Adrenal Fatigue Tests (Hormone)

Do you feel tired all the time?

Get the answers you need with our adrenal tests that measure adrenal function, cortisol levels, and vitamin and mineral status.

You may be suffering from adrenal fatigue. Many people suffer from adrenal fatigue, which is a medical disease. It happens when your body is forced to work harder than usual to cope with stress. Your adrenal glands control cortisol production in reaction to stress. Cortisol helps control blood sugar levels and maintain healthy blood pressure, so when it becomes unbalanced due to stress, it can cause a range of health issues. 

Physical stress (such as an illness or infection), emotional stress (such as relationship troubles), mental stress (such as work pressure), and environmental stress are all examples of stress (such as pollution). Chronic tiredness, which may be devastating, low energy levels, and feeling weary even after receiving adequate sleep are all symptoms of adrenal fatigue. It's also known as hypocortisolism or adrenal insufficiency. Low energy, difficulty sleeping, and feeling overwhelmed by daily responsibilities are among symptoms that might arise due to this. The good news is that adrenal fatigue can be detected with simple blood tests, and there are treatments available to help you manage your symptoms so you can get back to living life on your terms. 

If you want to learn more about adrenal fatigue and the lab tests that can help you, click on the title of the articles below.

We provide lab tests to assess your adrenal function, cortisol levels, and vitamin and mineral status, so you can obtain the information you need. With our adrenal fatigue blood tests, you can discover your cortisol levels and get back on track to feeling like yourself. 

Order your adrenal fatigue blood tests from the selection below today and stop letting fatigue hold you back!


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The Adrenal Complete Panel includes the following tests 

  • Aldosterone/Plasma Renin Activity Ratio, LC/MS/MS
  • Comprehensive Metabolic Panel (CMP)
  • DHEA Sulfate, Immunoassay 
  • Iron, Total
  • Lipid Panel with Ratios
  • Magnesium
  • Sex Hormone Binding Globulin (SHBG)

Adrenal Function Panel

Androstenedione is useful when evaluating patients with androgen excess and managing patients with Congenital Adrenal Hyperplasia (CAH).

Helpful in assessing testicular function in prepubescent hypogonadal males and in managing hirsutism, virilization in females

This is an uncapped test. Reference ranges above 1100 ng/dL can be reported with a quantitative result.

Helpful in assessing testicular function in males and managing hirsutism, virilization in females.

Testosterone circulates almost entirely bound to transport proteins: normally less than 1% is free. Measurement of Free Testosterone may be useful when disturbances in Sex Hormone Binding Globulin (SHBG) are suspected such as when patients are obese or have excessive estrogen. Testosterone measurements are used to assess erectile dysfunction, infertility, gynecomastia, and osteoporosis and to assess hormone replacement therapy.

This test is useful in the differential diagnosis of male hypogonadism. For males 18 years of age and older only. Pediatric and Female patients will need to order Testosterone, Total, MS #15983.

Due to changes in testosterone levels throughout the day, two morning (8:00-10:00 a.m.) specimens obtained on different days are recommended by The Endocrine Society for screening.

Please note: If Testosterone, Total, Males (Adult) Only #873 is ordered for a pediatric or female patient, the lab will automatically change the test to and charge for Testosterone, Total, MS #15983.

This test can report a value up to 3000 ng/dL. any number >3000 will be stated as >3000.

Helpful in assessing testicular function in male and managing hirsutism, virilization in females.

DHEA is a weakly androgenic steroid that is useful when congenital adrenal hyperplasia is suspected. It is also useful in determining the source of androgens in hyperandrogenic conditions, such as polycystic ovarian syndrome and adrenal tumors.

DHEA-S is the sulfated form of DHEA and is the major androgen produced by the adrenal glands. This test is used in the differential diagnosis of hirsute or virilized female patients and for the diagnosis of isolated premature adrenarche and adrenal tumors. About 10% of hirsute women with polycystic ovarian syndrome (PCOS) have elevated DHEA-S but normal levels of other androgens.

DHEA-S is the sulfated form of DHEA and is the major androgen produced by the adrenal glands. This test is used in the differential diagnosis of hirsute or virilized female patients and for the diagnosis of isolated premature adrenarche and adrenal tumors. About 10% of hirsute women with Polycystic Ovarian Syndrome (PCOS) have elevated DHEA-S but normal levels of other androgens.

17-Hydroxypregnenolone, LC/MS/MS

Clinical Significance

17-Hydroxypregnenolone is useful in the diagnosis of 3-Beta-Hydroxylase enzyme deficiency, a rare cause of congenital adrenal hyperplasia, and 17-Hydroxylase (P450c17) enzyme deficiency.


17-hydroxyprogesterone is elevated in patients with congenital adrenal hyperplasia (CAH). CAH is a group of autosomal recessive diseases characterized by a deficiency of cortisol and an excess of ACTH concentration. 17-hydroxyprogesterone is also useful in monitoring cortisol replacement therapy and in evaluating infertility and adrenal and ovarian neoplasms.

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Pregnenolone is a chemical substance that is a precursor to all steroid hormones. This test measures the amount of pregnenolone in the blood in order to help detect rare forms of congenital adrenal hyperplasia (CAH).

Determination of aldosterone is useful in the diagnosis and evaluation of primary aldosteronism, selective hypoaldosteronism, edematous states, and other conditions of electrolyte imbalance

Approximately 1-2% of individuals with primary hypertension have primary hyperaldosteronism characterized by hypokalemia (low potassium) and low direct renin. Because serum aldosterone concentrations vary due to dietary sodium intake and body position, some physicians prefer measurement of 24-hour urine concentration for aldosterone.

The Aldosterone-renin ratio is used to screen for primary aldosteronism

Antinuclear antibodies are associated with rheumatic diseases including Systemic Lupus Erythematous (SLE), mixed connective tissue disease, Sjogren's syndrome, scleroderma, polymyositis, CREST syndrome, and neurologic SLE. 

Reflex Information: If ANA Screen, IFA is positive, then ANA Titer and Pattern will be performed at an additional charge.

Comprehensive Metabolic Panel

Renin plays a central role in maintaining blood pressure by enzymatically converting angiotensinogen to angiotensin I, which is then cleaved by angiotensin converting enzyme to form angiotensin II. Angiotensin II increases blood pressure directly through vasoconstriction and indirectly by stimulating secretion of aldosterone, a hormone that promotes sodium retention and potassium loss. Renin secretion is inhibited by high blood pressure and stimulated by factors that lower blood pressure, such as upright posture and sodium deprivation. A variety of drug classes also physiologically affect plasma renin activity (PRA) levels (Table). PRA is typically used in conjunction with the measurement of aldosterone, sodium, and potassium levels in plasma and/or urine.

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Cortisol is increased in Cushing's Disease and decreased in Addison's Disease (adrenal insufficiency). Patient needs to have the specimen collected between 7 a.m.-9 a.m.

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Cortisol is increased in Cushing's Disease and decreased in Addison's Disease (adrenal insufficiency).

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. Collection Instructions

    1. Place contents on a clean and dry surface.
    2. Firmly attach the Collection Tube (E) provided to the base (D) of the Compression tube (C) (Figure 1). In preparation for saliva collection, pool saliva in the mouth. Sample collection may now begin.
    3. Place the tip of the pad of the Collector (A) where saliva has pooled (Figure 2).
    4. The Collector (A) may be removed from the mouth periodically to read the SVAI, but resume collection immediately afterward. Collect until the appearance of the SVAI (B) changes from white to fully red (Figure 3). The collection procedure should last approximately 1-5 minutes.
    6. Place the white absorbent pad end into the Compression Tube (C) holding the Collector (A) in an upright and vertical position and firmly push the plunger downwards to transfer saliva from the absorbent pad into the Collection Tube (E). Push and hold for 30 seconds (Figure 4).
    6. Gently remove the Collection Tube (E) from the end of the Compression Tube (C). It is appropriate to remove the Collection Tube (E) during expression if necessary due to foaming. Close the lid on the tube tightly.
    7. Label the collected sample immediately, include date and time of collection and store at refrigerated temperatures for shipment.
    For Technical Support, call 1-800-642-4657 ext. 2904.

    Transport Temperature

    Room temperature


Urinary Free Cortisol is useful in the detection of patients with Cushing's syndrome for whom Free Cortisol concentrations are elevated.

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Cortisol is increased in Cushing's Disease and decreased in Addison's Disease (adrenal insufficiency).

Congenital adrenal hyperplasia (CAH) is a collection of inherited problems of the adrenal gland. These tiny triangular organs are in the lower part of the body, just above the kidneys. They secret steroid hormones, namely cortisol, and aldosterone. In CAH, the shortage of enzymes required to produce these hormones leads to the abnormal functioning of the body. 

The adrenal gland converts cholesterol into pregnenolone. Then, specific enzymes complete the production of cortisol, aldosterone, and androgens. Dysfunctional enzymes or deficient ones result in abnormal production volumes of these substances. Insufficient levels of cortisol lead to an increased volume of the pituitary hormone, which is responsible for adrenal growth and hormone production (ACTH). The result is that the adrenal gland becomes oversized. Unfortunately, this increase in size and activity can’t compensate for the block in the production of cortisol. There are also Congenital Adrenal Hyperplasia forms that trigger excessive production of other steroid hormones known as androgens (such as 17-hydroxyprogesterone). Almost all cases of CAH, however, are due to a deficiency in the enzyme 21-hydroxylase (classical CAH), so we are going to focus solely on this in our article. 

One of the major effects of Congenital Adrenal Hyperplasia is a lowering of cortisol and aldosterone levels. In some cases, there’s also an increase in the androgens level. These male hormones can trigger modifications of genital organs in female infants. Often, these changes are visible at birth. Sometimes, the external genital organs on the newborn are ambiguous, making it hard to tell a male from a female. Although rare, CAH is the main cause of ambiguous external genitals in newborns. 

Male babies born with this condition will appear normal at birth, but they may experience early puberty caused by excess androgens. Female children may develop hirsutism (excess hair in otherwise hairless areas), as well as acne, clitoral enlargement, and other such signs of excess androgens. They will also suffer from irregular menstruation. Both males and females suffering from CAH have growth troubles. Children grow at a higher than normal rate, they experience early puberty, but they end up as shorter stature adults if left untreated. CAH may also trigger infertility by the time of adulthood. 

CAH enzyme deficiencies are the result of mutations in specific genes. These genes are autosomal recessive. This means the child needs to inherit the defective gene from both parents to develop the condition. Someone with only one copy will be a carrier but won’t experience any symptoms. If this individual meets someone who also has one copy of the mutated gene, and they have a baby together, the newborn will suffer from CAH. Scientists have identified different gene mutations. 

All but 10% of CAH cases are the result of a 21-hydroxylase deficiency, which is caused by a mutation in the CYP21A2 gene. These individuals may develop a classic (more severe) or nonclassic type of CAH. About three-quarters of all classic deficiency sufferers develop a “salt-wasting” CAH form with lower aldosterone levels, an excessive loss of fluids, low sodium, and high potassium levels. This is a life-threatening condition. 

Main Symptoms and Signs 

The symptoms of congenital adrenal hyperplasia depend on the type of enzyme deficiency and on the levels of cortisol, aldosterone, and androgens. These symptoms are variable in time, and they may worsen with stress or illness. 

The classic CAH type that leads to excess loss of fluids and salt can evolve to become a life-threatening adrenal crisis. 

The main signs and symptoms of adrenal crisis: 

  • Rapid heart rate, abnormal rhythm, low blood pressure 
  • Hyperkalemia (high potassium levels in the blood) 
  • Hypoglycemia (low blood sugar levels) 
  • Hyponatremia (low blood sodium levels) 
  • Irritability, confusion 
  • Dehydration 
  • Vomiting 
  • Females with classic CAH may also have ambiguous external genitals that aren’t clearly male or female. However, their reproductive system is normal (they have a normal uterus, ovaries, and fallopian tubes). 

Symptoms and signs of excess androgens in boys and girls in childhood and puberty: 

  • Accelerated growth (tall children end up as short adults) 
  • Deep voice 
  • Acne 
  • Enlarged penis in male sufferers (and enlarged clitoris in female sufferers) 
  • Hirsutism in females (excess hair on face and body) 
  • Infertility (or severe fertility issues) 
  • Irregular menstrual cycles in female sufferers 
  • Excess muscle growth 
  • Early growth of pubic and armpit hair 
  • Laboratory Tests 

Here are the main objectives of the congenital adrenal hyperplasia testing: 

  • Screening of all newborns for 21-hydroxylase deficiency 
  • Confirmation of the condition in those with positive screens 
  • Confirmation of the diagnosis in those with symptoms 
  • Determine the carrier status of an individual who has a family member with 21-hydroxylase deficiency 
  • Determine the chromosomal sex (XX or XY) of a newborn in case of ambiguous genitals 
  • Monitor and adjust CAH treatment 
  • Monitor the health evolution of an individual with adrenal crisis 
  • Detect 21-hydroxylase deficiency during pregnancy (not very frequent) 
  • Identify or exclude other types of CAH other than 21-hydroxylase deficiency 

The treatment stages may include the following: 


  • Newborn screening for 21-hydroxylase deficiency is part of the routine testing in the United States. Unfortunately, it doesn’t help to identify infants with other types of CAH. Also, this screening may generate false positives. 
  • Prenatal testing with amniocentesis or chorionic villus analysis. 

Diagnose and Detection 

17-OHP – this test may show highly elevated numbers with 21-hydroxylase deficiency 

ACTH stimulation – the test measures the blood cortisol levels before and after a synthetic ACTH injection. If the adrenal glands are normal, cortisol levels will increase as a result of the ACTH injection; this isn’t a widely used test, though. 

In case 17-OHP is elevated, doctors may order additional tests that may include any of the following: 

  • Androstenedione 
  • Testosterone 
  • 11-deoxycortisol 
  • Dehydroepiandrosterone sulfate (DHEAS) 
  • 17-hydroxypregnenolone 
  • Pregnenolone 
  • Aldosterone and renin – to check whether these substances are within normal limits 
  • Chromosome analysis (karyotyping) – to find out a baby’s gender by identifying their chromosomes (XX (female) or XY (male)) 
  • Genetic testing – useful for detecting gene mutations; not usually required for a firm diagnosis but may be used for prenatal detection. It can also be useful for detecting gene mutations in family members to help determine carrier status. This test can detect the most common mutations. If a family is already known to have a specific mutation, testing should include that mutation. 
  • Treatment Monitoring (Tests Repeated Every Few Months) 
  • 17-OHP 
  • Androstenedione 
  • Testosterone 
  • Renin 
  • Overall Health Monitoring 
  • Comprehensive Metabolic Panel