Cortisol, LC/MS/MS, Saliva, 2 Samples

The Cortisol, LC/MS/MS, Saliva, 2 Samples test contains 1 test with 4 biomarkers.

Brief Description: The Cortisol 2 Sample Saliva test is a diagnostic tool used to assess the levels of cortisol, a steroid hormone, in the body. This hormone is produced by the adrenal glands and is pivotal in several body processes, including metabolism, inflammation regulation, and the body's response to stress. The test evaluates cortisol levels by analyzing two separate saliva samples collected at specific times—usually once in the morning and once in the evening.

Also Known As: Cortisol Total Test, Cortisol Saliva Test, Cortisol 2 Specimen Test, 2 Specimen Cortisol Test, Cortisol Free Test, Cortisol Kit Test

Collection Method: Saliva Collection Kit

Specimen Type: Saliva

Test Preparation: Collection kit (instructions below)

Collection Times and Procedure: Your physician will guide you on the exact times to collect cortisol samples, as these are crucial for accurate results. Here are general guidelines based on the number of specimens required:

Two Specimens: Saliva

• Morning (8 AM): To capture peak cortisol levels.
• Evening (4 PM or later): To check for normal decline in levels.

Cortisol, LC/MS/MS, Saliva Collection Kit

1. Pick up the Cortisol, LC/MS/MS, Saliva Collection Kit from the Patient Service Center that is selected when placing the order.
2. Provide the Patient Requisition to obtain your Kit ((Transport Container  = Salivette® tubes (SARSTEDT))

Patient Preparation

1. Saliva should be collected as prescribed by your doctor or at the time(s) indicated below.
2. No food or fluids for 30 minutes prior to collection.
3. Do not use any creams, lotions, or steroid inhalers immediately prior to collection.
4. Avoid any activity that can cause your gums to bleed, including brushing and flossing your teeth. Consult with your doctor if this is a chronic problem.
5. Do not use this kit on children under 3 years of age or any patient with increased risk of swallowing or choking.

Time of Day for Saliva Collection

You must collect saliva two times in one day. The time of day for the two collections should be determined by your physician.

Collection Instructions

1. Rinse mouth thoroughly with water and discard. Do not swallow.
2. Hold the Salivette® at the rim of the suspended insert and remove the stopper.
3. Remove the swab.
4. Place the swab under the tongue until well saturated, approximately 1 minute.
5. Return the saturated swab to the suspended insert and close the Salivette® firmly with the stopper.
6. Do not remove the tube holding the insert. The Salivette® should be returned to the patient service center with the swab inside.
7. Label each Salivette® as it is collected with the following:
   1. patient name
   2. date of birth (DOB)
   3. date and time of collection
   4. Ulta Lab Test’s client # in the upper right hand corner of the Patient Requisition.
   5. (Note: Each tube must be labeled individually as it is collected)

Return Collected Samples & Patient Requisition Directly to Patient Service Center

• Return to the Patient Service Center where the test kit was obtained, within 48 hours of the specimen being first collected, each of the two Salivette® with the specimen collected. 
• Important, please also include the Ulta Lab Tests Patient Requisition for the Cortisol, LC/MS/MS, Saliva, 2 Samples when returning the specimens.

Storage instructions

Specimens can be stored at room temperature prior to returning to the Patient Service Center within 48 hours of collection of the first specimen. 

When is a Cortisol Saliva 2 Specimen test ordered?

When a person has symptoms that point to a high level of cortisol and Cushing syndrome, a cortisol test may be recommended.

Women with irregular menstrual periods and increased facial hair may be tested, and children with delayed development and small stature may also be tested.

When someone exhibits symptoms that point to a low cortisol level, adrenal insufficiency, or Addison disease, this test may be ordered.

What does a Cortisol Saliva 2 Specimen test check for?

Cortisol is a hormone that plays a function in protein, lipid, and carbohydrate metabolism. It has an effect on blood glucose levels, blood pressure, and immune system regulation. Only a small fraction of cortisol in the blood is "free" and biologically active; the majority is attached to a protein. Cortisol is a hormone that is produced into the urine and found in the saliva. This test determines how much cortisol is present in the blood, urine, or saliva.

Cortisol levels in the blood usually rise and fall in a pattern known as "diurnal variation." It reaches its highest point early in the morning, then gradually decreases over the day, reaching its lowest point around midnight. When a person works irregular shifts and sleeps at different times of the day, this rhythm might fluctuate, and it can be disrupted when a disease or condition inhibits or stimulates cortisol production.

The adrenal glands, two triangle organs that sit on top of the kidneys, generate and emit cortisol. The hypothalamus in the brain and the pituitary gland, a small organ below the brain, control the hormone's production. The hypothalamus produces corticotropin-releasing hormone when blood cortisol levels drop, which tells the pituitary gland to create ACTH. The adrenal glands are stimulated by ACTH to generate and release cortisol. The brain, pituitary, and adrenal glands must all be operating properly in order to produce enough levels of cortisol.

Cushing syndrome is a collection of signs and symptoms associated with an unusually high cortisol level. Cortisol production may be increased as a result of:

• Large doses of glucocorticosteroid hormones are given to treat a range of ailments, including autoimmune illness and certain cancers.
• Tumors that produce ACTH in the pituitary gland and/or other regions of the body.
• Cortisol production by the adrenal glands is increased as a result of a tumor or abnormal expansion of adrenal tissues.

Rarely, CRH-producing malignancies in various regions of the body.

Cortisol production may be reduced as a result of:

• Secondary adrenal insufficiency is caused by an underactive pituitary gland or a pituitary gland tumor that prevents ACTH production.
• Primary adrenal insufficiency, often known as Addison disease, is characterized by underactive or injured adrenal glands that limit cortisol production.

After quitting glucocorticosteroid hormone medication, especially if it was abruptly stopped after a long time of use.

Lab tests often ordered with a Cortisol Saliva 2 Specimen test:

When a 2 Sample Cortisol Saliva test is ordered, it's often part of a broader evaluation of endocrine function. Here are some tests commonly ordered alongside it:

1. 24-Hour Urinary Free Cortisol:

   • Purpose: To measure cortisol excretion over a 24-hour period.
   • Why Is It Ordered: To assess overall cortisol production. Elevated levels over 24 hours can indicate Cushing's syndrome.

2. ACTH (Adrenocorticotropic Hormone) Test:

   • Purpose: To measure the level of ACTH, a hormone that stimulates the adrenal glands to release cortisol.
   • Why Is It Ordered: To determine whether abnormalities in cortisol levels are due to a problem with the adrenal glands themselves or with the pituitary gland (which produces ACTH).

3. Dexamethasone Suppression Test:

   • Purpose: To assess the ability of dexamethasone (a synthetic glucocorticoid) to suppress cortisol production.
   • Why Is It Ordered: To help diagnose Cushing's syndrome and differentiate between various causes of excess cortisol production.

4. Blood Electrolyte Panel:

   • Purpose: To measure key electrolytes in the blood.
   • Why Is It Ordered: To evaluate for electrolyte imbalances, which can occur with adrenal disorders.

5. Renin and Aldosterone Levels:

   • Purpose: To measure levels of renin and aldosterone, hormones involved in regulating blood pressure and electrolyte balance.
   • Why Is It Ordered: In cases of suspected Addison’s disease or primary aldosteronism, particularly if cortisol levels are low.

6. Complete Blood Count (CBC):

   • Purpose: To evaluate overall blood health.
   • Why Is It Ordered: To check for anemia or leukocytosis, which can sometimes be associated with cortisol abnormalities.

7. Thyroid Function Tests:

   • Purpose: To assess thyroid gland function.
   • Why Is It Ordered: Because adrenal and thyroid function can impact each other, and symptoms of thyroid dysfunction can mimic or exacerbate adrenal disorders.

These tests, when ordered alongside a 2 Sample Cortisol Saliva test, provide a comprehensive evaluation of adrenal function and can help in diagnosing conditions like Cushing's syndrome or Addison’s disease. They are crucial for understanding the underlying cause of cortisol abnormalities and for guiding appropriate treatment. The specific combination of tests will depend on the individual’s symptoms, clinical presentation, and medical history.

Conditions where a Cortisol Saliva 2 Specimen test is recommended:

Various health conditions and diseases can warrant the use of the Cortisol 2 Sample Saliva test. These include Cushing's Syndrome, caused by an extended period of high cortisol exposure; Addison's Disease, a condition where the adrenal glands underproduce hormones; Adrenal Insufficiency, signifying inadequate steroid hormone production by the adrenal glands; and adrenal tumors, which can be benign or malignant and can affect cortisol production.

How does my health care provider use a Cortisol Saliva 2 Specimen test?

A cortisol test can be used to detect Cushing syndrome, which is characterized by an excess of cortisol, as well as adrenal insufficiency or Addison disease, which are characterized by a deficiency of cortisol. Cortisol is a hormone that regulates protein, lipid, and carbohydrate metabolism, among other functions. Cortisol levels in the blood normally increase and fall in a "diurnal variation" pattern, rising early in the morning, dropping during the day, and reaching their lowest point around midnight.

The adrenal glands generate and excrete cortisol. The hypothalamus in the brain and the pituitary gland, a small organ below the brain, control the hormone's production. The hypothalamus produces corticotropin-releasing hormone when blood cortisol levels drop, which tells the pituitary gland to create ACTH. The adrenal glands are stimulated by ACTH to generate and release cortisol. The brain, pituitary, and adrenal glands must all be operating properly in order to produce enough levels of cortisol.

Only a small fraction of cortisol in the blood is "free" and biologically active; the majority is attached to a protein. Blood cortisol testing assesses both protein-bound and free cortisol, but urine and saliva cortisol testing assesses only free cortisol, which should be in line with blood cortisol levels. Multiple blood and/or saliva cortisol levels collected at various times, such as 8 a.m. and 4 p.m., can be used to assess cortisol levels and diurnal variation. A 24-hour urine cortisol sample will not reveal diurnal variations; instead, it will assess the total quantity of unbound cortisol voided over the course of 24 hours.

If an elevated amount of cortisol is found, a health professional will conduct additional tests to confirm the results and discover the cause.

If a person's blood cortisol level is abnormally high, a doctor may order additional tests to be sure the high cortisol is indeed abnormal. Additional testing could involve monitoring 24-hour urinary cortisol, doing an overnight dexamethasone suppression test, and/or obtaining a salivary sample before sleep to detect cortisol at its lowest level. Urinary cortisol testing necessitates collecting urine over a set length of time, usually 24 hours. Because ACTH is released in pulses by the pituitary gland, this test can assist evaluate whether a raised blood cortisol level is a true rise.

An ACTH stimulation test may be ordered if a health practitioner feels that the adrenal glands are not releasing enough cortisol or if initial blood tests reveal insufficient cortisol production.

ACTH stimulation is a test that measures the amount of cortisol in a person's blood before and after a synthetic ACTH injection. Cortisol levels will rise in response to ACTH stimulation if the adrenal glands are functioning normally. Cortisol levels will be low if they are damaged or not working properly. To distinguish between adrenal and pituitary insufficiency, a lengthier variant of this test can be used.

What do my Cortisol test results mean?

Cortisol levels are typically lowest before bedtime and highest shortly after awakening, though this pattern can be disrupted if a person works rotating shifts and sleeps at various times on separate days.

Excess cortisol and Cushing syndrome are indicated by an increased or normal cortisol level shortly after awakening, as well as a level that does not diminish by bedtime. If the excess cortisol is not suppressed after an overnight dexamethasone suppression test, the 24-hour urine cortisol is elevated, or the late-night salivary cortisol level is elevated, the excess cortisol is likely due to abnormal increased ACTH production by the pituitary or a tumor outside of the pituitary, or abnormal production by the adrenal glands. Additional tests will aid in determining the root of the problem.

If the person examined responds to an ACTH stimulation test and has insufficient cortisol, the problem is most likely due to insufficient ACTH production by the pituitary. If the person does not respond to the ACTH stimulation test, the problem is most likely to be with the adrenal glands. Secondary adrenal insufficiency occurs when the adrenal glands are underactive as a result of pituitary dysfunction and/or insufficient ACTH synthesis. Adrenal injury causes decreased cortisol production, which is referred to as primary adrenal insufficiency or Addison disease.

Once an irregularity has been found and linked to the pituitary gland, adrenal glands, or another source, the health practitioner may utilize additional testing, such as a CT scan, to determine the extent of any gland damage.

Most Common Questions About the Cortisol 2 Sample Saliva test:

Purpose and Indications for the Cortisol 2 Sample Saliva Test

What is the primary purpose of the Cortisol 2 Sample Saliva test?

The Cortisol 2 Sample Saliva test is primarily designed to measure cortisol levels in the saliva at two different times of the day, typically morning and evening. These measurements can provide insights into the body's stress response and the function of the adrenal glands.

Why would someone need to take the Cortisol 2 Sample Saliva test?

This test can be beneficial for individuals experiencing symptoms like chronic fatigue, stress, unexplained weight gain or loss, or those suspected of having disorders related to the adrenal gland, such as Cushing's disease or Addison's disease.

Interpreting the Results

What do the results of the Cortisol 2 Sample Saliva test indicate?

The results will show the cortisol levels in the saliva samples taken at two different times. Elevated cortisol levels might indicate increased stress, Cushing's disease, or other conditions, while decreased levels could suggest Addison's disease, adrenal insufficiency, or other disorders.

How do cortisol levels vary throughout the day?

Cortisol levels typically follow a diurnal pattern, being highest in the morning shortly after waking up and declining throughout the day to reach their lowest at night. This pattern can be disrupted in certain medical conditions.

Dietary and Lifestyle Influence

Can my diet or lifestyle impact the Cortisol 2 Sample Saliva test results?

Yes, caffeine, certain foods, sleep patterns, physical activity, and acute stress can influence cortisol levels. It's advised to follow the specific guidelines provided before taking the test to ensure accurate results.

Follow-up and Treatment

What should be the next step after receiving the results of my Cortisol 2 Sample Saliva test?

Based on the results, if cortisol levels are abnormal, it's essential to consult with a healthcare professional. They might recommend further tests, lifestyle changes, or specific treatments depending on the identified condition.

If my cortisol levels are abnormal, does it mean I have an adrenal gland disorder?

Not necessarily. While abnormal cortisol levels can suggest a potential problem with the adrenal glands, they can also be influenced by various other factors, including acute stress or medication use. A comprehensive evaluation is needed to diagnose an adrenal gland disorder.

Conditions and Medications Influencing the Test

Can other medical conditions impact the Cortisol 2 Sample Saliva test results?

Yes, conditions such as major depression, anxiety disorders, physical trauma, malnutrition, pregnancy, and others can influence cortisol levels. It's essential to inform the healthcare provider about any existing conditions before the test.

Do medications affect the Cortisol 2 Sample Saliva test outcomes?

Certain medications, such as glucocorticoids, ACTH, birth control pills, and anti-seizure medicines, can influence cortisol levels. It's crucial to inform the healthcare professional about any medications taken before undergoing the test.

Lifestyle and Recommendations

Can factors like sleep deprivation or jet lag affect the Cortisol 2 Sample Saliva test?

Yes, disruptions in the body's internal clock, such as those caused by jet lag or sleep deprivation, can impact the diurnal rhythm of cortisol release, potentially affecting test results.

Is there a recommended time of day to take the Cortisol 2 Sample Saliva test?

The test usually requires two samples: one taken in the morning, typically within 30 minutes of waking, and another in the evening, however this can vary between physicians. This helps capture the natural variation in cortisol levels throughout the day.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.