Measurement and meaning of salivary cortisol: A focus on health and disease in children

Figures & data

Table I.  Selection of recent studies reporting morning salivary cortisol in children to show the wide variety of units of measurement and the wide range of values. One column lists levels of cortisol in the authors' choice of units; in a second column these have been converted into SI units of nmol/l. Conversion factors: μg/dl × 10 = ng/ml × 2.78 = nmol/l. Waking/30 min = single sample taken within 30 min of waking.

Mean age (or range) in years	Sample size	Sampling time	Cortisol in units provided (range, mean or median)	Cortisol (nmol/l)	Reference
(7–9)	68 boys	Waking	7–13 nmol/l	7–13
	72 girls		8–14 nmol/l	8–14	Jones et al. (2006)
11	109	0700–0800 h	0.48 μg/dl	13.3	Hessl et al. (2002)
11 (6–17)	90	Waking/30 min	0.14 μg/dl	3.9	Hessl et al. (2006)
(6–10)	217	0800–0900 h	0.5–0.9 μg/dl	13.9–25.0	Lupien et al. (2000)
11	178	0900 h	290 ng/dl	8.1	Moss et al. (1999)
(10–12)	262	0900 h	289 ng/dl	8.0	Hardie et al. (2002)
(10–12)	1768	0730 h	15.38 nmol/l	15.38	Rosmalen et al. (2005)
12.8 (8–16)	126	0800 h	3.30 ng/ml	9.17	Netherton et al. (2004)
(8–11)	340	Morning	7.5–8.1 nmol/l	7.5–8.1	Haines et al. (2001)
(8–10)	21	0900 h	291 nmol/l	291	Hershberger et al. (2004)
(7–15)	210 boys	0800–0900 h	8.8 nmol/l (highest value 53.9)	8.8 (53.9)
	176 girls		8.6 nmol/l (highest value 33.2)	8.6 (33.2)	Tornhage (2002)
4.5	56	Waking	2.88 ng/ml	8.0	Chryssanthopoulou et al. (2005)
(5–14)	1152	Waking/30 min	13.4 nmol/l for older children (highest value 231.2)	13.4 (231.2)
			14 nmol/l for younger children (highest value 246)	14 (246)	Koupil et al. (2005)
8.55 (Romanian)	18	Early morning	0.8 μg/dl	22.24
7.9 (Canadian)	27		0.68 μg/dl	18.9	Gunnar et al. (2001b)
9.4	12	Mid-morning	60–70 nmol/l	60–70	Jansen et al. (2003)
(11–17)	71	Early morning	0.4 mg/dl	11,120	Klimes-Dougan et al. (2001)
(6–7)	34	Waking/30 min	0.71 μg/dl	19.74	Bruce et al. (2002)

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Hessl D, Glaser B, Dyer-Friedman J, Blasey C, Hastie T, Gunnar M, Reiss AL. Cortisol and behavior in fragile X syndrome. Psychoneuroendocrinology 2002; 27: 855–872

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Hessl D, Glaser B, Dyer-Friedman J, Reiss AL. Social behavior and cortisol reactivity in children with fragile X syndrome. J Child Psychol Psychiatry 2006; 47: 602–610

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Lupien SJ, King S, Meaney MJ, McEwen BS. Child's stress hormone levels correlate with mother's socioeconomic status and depressive state. Biol Psychiatry 2000; 48: 976–980

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Moss HB, Vanyukov M, Yao JK, Kirillova GP. Salivary cortisol responses in prepubertal boys: The effects of parental substance abuse and association with drug use behavior during adolescence. Biol Psychiatry 1999; 45: 1293–1299

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Hardie TL, Moss HB, Vanyukov MM, Yao JK, Kirillovac GP. Does adverse family environment or sex matter in the salivary cortisol responses to anticipatory stress?. Psychiatry Res 2002; 112: 121–131

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Rosmalen JG, Oldehinkel AJ, Ormel J, de Winter AF, Buitelaar JK, Verhulst FC. Determinants of salivary cortisol levels in 10–12 year old children; a population-based study of individual differences. Psychoneuroendocrinology 2005; 30: 483–495

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Netherton C, Goodyer I, Tamplin A, Herbert J. Salivary cortisol and dehydroepiandrosterone in relation to puberty and gender. Psychoneuroendocrinology 2004; 29: 125–140

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Haines MM, Stansfeld SA, Job RF, Berglund B, Head J. Chronic aircraft noise exposure, stress responses, mental health and cognitive performance in school children. Psychol Med 2001; 1: 265–277

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Hershberger AM, McCammon MR, Garry JP, Mahar MT, Hickner RC. Responses of lipolysis and salivary cortisol to food intake and physical activity in lean and obese children. J Clin Endocrinol Metab 2004; 89: 4701–4707

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Tornhage CJ. Reference values for morning salivary cortisol concentrations in healthy school-aged children. J Pediatr Endocrinol Metab 2002; 15: 197–204

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Chryssanthopoulou CC, Turner-Cobb JM, Lucas A, Jessop D. Childcare as a stabilizing influence on HPA axis functioning: A reevaluation of maternal occupational patterns and familial relations. Dev Psychobiol 2005; 47: 354–368

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Koupil I, Mann V, Leon DA, Lundberg U, Byberg L, Vagero D. Morning cortisol does not mediate the association of size at birth with blood pressure in children born from full-term pregnancies. Clin Endocrinol (Oxf) 2005; 62: 661–666

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Gunnar MR, Morison SJ, Chisholm K, Schuder M. Salivary cortisol levels in children adopted from Romanian orphanages. Dev Psychopathol 2001b; 13: 611–628

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Jansen LM, Gispen-de Wied CC, van der Gaag RJ, van Engeland H. Differentiation between autism and multiple complex developmental disorder in response to psychosocial stress. Neuropsychopharmacology 2003; 28: 582–590

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Klimes-Dougan B, Hastings PD, Granger DA, Usher BA, Zahn-Waxler C. Adrenocortical activity in at-risk and normally developing adolescents: Individual differences in salivary cortisol basal levels, diurnal variation, and responses to social challenges. Dev Psychopathol 2001; 13: 695–719

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Bruce J, Davis EP, Gunnar MR. Individual differences in children's cortisol response to the beginning of a new school year. Psychoneuroendocrinology 2002; 27: 635–650

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