Cortisol, P.M. Most Popular

The Cortisol, P.M. test contains 1 test with 1 biomarker.

Brief Description: The Cortisol PM test measures the level of cortisol, a hormone produced by the adrenal glands, in the afternoon or evening. Cortisol plays a crucial role in regulating various bodily functions, including metabolism, immune response, and stress response.

Also Known As: Cortisol PM Test, Cortisol Total Test, Cortisol Test, Cortisol Blood Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: Must be drawn between 3 and 5 p.m.

When is Cortisol PM test ordered?

A healthcare provider may order a Cortisol PM test to evaluate the level of cortisol in the afternoon or evening. It is usually done as a follow-up to a morning cortisol test (Cortisol AM) to assess the diurnal pattern of cortisol secretion. This test is often ordered to investigate conditions related to cortisol imbalances, such as Cushing's syndrome or Addison's disease. Additionally, the test can help identify abnormal cortisol levels caused by chronic stress, medication usage, or certain medical conditions.

What does a Cortisol PM blood 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 PM test:

When a Cortisol PM test is ordered, it's often part of a broader evaluation of adrenal function and related hormonal balance. Here are some tests commonly ordered alongside it:

1. Cortisol AM:

   • Purpose: To measure cortisol levels in the morning when they should be at their peak.
   • Why Is It Ordered: Comparing AM and PM cortisol levels can help assess if the diurnal pattern of cortisol secretion is normal, which is important in diagnosing conditions like Cushing's syndrome or adrenal insufficiency.

2. ACTH (Adrenocorticotropic Hormone):

   • Purpose: To measure the level of ACTH, a pituitary hormone that stimulates cortisol production.
   • Why Is It Ordered: To help determine whether abnormalities in cortisol levels are due to primary adrenal gland dysfunction or secondary to pituitary gland issues.

3. Dexamethasone Suppression Test:

   • Purpose: To check how taking a corticosteroid (dexamethasone) affects cortisol production.
   • Why Is It Ordered: To help diagnose Cushing's syndrome and differentiate between different types of this condition.

4. 24-Hour Urinary Free Cortisol:

   • Purpose: To measure the amount of cortisol excreted in the urine over 24 hours.
   • Why Is It Ordered: To assess cortisol production over a full day, which can be helpful in diagnosing Cushing's syndrome.

5. Salivary Cortisol:

   • Purpose: To measure cortisol levels in saliva, which can reflect free (biologically active) cortisol levels in the blood.
   • Why Is It Ordered: To assess cortisol secretion patterns and diagnose disorders like Cushing's syndrome, especially in the evening when levels should be low.

6. Renin and Aldosterone:

   • Purpose: To measure levels of renin and aldosterone, hormones involved in blood pressure regulation.
   • Why Is It Ordered: To evaluate for conditions like hyperaldosteronism, especially if the patient has hypertension along with abnormal cortisol levels.

7. Complete Blood Count (CBC) and Comprehensive Metabolic Panel (CMP):

   • Purpose: To provide a broad picture of overall health.
   • Why Is It Ordered: To check for abnormalities in blood cells, electrolytes, and kidney and liver function, which can be affected by hormonal imbalances.

8. Blood Glucose and Hemoglobin A1c:

   • Purpose: To measure blood sugar control over time.
   • Why Is It Ordered: Elevated cortisol levels can affect blood sugar levels and may be associated with insulin resistance or diabetes.

These tests, when ordered alongside a Cortisol PM test, provide a comprehensive assessment of adrenal function, cortisol production patterns, and potential hormonal imbalances. They are crucial for diagnosing and managing conditions affecting the adrenal and pituitary glands, including Cushing's syndrome, adrenal insufficiency, and other related disorders. The specific combination of tests will depend on the individual’s symptoms, medical history, and preliminary test results.

Conditions where a Cortisol PM test is recommended:

A Cortisol PM test may be ordered to investigate or monitor various conditions, including:

1. Cushing's Syndrome: Characterized by excessive cortisol production, it may lead to weight gain, high blood pressure, and changes in the appearance of the face (moon face) and body (buffalo hump).

2. Addison's Disease: A condition in which the adrenal glands do not produce enough cortisol and other hormones, leading to fatigue, weight loss, and low blood pressure.

3. Chronic Stress: Prolonged stress can disrupt the normal cortisol diurnal pattern, leading to health issues.

How does my health care provider use a Cortisol PM 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 PM 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 PM test:

Understanding the Cortisol PM Test

What is the Cortisol PM test?

The Cortisol PM test is a blood test that measures the level of cortisol, a hormone produced by the adrenal glands, in the blood in the afternoon or evening. Cortisol levels normally fluctuate throughout the day and are typically lowest at night.

Why is the Cortisol PM test ordered?

The Cortisol PM test is often ordered when a healthcare provider suspects that a person may have an abnormal cortisol rhythm, such as in conditions like Cushing's syndrome or Addison's disease.

What do the results of the Cortisol PM test mean?

Cortisol levels are expected to decrease throughout the day, being highest in the morning and lowest in the evening. If the Cortisol PM test shows elevated levels, it may indicate a condition like Cushing's syndrome. If the levels are too low, it could suggest Addison's disease or adrenal insufficiency.

Interpreting Cortisol PM Test Results

What does a high Cortisol PM result mean?

A high Cortisol PM result could suggest that your body is producing too much cortisol, a condition known as hypercortisolism or Cushing's syndrome. This could be due to various reasons, including a tumor in the adrenal glands or pituitary gland, or long-term use of corticosteroid medications.

What does a low Cortisol PM result mean?

A low Cortisol PM result could indicate that your body is not producing enough cortisol, a condition known as hypocortisolism or Addison's disease. This could be due to damage to the adrenal glands or pituitary gland, or it could be the result of certain medications.

Cortisol PM Test and Specific Health Conditions

How is the Cortisol PM test used in diagnosing Cushing's syndrome?

In Cushing's syndrome, the body produces too much cortisol. Normally, cortisol levels drop in the evening, but in someone with Cushing's syndrome, cortisol levels may remain high. A Cortisol PM test can help confirm a diagnosis of Cushing's syndrome when other symptoms and tests suggest this condition.

How is the Cortisol PM test used in diagnosing Addison's disease?

In Addison's disease, the body does not produce enough cortisol. A Cortisol PM test, along with other tests and symptom assessment, can help diagnose this condition by showing lower than normal levels of cortisol.

Cortisol PM Test and Treatment Considerations

How do the results of the Cortisol PM test influence the treatment plan?

The results of the Cortisol PM test can guide treatment options. If cortisol levels are high, treatment may focus on reducing cortisol production or addressing the underlying cause, like a tumor. If cortisol levels are low, treatment may involve cortisol replacement therapy.

How frequently should the Cortisol PM test be repeated?

The frequency of the Cortisol PM test will depend on your individual situation, including your symptoms, the severity of your condition, and your response to treatment. Your healthcare provider will advise on how often you need the test.

Cortisol PM Test and Other Diagnostic Tools

How does the Cortisol PM test relate to other tests for adrenal function?

The Cortisol PM test is one of several tests that may be used to evaluate adrenal function. Other tests may include the Cortisol AM test, ACTH stimulation test, and dexamethasone suppression test.

Patient Considerations

Can lifestyle changes impact the Cortisol PM test results?

Yes, factors such as stress, lack of sleep, and certain dietary habits can affect cortisol levels and potentially impact the results of the Cortisol PM test.

What factors can influence the Cortisol PM test results?

Many factors can influence Cortisol PM test results, including physical stress, emotional stress, illness, certain medications (like corticosteroids), and disorders of the adrenal or pituitary gland.

Understanding Advancements and Limitations

How does the Cortisol PM test relate to the overall assessment of adrenal function?

The Cortisol PM test is an important part of the overall assessment of adrenal function. However, it's usually not used alone, and the results need to be interpreted in the context of other tests and clinical findings.

Can the Cortisol PM test predict the risk of developing adrenal disorders?

The Cortisol PM test is not typically used to predict the risk of developing adrenal disorders. It's used primarily as a diagnostic tool when a specific disorder is suspected.

Can the Cortisol PM test provide insights into the severity of an adrenal disorder?

Cortisol PM test results can help indicate the severity of certain adrenal disorders. For instance, in Cushing's syndrome, higher levels of cortisol might indicate a more severe condition.

Can certain medications affect the Cortisol PM test results?

Yes, certain medications, especially corticosteroids, can significantly affect Cortisol PM test results. It's important to inform your healthcare provider about all medications you're taking.

Can the Cortisol PM test be used in conjunction with imaging tests?

Yes, if an adrenal or pituitary gland disorder is suspected, the Cortisol PM test may be used in conjunction with imaging tests, such as a CT scan or MRI, to provide a more comprehensive evaluation.

Can the Cortisol PM test be used in monitoring the effectiveness of treatment for adrenal disorders?

Yes, the Cortisol PM test can be useful in monitoring the effectiveness of treatments for conditions like Cushing's syndrome or Addison's disease. Changes in cortisol levels can help indicate whether treatment is working.

Can the Cortisol PM test be used in studying the effects of stress or other psychological factors on the body?

Yes, because cortisol is a stress hormone, the Cortisol PM test can be used in research settings to study the effects of stress or other psychological factors on the body.

Can the Cortisol PM test provide insights into other aspects of health?

While the primary use of the Cortisol PM test is to evaluate adrenal function, cortisol is involved in many bodily functions, including metabolism, immune response, and stress response. So, the test may provide some insight into these aspects of health as well.

Can the Cortisol PM test be used to evaluate the impact of interventions aimed at reducing stress?

In a research setting, the Cortisol PM test might be used to evaluate the effectiveness of interventions aimed at reducing stress, such as mindfulness-based stress reduction or cognitive-behavioral therapy.

Can certain diseases or conditions affect the Cortisol PM test results?

Yes, diseases or conditions that affect the adrenal or pituitary glands can impact the results of the Cortisol PM test. These could include tumors, infections, or autoimmune conditions.

Can the Cortisol PM test be used in a differential diagnosis of adrenal disorders?

Yes, the Cortisol PM test, in combination with other tests and clinical findings, can be used in a differential diagnosis of adrenal disorders, helping to distinguish between conditions with similar symptoms.

Can the Cortisol PM test be used to determine the need for further diagnostic testing?

Yes, if the Cortisol PM test results are abnormal, it might suggest the need for further diagnostic testing, such as imaging tests, to more accurately diagnose the underlying cause.

Can the Cortisol PM test be used in risk stratification for patients with known adrenal disorders?

Yes, in some cases, the Cortisol PM test could be used as part of risk stratification in patients with known adrenal disorders, helping to guide treatment decisions and prognosis.

Patient needs to have the specimen collected between 3 p.m - 5 p.m.

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