Cortisol - Free Urine 24H

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Detects free cortisol excretion.

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Cortisol - Free Urine 24H Test Information Guide

Why is it done?
- Test Purpose: Measures the amount of free (unbound) cortisol excreted in urine over a 24-hour period. This test evaluates adrenal gland function and helps detect cortisol excess or deficiency.
- Primary Indications: Suspected Cushing's syndrome (hypercortisolism) Evaluation of adrenal insufficiency Assessment of unexplained hypertension Investigation of metabolic abnormalities (unexplained weight gain, diabetes, osteoporosis) Evaluation of anxiety, depression, or mood disorders Monitoring of adrenal disorders
- Typical Timing: Performed when clinical symptoms suggest abnormal cortisol levels, typically during initial diagnostic workup or routine screening in patients with metabolic or psychiatric concerns.
Normal Range
- Reference Range: 20-90 µg/24 hours (some labs: 10-100 µg/24 hours) May vary slightly between laboratories based on methodology
- Units of Measurement: Micrograms per 24 hours (µg/24h) or nanomoles per 24 hours (nmol/24h) Conversion: 1 µg = 2.76 nmol Normal range in SI units: approximately 55-250 nmol/24h
- Interpretation of Results: Normal: Within reference range indicates appropriate adrenal function Low (< 20 µg/24h): May suggest adrenal insufficiency High (> 90 µg/24h): May suggest Cushing's syndrome or other cortisol excess conditions Borderline values: Warrant repeat testing or additional diagnostic studies
- Clinical Significance: Normal values support intact hypothalamic-pituitary-adrenal (HPA) axis function Abnormal values require correlation with clinical presentation and additional testing
Interpretation
- Elevated Results (> 90 µg/24h): Suggests hypercortisolism or Cushing's syndrome May indicate ACTH-secreting pituitary adenoma (Cushing's disease) Could reflect ectopic ACTH production (small cell lung cancer, carcinoid tumors) May represent primary adrenal pathology Can occur with severe stress or depression Rarely elevated from excessive glucocorticoid medication use
- Decreased Results (< 20 µg/24h): Suggests adrenal insufficiency (Addison's disease) May indicate secondary adrenal insufficiency (pituitary/hypothalamic disease) Could reflect hypopituitarism May result from prolonged glucocorticoid suppression Seen in certain autoimmune conditions
- Factors Affecting Results: Physical or emotional stress Acute illness or hospitalization Sleep disorders and shift work Obesity Pregnancy Certain medications (dexamethasone, prednisone, phenytoin) Estrogen therapy Alcohol and substance use Collection technique errors (incomplete 24-hour collection)
- Clinical Significance: Free urine cortisol reflects physiologically active (unbound) cortisol More specific than total serum cortisol for detecting hypercortisolism Represents integrated cortisol excretion over full 24-hour period Less affected by stress of blood draw compared to serum testing Considered one of the best screening tests for Cushing's syndrome
Associated Organs
- Primary Organ System: Hypothalamic-pituitary-adrenal (HPA) axis Adrenal cortex (zona fasciculata) Kidneys (excretion of cortisol)
- Associated Conditions - Hypercortisolism: Cushing's syndrome (pituitary-dependent adenoma) Ectopic ACTH syndrome (lung cancer, carcinoid tumors, thymic tumors) Primary adrenal disorders (adrenocortical carcinoma, adenoma) Pseudo-Cushing's syndrome (depression, alcoholism, obesity) Iatrogenic Cushing's (glucocorticoid medication excess)
- Associated Conditions - Hypocortisolism: Primary adrenal insufficiency (Addison's disease) Secondary adrenal insufficiency (pituitary or hypothalamic disease) Tertiary adrenal insufficiency (prolonged glucocorticoid suppression) Autoimmune adrenalitis Adrenal hemorrhage Tuberculosis of adrenal glands Adrenal infiltration (sarcoidosis, histoplasmosis, lymphoma)
- Potential Complications of Abnormal Results: Hypertension and cardiovascular disease Diabetes mellitus and metabolic syndrome Osteoporosis and bone fractures Immunosuppression and infections Severe electrolyte disturbances Acute adrenal crisis (in adrenal insufficiency) Psychiatric manifestations (depression, psychosis) Muscle weakness and atrophy
Follow-up Tests
- If Elevated Cortisol Results: Low-dose dexamethasone suppression test (1 mg overnight or 2-day protocol) Midnight salivary cortisol or late-night serum cortisol Plasma ACTH level (to differentiate ACTH-dependent from independent causes) CRH (corticotropin-releasing hormone) stimulation test High-dose dexamethasone suppression test Imaging studies: MRI of pituitary, CT of adrenal glands or chest Inferior petrosal sinus sampling (if ACTH-dependent Cushing's suspected) Urine metanephrines (if adrenal tumor suspected)
- If Decreased Cortisol Results: ACTH stimulation test (to differentiate primary from secondary insufficiency) Plasma ACTH level TSH and free T4 (evaluate thyroid function) LH, FSH, and testosterone/estradiol (assess gonadal function) Growth hormone level MRI of pituitary gland Chest X-ray or CT (tuberculosis screening) Autoimmune antibody testing (adrenal peroxidase, 21-hydroxylase)
- Complementary Tests: Serum electrolytes (sodium, potassium, chloride) Blood glucose and glucose tolerance test Lipid panel Bone density scan (DEXA) Blood pressure monitoring 24-hour urine metanephrines Serum prolactin level
- Monitoring Frequency: Initial diagnosis: May repeat testing to confirm diagnosis Post-treatment: Follow-up at 2-4 weeks after treatment initiation During medication adjustment: As clinically indicated Chronic management: Annually or as symptoms warrant After adrenal surgery: At 3-6 months then annually On replacement therapy: With each medication adjustment
Fasting Required?
- Fasting Status: NO - Fasting is not required for this test
- Special Instructions: This is a 24-hour urine collection, not a blood test Begin collection first thing in the morning by emptying bladder (discard this specimen) Collect all urine passed during the next 24 hours End collection the following morning by collecting the first void All urine must be collected in provided container (may contain preservative) Keep specimen at room temperature or refrigerated as directed by laboratory
- Medications to Avoid: Dexamethasone (discuss with provider if possible to discontinue 48 hours before) Prednisone or other glucocorticoids (if possible to avoid) Estrogen-containing contraceptives (may increase results) Phenytoin (Dilantin) Do NOT stop essential medications without consulting provider Inform laboratory of all current medications
- Patient Preparation: Maintain normal diet and activity level during collection period Avoid excessive physical or emotional stress if possible Normal fluid intake is acceptable Alcohol consumption should be minimized Adequate sleep the night before collection is recommended Normal bathroom hygiene, but avoid contamination with feces or toilet paper For women: Not recommended during menstrual period (due to contamination risk) Record collection start and end times precisely Return specimen to laboratory promptly after collection
- Important Considerations: Incomplete 24-hour collection invalidates results Missed or contaminated specimens require recollection Multiple collections may be recommended for confirmation Results are most reliable when obtained during stable clinical state Timing of collection (day vs. night shift) should be noted

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