In 2008 the Endocrine Society published diagnostic guidelines for Cushing’s syndrome, wherein they recommended midnight salivary cortisol testing on two consecutive days as one possible initial screening tool.  A 2009 review concluded that late-night salivary cortisol testing is a suitable alternative to serum cortisol testing for diagnosing Cushing’s syndrome, reporting that both sensitivity and specificity exceeded ninety percent.  In 2010 Sakihara, et al ., evaluated the usefulness and accuracy of salivary, plasma, and urinary cortisol levels and determined salivary cortisol to be the “method of choice” for Cushing’s syndrome screening.  In 2008 Restituto, et al ., found early morning salivary cortisol to be “as good as serum” as an Addison’s disease screening technique.  In 2010 Bagcim et al ., determined that saliva melatonin levels “reflect those in serum at any time of the day” and are a reliable alternative to serum melatonin to study the pineal physiology in newborns.  A 2008 review article described saliva melatonin testing as a “practical and reliable method for field, clinical, and research trials”. 
The caudal approach to the epidural space involves the use of a Tuohy needle, an intravenous catheter, or a hypodermic needle to puncture the sacrococcygeal membrane . Injecting local anaesthetic at this level can result in analgesia and/or anaesthesia of the perineum and groin areas. The caudal epidural technique is often used in infants and children undergoing surgery involving the groin, pelvis or lower extremities. In this population, caudal epidural analgesia is usually combined with general anaesthesia since most children do not tolerate surgery when regional anaesthesia is employed as the sole modality.