Cortisone (S1) - Waking

This sample measures cortisone, the inactive form of cortisol, in your saliva at the moment you wake up. The enzyme 11b-HSD2 in the salivary glands converts active cortisol into cortisone before it appears in your saliva sample.

Notice that salivary cortisone levels are substantially higher than salivary cortisol levels at every time point. This is normal and expected. The 11b-HSD2 enzyme in the salivary glands is highly active, so cortisone is always the dominant form in saliva. What matters clinically is whether cortisone tracks with cortisol across the day or diverges from it.

How to Use This Reading

When waking cortisone and waking cortisol point in the same direction (both high, both low, or both within range), cortisone confirms the cortisol picture. This gives you confidence that the cortisol value accurately reflects your true circulating level.

When they diverge, cortisone may be more informative. If your waking cortisol is low but your waking cortisone is normal or elevated, your true circulating cortisol may not be as low as the cortisol reading implies. This pattern can occur when 11b-HSD2 is particularly active, converting a larger share of cortisol into cortisone in the salivary glands. Recognizing this prevents incorrect treatment for very low cortisol when blood levels may actually be adequate.

Questions This Biomarker Can Answer

• Does my waking cortisone confirm what my waking cortisol shows?
• Could my salivary glands be converting more cortisol to cortisone than usual, making cortisol appear falsely low?
• What is my most reliable estimate of true circulating cortisol at the moment of waking?