Adrenal Fatigue Tests

Find the right adrenal tests with Ulta Lab Tests to monitor your health with an accurate reading of your results sent confidentially online in 24 to 48 hours. Order from Ulta Lab Tests today! 


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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.

Clinical Significance

21- Hydroxylase Antibody - 21-Hydroxylase Antibody is present in patients with autoimmune destruction of the adrenal glands, leading to Addison's disease. Antibody is also seen in autoimmune polyglandular syndrome.


Determination of ACTH is useful in differentiating between primary and secondary adrenocortical hypo- and hyperfunctional disorders: Addison's disease, Cushing's syndrome, adrenal carcinoma, ectopic ACTH syndrome, and adrenal nodular hyperplasia.

The Adrenal Complete Panel includes the following tests 

  • Aldosterone/Plasma Renin Activity Ratio, LC/MS/MS
  • Comprehensive Metabolic Panel (CMP)
  • CORTISOL, LC/MS/MS, SALIVA, 4 SAMPLES
  • DHEA Sulfate, Immunoassay 
  • Iron, Total
  • Lipid Panel with Ratios
  • Magnesium
  • Sex Hormone Binding Globulin (SHBG)

Adrenal Function Panel


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

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

Antiadrenal Antibody Screen With Reflex To Titer

This is a reflex test that may require additional tests to be run at additional cost to the patient.

If  Adrenal Antibody Screen is positive, Adrenal Antibody Titer will be performed at an additional charge (CPT code(s): 86256).


Increased CRP levels are found in inflammatory conditions including: bacterial infection, rheumatic fever, active arthritis, myocardial infarction, malignancies and in the post-operative state. This test cannot detect the relatively small elevations of CRP that are associated with increased cardiovascular risk.

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Serum calcium is involved in the regulation of neuromuscular and enzyme activity, bone metabolism and blood coagulation. Calcium blood levels are controlled by a complex interaction of parathyroid hormone, vitamin D, calcitonin and adrenal cortical steroids. Calcium measurements are useful in the diagnosis of parathyroid disease, some bone disorders and chronic renal disease. A low level of calcium may result in tetany.

Catecholamines, Fractionated, 24-Hour Urine with Creatinine 

Includes: Creatinine, Norepinephrine, Epinephrine, Dopamine, and Total Catecholamines (calculated)

Patient Preparation: It is preferable for the patient to be off medications for three days prior to collection. Common antihypertensives (Diuretics, Ace Inhibitors, Calcium Channel Blockers, Alpha and Beta Blockers) may cause minimal or no interference.

Preferred Specimen(s): 10 mL aliquot from a 24-hour collection preserved with 6N HCI at the start of collection 


A Complete Blood Count (CBC) Panel is used as a screening test for various disease states including anemia, leukemia and inflammatory processes.

A CBC blood test includes the following biomarkers: WBC, RBC, Hemoglobin, Hematocrit, MCV, MCH, MCHC, RDW, Platelet count, Neutrophils, Lymphs, Monocytes, Eos, Basos, Neutrophils (Absolute), Lymphs (Absolute), Monocytes(Absolute), Eos (Absolute), Basos (Absolute), Immature Granulocytes, Immature Grans (Abs)


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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

     


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

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

Cortisol is increased in Cushing's disease and decreased in Addison's disease (adrenal insufficiency). This test requires 5 individual serum blood specimens to be drawn; 30 minutes apart. Patient should plan for 3 hours at the patient service center.


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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.


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

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

Reference Range(s)

Adult    
8:00 A.M.-10:00 A.M. 0.07-0.93 µg/dL
4:00 P.M.-6:00 P.M. 0.04-0.45 µg/dL
10:00 P.M.-11:00 P.M. 0.04-0.35 µg/dL

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. 


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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: 

Screening 

  • 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