Cortisone (S4) - Dinner

This sample measures cortisone, the inactive form of cortisol, in your saliva at dinnertime. Cortisone is produced when the enzyme 11b-HSD2 deactivates cortisol in the salivary glands. Because salivary cortisone comes directly from cortisol that was recently active, it acts as a secondary, confirmatory marker for the up and down daily pattern of cortisol.

Cortisone does not have a daily rhythm in the blood, but it does in saliva and urine. This is because the enzyme conversion in the salivary glands creates a local pattern that mirrors cortisol's own rise and fall. By dinner, cortisone should be declining in parallel with cortisol.

How to Read This Alongside Dinner Cortisol

When cortisol and cortisone both follow the same pattern at dinnertime (both elevated, both low, or both within range), cortisone confirms the cortisol picture. High cortisol in the afternoon and evening confirmed by high cortisone in the afternoon and evening gives you confidence that the elevation is real and not an artifact.

When they diverge, cortisone may be more informative. If your dinner cortisol is low but cortisone is normal or elevated, your true circulating cortisol may not be as low as the cortisol reading implies. The 11b-HSD2 enzyme in the salivary glands may be converting a larger share of cortisol into cortisone, making cortisol appear artificially low. If cortisol is elevated but cortisone is not, it could suggest a transient stress spike or possible hydrocortisone contamination rather than a sustained elevation.

Questions This Biomarker Can Answer

• Does my dinner cortisone confirm that cortisol is declining normally in the evening?
• Could my true circulating cortisol at dinner be different from what the cortisol reading alone shows?
• Is a mismatch between cortisol and cortisone at this time point suggesting enzyme activity or sample contamination?