awakening response: Expert consensus guidelines. Psychoneuroendocrinology. (2016)
This content is for licensed healthcare practitioners only and does not constitute medical advice. Clinical decisions should be based on the full clinical picture and not on any single test result.
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