Cortisol

Hormone/ Element

Report in 4Hrs

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No Fasting Required

Details

Measures cortisol levels.

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Cortisol Test Information Guide

Why is it done?
- Measures the level of cortisol, a steroid hormone produced by the adrenal glands that helps regulate stress response, blood pressure, and glucose metabolism
- Evaluates adrenal gland function and detects disorders of the hypothalamic-pituitary-adrenal (HPA) axis
- Diagnoses Cushing's syndrome (high cortisol) or Addison's disease (low cortisol)
- Investigates symptoms such as unexplained weight gain, muscle weakness, mood changes, or fatigue
- Monitors patients with known pituitary or adrenal disorders
- Typically performed in the morning when cortisol levels are naturally highest, or can be done at specific times to evaluate the diurnal cortisol pattern
Normal Range
- Morning cortisol (8 AM): 10-20 mcg/dL (or 275-555 nmol/L)
- Evening cortisol (4 PM): 3-10 mcg/dL (or 83-276 nmol/L)
- 24-hour urine cortisol: 20-90 mcg/24 hours (or 55-248 nmol/24 hours)
- Midnight salivary cortisol: Less than 0.5 ng/mL (or less than 1.5 nmol/L)
- Interpretation Guidelines: • Normal: Results within reference range indicate proper adrenal function • High (Elevated): Cortisol above normal range may indicate Cushing's syndrome or other disorders • Low: Cortisol below normal range may indicate Addison's disease or secondary adrenal insufficiency • Normal reference ranges may vary by laboratory; always consult your specific laboratory's reference values
Interpretation
- Elevated Cortisol Levels: Suggests Cushing's syndrome (pituitary or adrenal tumor), ectopic ACTH production, severe stress, or chronic illness
- Persistently Elevated (24-hour urine or midnight salivary): More specific for Cushing's syndrome than single morning cortisol levels
- Loss of Diurnal Rhythm: When cortisol remains high at evening, indicates abnormal HPA axis regulation
- Low Cortisol Levels: Suggests primary adrenal insufficiency (Addison's disease) or secondary insufficiency (pituitary dysfunction)
- Factors Affecting Results: Stress, sleep disruption, depression, obesity, alcohol use, estrogen levels, medications (oral contraceptives, glucocorticoids), and time of collection significantly affect cortisol levels
- Clinical Significance: Cortisol testing requires careful interpretation considering clinical context; multiple testing methods and timing are often necessary for accurate diagnosis
Associated Organs
- Primary Organs: Adrenal glands (cortex), pituitary gland, hypothalamus
- Cushing's Syndrome: Excess cortisol causes weight gain, skin changes, muscle weakness, diabetes, hypertension, and osteoporosis
- Addison's Disease: Insufficient cortisol leads to fatigue, weakness, hypotension, electrolyte imbalances, and potential adrenal crisis
- Pituitary Disorders: Pituitary tumors or dysfunction affect ACTH production, leading to secondary adrenal insufficiency
- Associated Complications: Hypertension, metabolic syndrome, cardiovascular disease, immune suppression, psychiatric disorders, and osteoporosis
Follow-up Tests
- If Elevated Cortisol: ACTH level, low-dose dexamethasone suppression test, high-dose dexamethasone suppression test, CRH stimulation test
- If Low Cortisol: ACTH level, adrenocorticotropic hormone (ACTH) stimulation test, other pituitary hormone levels (TSH, prolactin, growth hormone)
- Imaging Studies: MRI of pituitary gland, CT scan of abdomen (for adrenal evaluation), or PET scan if ectopic ACTH suspected
- Complementary Blood Tests: Electrolytes, glucose, DHEA-S, aldosterone, renin, thyroid function tests
- Monitoring Frequency: For diagnosed disorders, periodic cortisol testing (every 3-6 months) may be needed to assess treatment efficacy
Fasting Required?
- Fasting Status: No - fasting is not required for cortisol testing
- Timing Importance: Blood collection must be done at specific times (typically 8 AM for morning cortisol) as cortisol follows a diurnal rhythm
- Pre-Test Preparation: Avoid excessive stress or strenuous exercise for 24 hours prior to testing; remain seated or lying down for at least 30 minutes before blood draw
- Medications to Avoid/Report: Estrogen-containing medications, glucocorticoids, certain antifungals (ketoconazole), and phenytoin may affect results; inform your doctor of all medications
- For 24-Hour Urine Collection: Collect all urine over 24 hours in provided container; store in cool place; note start and end times
- For Midnight Salivary Cortisol: Patient collects saliva at home at midnight using special swab; no eating or drinking 30 minutes before collection

How our test process works!