MON-477 Isolated Elevated Salivary Cortisol Levels in a Patient receiving Dextroamphetamine, a Case Report

Abstract Disclosure: M. Ahmad: None. A.K. Fernando: None. B. Sharma: None. J.R. Anolik: None. Introduction: Cushing syndrome is a condition characterized by pathological hypercortisolism. Current tests available for screening for this entity include a 24-hour urine cortisol level, low dose dexamethasone suppression test (LDST) and late-night salivary cortisol. Each of these tests, however, has unique caveats that must be considered when interpreting their results. We present a case of a 47-year-old patient with a history of ADHD on dextroamphetamine found to have significantly elevated salivary cortisol levels. Case description: A 47-year-old female with a past medical history of attention-deficit/hyperactivity disorder (ADHD) on dextroamphetamine and depression presented to the endocrinology clinic for evaluation of chronic fatigue. Physical exam was significant for normal vital signs (blood pressure: 119/79 mmHg, heart rate: 97 beats per minute, respiratory rate: 18 breaths per minute, temperature: 36.7 degrees C) with no clinical signs of hypercortisolism. She underwent testing by her primary physician which demonstrated elevated salivary cortisol levels: 0.211 ug/dL and >1 ug/dL at 12 AM (normal range: <0.01 -0.09 ug/dL). The patient underwent further testing which demonstrated a normal 24-hour urine cortisol level of 13 ug/24 h (normal range: 6-42 ug/24 h) and a negative LDST: serum cortisol <1.0 ug/dL (normal range: <1.8 ug/dL). Repeat salivary cortisol level at 12 AM showed improved however slightly elevated level at 0.165 ug/dL respectively. Given her non-specific symptoms, lack of Cushingoid signs and symptoms and normal LDST and urine cortisol, it was suspected that the cause of her elevated salivary cortisol may have been related to her dextroamphetamine use. Discussion: Salivary cortisol measurement is a common test utilized to diagnose Cushing’s syndrome. Studies in the past have shown that children with ADHD generally exhibit lower diurnal cortisol levels compared to those without ADHD. When treated with dextroamphetamine, there is evidence demonstrating an increase in salivary cortisol levels and also alterations in their diurnal pattern. Amphetamines are known to cause gingival irritation and xerostomia which we propose may also be a potential mechanism leading to erroneously elevated salivary cortisol levels. We suggest further research exploring the effect of CNS stimulating medications on salivary cortisol levels to assess whether salivary cortisol is an accurate representation of hypercortisolism in these patients. Presentation: Monday, July 14, 2025