Cortisol Test

The adrenal glands are the small glands sitting on top of each of your kidneys. They produce a steroid hormone called cortisol, which affects your immune and nervous system functions.

It also plays a vital role in the body’s response to stress. Doctors sometimes call it the “stress hormone” because the adrenal glands release them when your body perceives stress.¹ 

Our in-house expert, Dr. Rizza Mira, explains, saying: “In an alarming situation that calls for a fight-or-flight response, cortisol levels spike to effect many changes in almost all body systems.”

Medical experts test your cortisol levels through blood, saliva, or urine. The cortisol measured in these body fluids helps detect or keep track of health conditions linked to your adrenal glands.

Quick Facts On Cortisol Testing

• Also called the serum cortisol test
• Measures the cortisol or stress hormone level
• Requires either a blood, urine, or saliva sample

Why Take A Cortisol Test?

A cortisol test helps your doctor evaluate if your adrenal glands are making sufficient amounts of the cortisol hormone. It can be both diagnostic and also used for monitoring your levels.

Doctors use cortisol testing to diagnose or rule out the cause/s of your symptoms. It detects conditions that cause unusual changes in the cortisol levels, such as:

• Cushing’s syndrome — a health condition that results from too much cortisol
• Cushing’s disease — a condition where the pituitary gland (master gland of the body) produces an excessive amount of adrenocorticotropic hormone (ACTH), which leads to excess cortisol 
• Addison disease — a disorder of the adrenal gland. It is marked by insufficient production of hormones, including cortisol

Medical experts also use cortisol tests to monitor your body’s response to medications. It helps them assess how effective the treatments are for unusually high or low cortisol levels.

What Does A Cortisol Test Show?

A cortisol test shows the amount of cortisol in your body fluids like blood, saliva, or urine. Cortisol is a type of glucocorticoid hormone that helps with many bodily functions, such as:

• Regulating blood sugar
• Suppressing inflammation
• Controlling metabolism
• Coordinating sleep cycles

A sudden increase in cortisol strengthens your immune response by limiting inflammation. These floods of cortisol are also crucial in helping you stay alert during “fight or flight” situations.²

Typically, your cortisol levels vary depending on the stressors you’re facing from day to day. The body goes through several steps during the process of releasing cortisol:

• The hypothalamus, or the region at the base of your brain, produces corticotropin-releasing hormone (CRH). 
• CRH advances to the pituitary gland. It stimulates the production of the adrenocorticotropic hormone (ACTH).
• The bloodstream transports the ACTH to your adrenal glands. This hormone triggers cortisol release.

Cortisol levels circulating in your body provide the trigger, so involved glands and organs carry out these steps normally. A cortisol test can potentially show if they are functioning correctly or not.

Further testing reveals more health information about your glands, such as an ACTH stimulation test, which measures how well your adrenal glands are in making cortisol.

When To Test Cortisol Levels

Doctors recommend cortisol testing for the following circumstances: 

• Health conditions affecting the hypothalamus, adrenal, and pituitary glands, like tumors and masses
• People with signs and symptoms of endocrine problems
• Monitoring the cortisol levels of people on steroid medications

For example, doctors may initiate cortisol tests for a young adult with hypertension. It’s because your risk of developing cardiovascular diseases increases when you have an excess of cortisol.³

Your doctor may order a cortisol test if you show one or more signs of high cortisol levels. The symptoms include:

• Sudden weight gain
• Fat build-up around the base of your neck and between the shoulders
• Unexplained facial or body hair growth
• Irregular or absence of menstrual period
• Erectile dysfunction in men
• High blood pressure
• High blood sugar

You can also experience health problems from too little cortisol. In emergency cases, your doctor will ask for a cortisol test if they suspect that your symptoms are due to an acute adrenal crisis. 

Other causes of insufficient cortisol are Addison’s disease, abrupt discontinuation of steroid medications, removal of the adrenal or pituitary gland, or loss of blood supply to the adrenals.

Adrenal crises occur when your body has insufficient cortisol levels. It is life-threatening and must be treated immediately.⁴ 

Adrenal crisis causes a shutdown of almost all organ systems.

The signs of low cortisol levels include:

• Persistent fatigue 
• Muscle weakness
• Loss of appetite
• Unexplained weight loss
• Pain in the abdomen

Medical conditions that cause too much or too little cortisol are uncommon. And more often than not, symptoms of abnormal cortisol levels can be linked to various diseases. 

This is why doctors check more common health problems like thyroid conditions first before ordering a cortisol test.

How Much Does A Cortisol Test Cost?

The total cost of a cortisol test may depend on these factors: 

• The type of sample used — blood, urine, or saliva
• If it’s a single test or part of a series of lab works
• Whether it’s a repeat test
• The facility where you’ll take the test
• What your health insurance covers
• Other fees, such as doctor’s visits, sample collection, and lab analysis

Your health insurance may cover some of these fees. But expect that you’ll pay for deductibles or co-payments. 

The hospital’s billing office or your health insurance provider can give a more accurate pricing estimate. 

You may reach out to the hospital if you don’t have health coverage. Inquire if they offer programs to lessen the testing cost.

How Cortisol Testing Works

The cortisol hormone can be measured using blood, saliva, or urine samples. 

Your cortisol levels change the entire day, so your doctor will likely set a specific time to conduct the test.

For example, the cortisol in your blood is at its peak early in the day. In the afternoon, it reaches its lowest value. The blood samples for a cortisol blood test are often collected in the morning.⁵ 

Some tests also collect a sample in the afternoon. They check if cortisol levels are dropping as they normally should.

The cortisol in your saliva and the active or free cortisol in your plasma are balanced in the evening. Your doctor will require you to collect the specimen for a cortisol saliva test at night.⁶

A cortisol urine test requires that you collect all your urine within a 24-hour period. The lab will provide sterile containers for obtaining your urine sample. They’ll also instruct you on how to collect your urine specimen.

Before Your Test

Tell your doctor if you have an unusual sleeping schedule before taking a cortisol test. Your sleeping patterns influence the changes in your cortisol levels throughout the day.⁷

Your doctor will also ask you to discontinue medications that affect the test results. They may include anti-psychotic and steroidal, and hormonal drugs.

Refrain from high-intensity workouts until after you take the cortisol test. Vigorous exercise can increase the circulating cortisol in the blood.⁸

During Your Test

The instructions depend on which sample the lab will collect from you.

1. Blood cortisol test 

The medical expert will draw a blood sample from your arm. They’ll tie an elastic band around your upper arm before inserting a needle into one of your veins. 

The blood goes into a tube attached to the needle. You may feel a slight sting once the needle pierces through your skin, which usually goes away shortly. 

2. Salivary cortisol test 

You may need to rinse your mouth or chew on gum or cotton to trigger saliva production. Next, you’ll spit into a sterile container or use a swab to collect the saliva specimen.

Saliva testing takes a few minutes — you can do it at a lab or at home. Sometimes, the doctor may ask for multiple samples for several days. You can bring them to the testing facility at once.

3. Urinary cortisol testing

Doctors require collecting all urine samples in 24 hours. The lab will give you multiple containers for obtaining your sample every time you pee.

Follow their instructions on how and when to start collecting your urine sample. The process usually begins early in the morning and lasts til the following day.

After Your Test

Once you’re done with blood, urine, or saliva testing, you can carry on with your normal activities. These tests usually have no side effects or restrictions.

After the blood draw, the medical worker will cover the pierced skin with a bandage. You may feel some stinging or slight bruising on the injection site, which should go away shortly.

If you’re collecting your samples at home, bring the containers to the facility within the required period. This is applicable to both saliva and urine samples. 

What Your Cortisol Test Results Mean

Your test results will show the amount of cortisol detected from the test samples. The lab report will also reference the normal range of cortisol in healthy people.

However, doctors consider a person’s current health when interpreting the test results. 

In some patients, a cortisol level within the expected range confirms that they have sufficient cortisol. While other people may need to undergo multiple tests to determine their cortisol levels. 

High Cortisol Levels

The following health conditions cause a high cortisol level or hypercortisolism:

• Cushing’s syndrome —most often a result of prolonged use or high dosages of steroid medications 
• Cushing’s disease — occurs when a non-malignant tumor on the pituitary gland triggers excessive ACTH production. It results in excessive cortisol secretion.
• Ectopic Cushing’s syndrome — a condition that occurs when a tumor in a different part of the body releases ACTH
• A tumor in the adrenal gland
• Pregnancy
• Obesity
• Diabetes
• Physical and mental stress
• Depression
• Alcoholism
• Sleep apnea 

Low Cortisol Levels

The health conditions that can lower your cortisol levels are:

• Addison’s disease — is also called primary adrenal insufficiency. It occurs when your adrenal glands are damaged and can’t make enough cortisol 
• Secondary adrenal insufficiency — happens when the pituitary gland produces insufficient ACTH
• Tertiary adrenal insufficiency — occurs when the hypothalamus doesn’t make enough corticotropin-releasing hormone (CRH)

Is There An At-Home Cortisol Test?

Yes. At-home cortisol tests are commercially available. 

Most consumer companies call them at-home stress tests and sleep panels. They also check other substances that affect your sleep and your body’s response to stress.

At-home cortisol testing involves collecting your sample and mailing them back for analysis. You may need to follow the same instructions with a physician-ordered cortisol test.

While at-home tests can look into your cortisol levels, they shouldn’t replace a doctor’s visit. A healthcare expert must evaluate your symptoms for a more accurate diagnosis.

LetsGetChecked At-Home Cortisol Test