Adrenal Fatigue Tests (Hormone)

Adrenal Fatigue Testing and health information

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!

 


Name Matches

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)

This panel contains both Cortisol, A.M. #4212 and Cortisol, P.M. #4213, which will require the patient to visit the patient service center twice in one day.

  • First visit between 7 a.m. - 9 a.m. to have Cortisol, A.M. #4212 drawn along with most of the panel
  • Second visit between 3 p.m. – 5 p.m. to have Cortisol, P.M. #4213 drawn.

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

Brief Description: Testosterone, Free (Dialysis) and Total, MS is a blood test used to detect abnormal levels of testosterone in both male and female patients, and diagnose causes of erectile dysfunction, infertility, virilization, polycystic ovary syndrome, and delayed or early puberty in children.

Also Known As: Total Testosterone, Free Testosterone, Testosterone Free and Total

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a Free and Total Testosterone test ordered?

When infertility is suspected, or when a man has decreased sex drive or erectile difficulties, a testosterone test may be ordered. Other signs include a lack of beard and body hair, a loss of muscle mass, and the formation of breast tissue. Low total and bioavailable testosterone levels have also been linked to, or caused by, increased visceral fat, insulin resistance, and an increased risk of coronary artery disease.

The test is frequently ordered in conjunction with the FSH and LH tests in males who are experiencing delayed or slow puberty. Although the age at which puberty begins varies from person to person, it usually begins around the age of ten. The following are some of the signs and symptoms of delayed puberty:

  • Muscle mass development is delayed.
  • Voice not getting lower or a lack of body hair growth
  • Growth of the testicles and penis is slowed or delayed.

When a young boy appears to be going through an early puberty with clear secondary sex traits, the test can be ordered. Various malignancies and congenital adrenal hyperplasia can cause early puberty in boys due to elevated testosterone.

When a woman has irregular or no menstrual cycles, is having trouble getting pregnant, or displays masculine traits such as abundant facial and body hair, male pattern baldness, and/or a low voice, testosterone testing may be done. Testosterone levels can rise as a result of malignancies in the ovary or adrenal gland, as well as other illnesses including polycystic ovarian syndrome.

What does a Testosterone Total and Free blood test check for?

In men, testosterone is the primary sex hormone. It's in charge of a man's physical appearance. Although it is thought to be a "masculine" sex hormone, it is found in both men and women's blood. This test determines the amount of testosterone in a person's blood.

Testosterone is primarily produced in the male testicles by unique endocrine tissue called Leydig cells. It's also made by the adrenal glands in both males and females, as well as the ovaries in females in modest amounts.

In males, testosterone promotes the formation of secondary sex characteristics such as penis size, body hair growth, muscle development, and a deeper voice. It is abundant in males during adolescence and adulthood in order to regulate sex drive and preserve muscle mass. Estradiol is the major sex hormone in females, and testosterone is converted to it in women.

The pituitary gland produces luteinizing hormone, which stimulates and regulates testosterone synthesis. Testosterone functions in a negative feedback loop: when testosterone levels rise, LH production falls, slowing testosterone production; lower testosterone levels cause higher LH production, which promotes testosterone production.

Testosterone levels fluctuate throughout the day, increasing in the early morning hours and dropping in the evening. Levels rise after activity and fall as people get older.

About two-thirds of testosterone is attached to sex-hormone binding globulin in the bloodstream, with the remaining one-third bound to albumin. Only a small percentage of testosterone is released into the bloodstream as free testosterone. The bioavailable fraction is the free plus albumin-bound testosterone, which can act on target tissues.

Lab tests often ordered with a Testosterone Free and Total test:

  • Estradiol
  • Dihydrotestosterone
  • FSH
  • LH
  • Estrogens
  • Estriol
  • Estrone
  • Albumin
  • Prolactin
  • Anti-mullerian Hormone
  • Androstenedione
  • Sex Hormone Binding Globulin

Conditions where a Testosterone Free and Total test is recommended:

  • Polycystic Ovary Syndrome
  • Alcoholism
  • Mumps
  • Hypothalamic disease
  • Pituitary disease
  • Infertility
  • Liver disease
  • Hyperthyroidism
  • Eating disorders
  • Pregnancy
  • Cushing Syndrome
  • Hypothyroidism
  • Testicular cancer
  • Adrenal insufficiency
  • Congenital Adrenal Hyperplasia

Commonly Asked Questions:

How does my health care provider use a Testosterone Free and Total test?

In men, women, girls, and boys, testosterone testing is used to identify a variety of problems. Testosterone is the major sex hormone in males, and it is responsible for masculine physical traits. It is produced mostly by the testicles. Although it is thought to be a "male" sex hormone, it is found in both males and females.

The testosterone test can be used to determine whether or not you're experiencing:

  • Delayed or early puberty in boys
  • In both men and women, sex drive has decreased.
  • Men's erectile dysfunction
  • Male and female infertility
  • Tumors of the testicles in men
  • Disorders of the hypothalamus or pituitary gland
  • Virilization and hirsutism in girls and women

A testosterone total test is usually used to diagnose a condition. The free and total testosterone test distinguishes between testosterone that is bound to proteins in the blood and testosterone that is not attached to proteins.

About two-thirds of testosterone is tied to SHBG in the blood, with the remaining one-third attached to albumin. Free testosterone circulates in a tiny percentage. Bioavailable testosterone is made up of free testosterone and testosterone bound to albumin, and it can operate on target tissues.

A test for free or bioavailable testosterone may be performed in some circumstances, such as when the level of SHBG is abnormal, as it may more accurately indicate the presence of a medical issue.

Other tests and hormone levels may be performed in conjunction with testosterone testing, depending on the reason for testing. Here are a few examples:

  • FSH
  • LH
  • Estrogen
  • Estradiol
  • SHBG
  • DHEA-S
  • Prolactin
  • Androstenedione
  • 17-Hydroxyprogesterone

What does my testosterone test result mean?

Males: 

Testosterone levels often begin to fall after the age of 30. Testosterone levels may drop more in obese or chronically unwell men, as well as with the use of certain drugs.

Hypogonadism can be caused by a variety of factors, including:

  • Pituitary or hypothalamic illness
  • Reduced testosterone production in young males can be caused by genetic disorders
  • Possible infertility or testicular failure
  • Acquired damage to the testes, such as from drinking, physical injury, or viral infections like mumps, reduces testosterone production.
  • Diabetes

Healthcare practitioners may recommend testosterone replacement therapy to men who have consistently low testosterone levels and associated signs and symptoms. The Food and Drug Administration has not approved testosterone supplements to improve strength, sports performance, or avoid aging disorders. It's possible that using it for these purposes is dangerous.

Increased testosterone levels in men can mean one of several things:

  • Tumors of the testicles
  • Testosterone-producing tumors in the adrenal glands
  • Use of anabolic steroids
  • Early puberty in males due to an unknown cause
  • Adrenal hyperplasia in toddlers and babies

Females:

Testosterone levels in women are typically low. Increased testosterone levels can mean one of the following things:

  • Ovarian or adrenal gland tumor
  • PCOS
  • Adrenal hyperplasia that occurs at birth.

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


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

Description: Testosterone Free and Total with Sex Hormone Binding Globulin is a blood test used to detect abnormal levels of testosterone in both male and female patients, and diagnose causes of erectile dysfunction, infertility, virilization, polycystic ovary syndrome, and delayed or early puberty in children.

Also Known As: Total Testosterone Test, Free Testosterone Test, Testosterone Free and Total Test, Sex Hormone Binding Globulin Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a Testosterone Free and Total with Sex Hormone Binding Globulin test ordered?

When infertility is suspected, or when a man has decreased sex drive or erectile difficulties, a testosterone test may be ordered. Other signs include a lack of beard and body hair, a loss of muscle mass, and the formation of breast tissue. Low total and bioavailable testosterone levels have also been linked to, or caused by, increased visceral fat, insulin resistance, and an increased risk of coronary artery disease.

The test is frequently ordered in conjunction with the FSH and LH tests in males who are experiencing delayed or slow puberty. Although the age at which puberty begins varies from person to person, it usually begins around the age of ten. The following are some of the signs and symptoms of delayed puberty:

  • Muscle mass development is delayed.
  • Voice not getting lower or a lack of body hair growth
  • Growth of the testicles and penis is slowed or delayed.

When a young boy appears to be going through an early puberty with clear secondary sex traits, the test can be ordered. Various malignancies and congenital adrenal hyperplasia can cause early puberty in boys due to elevated testosterone.

When a woman has irregular or no menstrual cycles, is having trouble getting pregnant, or displays masculine traits such as abundant facial and body hair, male pattern baldness, and/or a low voice, testosterone testing may be done. Testosterone levels can rise as a result of malignancies in the ovary or adrenal gland, as well as other illnesses including polycystic ovarian syndrome.

What does a Testosterone Total and Free with Sex Hormone Binding Globulin blood test check for?

In men, testosterone is the primary sex hormone. It's in charge of a man's physical appearance. Although it is thought to be a "masculine" sex hormone, it is found in both men and women's blood. This test determines the amount of testosterone in a person's blood.

Testosterone is primarily produced in the male testicles by unique endocrine tissue called Leydig cells. It's also made by the adrenal glands in both males and females, as well as the ovaries in females in modest amounts.

In males, testosterone promotes the formation of secondary sex characteristics such as penis size, body hair growth, muscle development, and a deeper voice. It is abundant in males during adolescence and adulthood in order to regulate sex drive and preserve muscle mass. Estradiol is the major sex hormone in females, and testosterone is converted to it in women.

The pituitary gland produces luteinizing hormone, which stimulates and regulates testosterone synthesis. Testosterone functions in a negative feedback loop: when testosterone levels rise, LH production falls, slowing testosterone production; lower testosterone levels cause higher LH production, which promotes testosterone production.

Testosterone levels fluctuate throughout the day, increasing in the early morning hours and dropping in the evening. Levels rise after activity and fall as people get older.

About two-thirds of testosterone is attached to sex-hormone binding globulin in the bloodstream, with the remaining one-third bound to albumin. Only a small percentage of testosterone is released into the bloodstream as free testosterone. The bioavailable fraction is the free plus albumin-bound testosterone, which can act on target tissues.

In many circumstances, measuring total testosterone is sufficient information for a healthcare provider. A test for free or bioavailable testosterone may be performed in some circumstances, such as when the level of SHBG is abnormal, as it may more accurately indicate the presence of a medical issue.

SHBG is a liver-produced protein that strongly binds to the hormones testosterone, dihydrotestosterone, and estradiol. SHBG distributes these hormones in the blood as physiologically inactive versions when they are bound. This test examines the amount of SHBG in the blood and is most commonly used to determine whether a person has too much or too little testosterone.

In men, SHBG binds roughly 45 percent to 65 percent of testosterone in the blood, with the rest weakly and reversibly linked to albumin. Only around 2% to 3% of testosterone is accessible to tissues as free testosterone, but testosterone that is weakly linked to albumin is also bioavailable and can be rapidly absorbed by the body's tissues.

In women, a somewhat higher percentage of testosterone is bound to SHBG in the blood than in men. SHBG is important in controlling the quantities of bioavailable male sex hormones and estrogens circulating throughout the body in women. Because SHBG has a stronger affinity for the androgens testosterone and DHT, women with low SHBG may experience signs and symptoms of androgen excess.

A total testosterone test does not differentiate between bound and unbound testosterone; instead, it determines the total amount of testosterone present. In many circumstances, this is sufficient to determine if testosterone production is excessive or inadequate. However, if a person's SHBG level is abnormal, the total testosterone level may not accurately reflect the amount of testosterone available to the person's tissues. When a person's indications and symptoms do not match the results of a total testosterone test, a SHBG test may be conducted.

Lab tests often ordered with a Testosterone Free and Total with Sex Hormone Binding Globulin test:

  • Estradiol
  • Dihydrotestosterone
  • FSH
  • LH
  • Estrogens
  • Estriol
  • Estrone
  • Albumin
  • Prolactin
  • Anti-mullerian Hormone
  • Androstenedione

Conditions where a Testosterone Free and Total with Sex Hormone Binding Globulin test is recommended:

  • Polycystic Ovary Syndrome
  • Alcoholism
  • Mumps
  • Hypothalamic disease
  • Pituitary disease
  • Infertility
  • Liver disease
  • Hyperthyroidism
  • Eating disorders
  • Pregnancy
  • Cushing Syndrome
  • Hypothyroidism
  • Testicular cancer
  • Adrenal insufficiency
  • Congenital Adrenal Hyperplasia

Commonly Asked Questions:

How does my health care provider use a Testosterone Free and Total with Sex Hormone Binding Globulin test?

In men, women, girls, and boys, testosterone testing is used to identify a variety of problems. Testosterone is the major sex hormone in males, and it is responsible for masculine physical traits. It is produced mostly by the testicles. Although it is thought to be a "male" sex hormone, it is found in both males and females.

The testosterone test can be used to determine whether or not you're experiencing:

  • Delayed or early puberty in boys
  • In both men and women, sex drive has decreased.
  • Men's erectile dysfunction
  • Male and female infertility
  • Tumors of the testicles in men
  • Disorders of the hypothalamus or pituitary gland
  • Virilization and hirsutism in girls and women

A testosterone total test is usually used to diagnose a condition. The free and total testosterone test distinguishes between testosterone that is bound to proteins in the blood and testosterone that is not attached to proteins.

About two-thirds of testosterone is tied to SHBG in the blood, with the remaining one-third attached to albumin. Free testosterone circulates in a tiny percentage. Bioavailable testosterone is made up of free testosterone and testosterone bound to albumin, and it can operate on target tissues.

A test for free or bioavailable testosterone may be performed in some circumstances, such as when the level of SHBG is abnormal, as it may more accurately indicate the presence of a medical issue.

Other tests and hormone levels may be performed in conjunction with testosterone testing, depending on the reason for testing. Here are a few examples:

  • FSH
  • LH
  • Estrogen
  • Estradiol
  • SHBG
  • DHEA-S
  • Prolactin
  • Androstenedione
  • 17-Hydroxyprogesterone
  • The sex hormone binding globulin test can be performed to determine whether a man has low testosterone or if a woman has too much testosterone. It can be used in conjunction with other tests to assess a person's sex hormone status.

SHBG is a protein that binds to testosterone, dihydrotestosterone, and estradiol, among other hormones. SHBG distributes these hormones in the blood as physiologically inactive versions when they are bound. Changes in SHBG levels can have an impact on the amount of hormone accessible to the body's tissues.

To assess a person's current hormonal balance, tests for albumin and one or more additional sex hormones, such as prolactin, estradiol, and LH may be conducted.

In men

In order to diagnose the cause of infertility, diminished sex drive, or erectile dysfunction in an adult male, SHBG and total testosterone levels may be ordered. When total testosterone findings are contradictory with clinical symptoms, measuring SHBG in addition to testosterone is extremely beneficial.

Total testosterone in the blood is measured without distinguishing between bound and unbound testosterone; rather, it determines the total amount of testosterone in the blood. In many circumstances, this is sufficient to determine if testosterone production is excessive or inadequate. However, if a person's SHBG level is abnormal, the total testosterone level may not accurately reflect the amount of testosterone available to the body's tissues.

With a simple total testosterone assessment, health practitioners can estimate bioavailable testosterone by measuring SHBG. Because less testosterone is accessible to the body's tissues, increased SHBG in males may be linked to symptoms of low testosterone levels.

Total testosterone should be measured in the initial screening for testosterone deficiency, according to the Endocrine Society's professional standards. If the results are abnormal, the test is repeated the next day. They propose one of the following if repeat readings are low-normal and/or SHBG is abnormal:

In women

The ovaries and adrenal glands produce modest amounts of testosterone in women. Even little increases in testosterone production can throw off the hormone balance, resulting in symptoms including irregular or missed periods, infertility, acne, and excessive face and body hair. These and other signs and symptoms are common in polycystic ovarian syndrome, a disorder marked by an overproduction of male sex hormones. SHBG and testosterone testing may be helpful in detecting and evaluating excess testosterone production and/or decreasing SHBG concentrations, as well as in evaluating women with PCOS.

What does my testosterone test result mean?

Males: 

Testosterone levels often begin to fall after the age of 30. Testosterone levels may drop more in obese or chronically unwell men, as well as with the use of certain drugs.

Hypogonadism can be caused by a variety of factors, including:

  • Pituitary or hypothalamic illness
  • Reduced testosterone production in young males can be caused by genetic disorders
  • Possible infertility or testicular failure
  • Acquired damage to the testes, such as from drinking, physical injury, or viral infections like mumps, reduces testosterone production.
  • Diabetes

Healthcare practitioners may recommend testosterone replacement therapy to men who have consistently low testosterone levels and associated signs and symptoms. The Food and Drug Administration has not approved testosterone supplements to improve strength, sports performance, or avoid aging disorders. It's possible that using it for these purposes is dangerous.

Increased testosterone levels in men can mean one of several things:

  • Tumors of the testicles
  • Testosterone-producing tumors in the adrenal glands
  • Use of anabolic steroids
  • Early puberty in males due to an unknown cause
  • Adrenal hyperplasia in toddlers and babies

Females:

Testosterone levels in women are typically low. Increased testosterone levels can mean one of the following things:

  • Ovarian or adrenal gland tumor
  • PCOS
  • Adrenal hyperplasia that occurs at birth.

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


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.

Description: Testosterone, Total, Male is a blood test used to detect abnormal levels of testosterone in male patients, diagnose causes of erectile dysfunction and infertility.

Also Known As: Total Testosterone Test, Testosterone Total Test, Male Testosterone Test, Testosterone Male Test, Testosterone Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

This test is for male patients 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.

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

When is a Testosterone Total Male test ordered?

When infertility is suspected, or when a man has decreased sex drive or erectile difficulties, a testosterone test may be ordered. Other signs include a lack of beard and body hair, a loss of muscle mass, and the formation of breast tissue. Low total and bioavailable testosterone levels have also been linked to, or caused by, increased visceral fat, insulin resistance, and an increased risk of coronary artery disease.

What does a Testosterone Total Male blood test check for?

In men, testosterone is the primary sex hormone. It's in charge of a man's physical appearance. This test determines the amount of testosterone in a person's blood.

Testosterone is primarily produced in the male testicles by unique endocrine tissue called Leydig cells. It's made by the adrenal glands in males.

In males, testosterone promotes the formation of secondary sex characteristics such as penis size, body hair growth, muscle development, and a deeper voice. It is abundant in males during adolescence and adulthood in order to regulate sex drive and preserve muscle mass.

The pituitary gland produces luteinizing hormone, which stimulates and regulates testosterone synthesis. Testosterone functions in a negative feedback loop: when testosterone levels rise, LH production falls, slowing testosterone production; lower testosterone levels cause higher LH production, which promotes testosterone production.

Testosterone levels fluctuate throughout the day, increasing in the early morning hours and dropping in the evening. Levels rise after activity and fall as people get older.

About two-thirds of testosterone is attached to sex-hormone binding globulin in the bloodstream, with the remaining one-third bound to albumin. Only a small percentage of testosterone is released into the bloodstream as free testosterone. The bioavailable fraction is the free plus albumin-bound testosterone, which can act on target tissues.

In many circumstances, measuring total testosterone is sufficient information for a healthcare provider. A test for free or bioavailable testosterone may be performed in some circumstances, such as when the level of SHBG is abnormal, as it may more accurately indicate the presence of a medical issue.

Lab tests often ordered with a Testosterone Total Male test:

  • Estradiol
  • Dihydrotestosterone
  • FSH
  • LH
  • Estrogens
  • Estriol
  • Estrone
  • Albumin
  • Prolactin
  • Anti-mullerian Hormone
  • Androstenedione
  • Sex Hormone Binding Globulin

Conditions where a Testosterone Total Male test is recommended:

  • Polycystic Ovary Syndrome
  • Alcoholism
  • Mumps
  • Hypothalamic disease
  • Pituitary disease
  • Infertility
  • Liver disease
  • Hyperthyroidism
  • Eating disorders
  • Pregnancy
  • Cushing Syndrome
  • Hypothyroidism
  • Testicular cancer
  • Adrenal insufficiency
  • Congenital Adrenal Hyperplasia

Commonly Asked Questions:

How is this test used by my health care provider?

In men, testosterone testing is used to identify a variety of problems. Testosterone is the major sex hormone in males, and it is responsible for masculine physical traits. It is produced mostly by the testicles.

The testosterone test can be used to determine whether or not you're experiencing:

  • Decreases sex drive
  • Men's erectile dysfunction
  • Male infertility
  • Tumors of the testicles in men
  • Disorders of the hypothalamus or pituitary gland

A testosterone total test is usually used to diagnose a condition. The free and total testosterone test distinguishes between testosterone that is bound to proteins in the blood and testosterone that is not attached to proteins.

About two-thirds of testosterone is tied to SHBG in the blood, with the remaining one-third attached to albumin. Free testosterone circulates in a tiny percentage. Bioavailable testosterone is made up of free testosterone and testosterone bound to albumin, and it can operate on target tissues.

A test for free or bioavailable testosterone may be performed in some circumstances, such as when the level of SHBG is abnormal, as it may more accurately indicate the presence of a medical issue.

Other tests and hormone levels may be performed in conjunction with testosterone testing, depending on the reason for testing. Here are a few examples:

  • FSH
  • LH
  • Estrogen
  • Estradiol
  • SHBG
  • DHEA-S
  • Prolactin
  • Androstenedione
  • 17-Hydroxyprogesterone

What does my testosterone test result mean?

Testosterone levels often begin to fall after the age of 30. Testosterone levels may drop more in obese or chronically unwell men, as well as with the use of certain drugs.

Hypogonadism can be caused by a variety of factors, including:

  • Pituitary or hypothalamic illness
  • Reduced testosterone production in young males can be caused by genetic disorders
  • Possible infertility or testicular failure
  • Acquired damage to the testes, such as from drinking, physical injury, or viral infections like mumps, reduces testosterone production.
  • Diabetes

Healthcare practitioners may recommend testosterone replacement therapy to men who have consistently low testosterone levels and associated signs and symptoms. The Food and Drug Administration has not approved testosterone supplements to improve strength, sports performance, or avoid aging disorders. It's possible that using it for these purposes is dangerous.

Increased testosterone levels in men can mean one of several things:

  • Tumors of the testicles
  • Testosterone-producing tumors in the adrenal glands
  • Use of anabolic steroids

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


Description: Testosterone, Total, MS is a blood test used to detect abnormal levels of testosterone in both male and female patients, and diagnose causes of erectile dysfunction, infertility, virilization, polycystic ovary syndrome, and delayed or early puberty in children.

Also Known As: Total Testosterone Test, Testosterone Total Test, Female Testosterone Test, Pediatric Testosterone Test, Ultrasensitive Testosterone Test, Uncapped Testosterone Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a Testosterone Total test ordered?

When infertility is suspected, or when a man has decreased sex drive or erectile difficulties, a testosterone test may be ordered. Other signs include a lack of beard and body hair, a loss of muscle mass, and the formation of breast tissue. Low total and bioavailable testosterone levels have also been linked to, or caused by, increased visceral fat, insulin resistance, and an increased risk of coronary artery disease.

The test is frequently ordered in conjunction with the FSH and LH tests in males who are experiencing delayed or slow puberty. Although the age at which puberty begins varies from person to person, it usually begins around the age of ten. The following are some of the signs and symptoms of delayed puberty:

  • Muscle mass development is delayed.
  • Voice not getting lower or a lack of body hair growth
  • Growth of the testicles and penis is slowed or delayed.

When a young boy appears to be going through an early puberty with clear secondary sex traits, the test can be ordered. Various malignancies and congenital adrenal hyperplasia can cause early puberty in boys due to elevated testosterone.

When a woman has irregular or no menstrual cycles, is having trouble getting pregnant, or displays masculine traits such as abundant facial and body hair, male pattern baldness, and/or a low voice, testosterone testing may be done. Testosterone levels can rise as a result of malignancies in the ovary or adrenal gland, as well as other illnesses including polycystic ovarian syndrome.

What does a Testosterone Total blood test check for?

In men, testosterone is the primary sex hormone. It's in charge of a man's physical appearance. Although it is thought to be a "masculine" sex hormone, it is found in both men and women's blood. This test determines the amount of testosterone in a person's blood.

Testosterone is primarily produced in the male testicles by unique endocrine tissue called Leydig cells. It's also made by the adrenal glands in both males and females, as well as the ovaries in females in modest amounts.

In males, testosterone promotes the formation of secondary sex characteristics such as penis size, body hair growth, muscle development, and a deeper voice. It is abundant in males during adolescence and adulthood in order to regulate sex drive and preserve muscle mass. Estradiol is the major sex hormone in females, and testosterone is converted to it in women.

The pituitary gland produces luteinizing hormone, which stimulates and regulates testosterone synthesis. Testosterone functions in a negative feedback loop: when testosterone levels rise, LH production falls, slowing testosterone production; lower testosterone levels cause higher LH production, which promotes testosterone production.

Testosterone levels fluctuate throughout the day, increasing in the early morning hours and dropping in the evening. Levels rise after activity and fall as people get older.

About two-thirds of testosterone is attached to sex-hormone binding globulin in the bloodstream, with the remaining one-third bound to albumin. Only a small percentage of testosterone is released into the bloodstream as free testosterone. The bioavailable fraction is the free plus albumin-bound testosterone, which can act on target tissues.

In many circumstances, measuring total testosterone is sufficient information for a healthcare provider. A test for free or bioavailable testosterone may be performed in some circumstances, such as when the level of SHBG is abnormal, as it may more accurately indicate the presence of a medical issue.

Lab tests often ordered with a Testosterone Total test:

  • Estradiol
  • Dihydrotestosterone
  • FSH
  • LH
  • Estrogens
  • Estriol
  • Estrone
  • Albumin
  • Prolactin
  • Anti-mullerian Hormone
  • Androstenedione
  • Sex Hormone Binding Globulin

Conditions where a Testosterone Total test is recommended:

  • Polycystic Ovary Syndrome
  • Alcoholism
  • Mumps
  • Hypothalamic disease
  • Pituitary disease
  • Infertility
  • Liver disease
  • Hyperthyroidism
  • Eating disorders
  • Pregnancy
  • Cushing Syndrome
  • Hypothyroidism
  • Testicular cancer
  • Adrenal insufficiency
  • Congenital Adrenal Hyperplasia

Commonly Asked Questions:

How does my health care provider use a Testosterone Total test?

In men, women, girls, and boys, testosterone testing is used to identify a variety of problems. Testosterone is the major sex hormone in males, and it is responsible for masculine physical traits. It is produced mostly by the testicles. Although it is thought to be a "male" sex hormone, it is found in both males and females.

The testosterone test can be used to determine whether or not you're experiencing:

  • Delayed or early puberty in boys
  • In both men and women, sex drive has decreased.
  • Men's erectile dysfunction
  • Male and female infertility
  • Tumors of the testicles in men
  • Disorders of the hypothalamus or pituitary gland
  • Virilization and hirsutism in girls and women

A testosterone total test is usually used to diagnose a condition. The free and total testosterone test distinguishes between testosterone that is bound to proteins in the blood and testosterone that is not attached to proteins.

About two-thirds of testosterone is tied to SHBG in the blood, with the remaining one-third attached to albumin. Free testosterone circulates in a tiny percentage. Bioavailable testosterone is made up of free testosterone and testosterone bound to albumin, and it can operate on target tissues.

A test for free or bioavailable testosterone may be performed in some circumstances, such as when the level of SHBG is abnormal, as it may more accurately indicate the presence of a medical issue.

Other tests and hormone levels may be performed in conjunction with testosterone testing, depending on the reason for testing. Here are a few examples:

  • FSH
  • LH
  • Estrogen
  • Estradiol
  • SHBG
  • DHEA-S
  • Prolactin
  • Androstenedione
  • 17-Hydroxyprogesterone

What does my testosterone test result mean?

Males: 

Testosterone levels often begin to fall after the age of 30. Testosterone levels may drop more in obese or chronically unwell men, as well as with the use of certain drugs.

Hypogonadism can be caused by a variety of factors, including:

  • Pituitary or hypothalamic illness
  • Reduced testosterone production in young males can be caused by genetic disorders
  • Possible infertility or testicular failure
  • Acquired damage to the testes, such as from drinking, physical injury, or viral infections like mumps, reduces testosterone production.
  • Diabetes

Healthcare practitioners may recommend testosterone replacement therapy to men who have consistently low testosterone levels and associated signs and symptoms. The Food and Drug Administration has not approved testosterone supplements to improve strength, sports performance, or avoid aging disorders. It's possible that using it for these purposes is dangerous.

Increased testosterone levels in men can mean one of several things:

  • Tumors of the testicles
  • Testosterone-producing tumors in the adrenal glands
  • Use of anabolic steroids
  • Early puberty in males due to an unknown cause
  • Adrenal hyperplasia in toddlers and babies

Females:

Testosterone levels in women are typically low. Increased testosterone levels can mean one of the following things:

  • Ovarian or adrenal gland tumor
  • PCOS
  • Adrenal hyperplasia that occurs at birth.

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


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.

Brief Description: DHEA Sulfate is a blood test that is measuring the levels of Dehydroepiandrosterone Sulfate in the blood. It is often used to diagnose any problems in the adrenal glands such as cancer or a tumor. It can also be used to evaluate the cause of early puberty in young boys and male characteristics or appearance in women.

Also Known As: DHEA-SO4 Test, DHEAS Test, DHES1 Test, Dehydroepiandrosterone Sulfate Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a DHEA Sulfate test ordered?

When excess androgen production is suspected and/or a health practitioner wants to analyze a person's adrenal gland function, a DHEAS test, along with other hormone testing, may be requested.

It can be assessed when a woman exhibits signs and symptoms of amenorrhea, infertility, and/or virilization. The intensity of these alterations varies, but they may include:

  • A huskier voice
  • Hair on the face or on the body that is excessive
  • Baldness in men
  • Muscularity
  • Acne
  • The Adam's apple has been enlarged
  • Breast size has shrunk

It may also be ordered if a young girl exhibits evidence of virilization or if a female infant's external genitalia are not clearly male or female.

When young males show indicators of premature puberty, such as a deeper voice, pubic hair, muscularity, and an enlarged penis before the age of typical puberty, DHEAS may be evaluated.

What does a DHEA Sulfate blood test check for?

Male sex hormone dehydroepiandrosterone sulfate is found in both men and women. This test determines the amount of DHEAS in your blood.

DHEAS:

  • At puberty, it aids in the development of male secondary sexual traits.
  • Can be transformed into more strong androgens like testosterone and androstenedione by the body.
  • It has the ability to transform into estrogen.

DHEAS is almost entirely produced by the adrenal glands, with minor contributions from a woman's ovaries and a man's testicles.

It's a good indicator of how well the adrenal glands are working. Overproduction of DHEAS can be caused by malignant and non-cancerous adrenal tumors, as well as adrenal hyperplasia. DHEAS can be produced by an ovarian tumor in rare cases.

DHEAS excess:

  • In adult men, it may go unnoticed.
  • In young boys, it can cause early puberty.
  • Menstrual irregularities and the development of masculine physical traits in girls and women, such as excess body and facial hair
  • Can result in a female infant being born with genitals that aren't clearly male or female

Lab tests often ordered with a DHEA Sulfate test:

  • Testosterone
  • ACTH
  • FSH
  • LH
  • Prolactin
  • Estrogen
  • Estradiol
  • Sex Hormone Binding Globulin
  • 17-Hydroxyprogesterone
  • Androstenedione

Conditions where a DHEA Sulfate test is recommended:

  • PCOS
  • Infertility
  • Endocrine Syndromes
  • Adrenal Insufficiency
  • Congenital Adrenal Hyperplasia

How does my health care provider use a DHEA Sulfate test?

The dehydroepiandrosterone sulfate test is ordered in conjunction with testosterone and other male hormones assays to:

  • Examine the adrenal glands' performance.
  • Differentiate DHEAS-secreting disorders produced by the adrenal glands from those caused by the testicles or, in rare cases, the ovaries
  • Adrenocortical tumors and adrenal malignancies can be diagnosed with this test.
  • Assist in the diagnosis of congenital and adult-onset adrenal hyperplasia.

DHEAS levels are frequently examined in women, along with other hormones like FSH, LH, prolactin, estrogen, and testosterone, to help diagnose polycystic ovarian syndrome and rule out other reasons of infertility, lack of monthly cycle, and excess facial and body hair.

DHEAS levels, along with other hormones, may be requested to examine and diagnose the cause of young females developing masculine physical traits and young boys developing early puberty.

What do my DHEA-S test results mean?

A normal DHEAS level, together with other normal male hormone levels, suggests that the adrenal gland is working properly. When an adrenal tumor or cancer is present but not secreting hormones, DHEAS may be normal.

A high DHEAS blood level could indicate that the person's symptoms are caused or exacerbated by excessive DHEAS production. An elevated level of DHEAS, on the other hand, is not used to make a diagnosis of any particular condition; rather, it usually signals that further testing is required to determine the source of the hormone imbalance. An adrenocortical tumor, Cushing illness, adrenal cancer, or adrenal hyperplasia, as well as a DHEAS-producing ovarian tumor, can all cause high DHEAS.

DHEAS levels may be high in polycystic ovary syndrome, but they may also be normal, as PCOS is usually associated with ovarian androgen production.

Adrenal insufficiency, adrenal dysfunction, Addison disease, or hypopituitarism, a disorder characterized by low levels of pituitary hormones that govern the generation and secretion of adrenal hormones, can all produce low DHEAS levels.

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


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.

 


Description: 17-hydroxyprogesterone is a test that is measuring the levels of 17-OHP in the blood. 17-OHP is used to detect and monitor the treatment processes for congenital adrenal hyperplasia.

Also Known As: 17-OHP Test, 17-OH Progesterone Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a 17-Hydroxyprogesterone test ordered?

The 17-OHP test is regularly ordered as part of a newborn screening and may be repeated if the screening test results are elevated to confirm the initial findings.

When an infant or young kid exhibits signs and symptoms of adrenal insufficiency or CAH, a 17-OHP test may be administered.

When the milder type of CAH is suspected, this test may be ordered in older children or adults. When a girl or woman is having symptoms that could be caused by CAH or another illness, such as PCOS, the 17-OHP test can be used.

Boys and men may be tested if they are experiencing early puberty or infertility.

When a person is diagnosed with 21-hydroxylase deficiency, a 17-OHP test may be ordered on a regular basis to assess treatment effectiveness.

What does a 17-Hydroxyprogesterone blood test check for?

17-hydroxyprogesterone is a steroid hormone that is created during the cortisol production process. This test detects and/or evaluates congenital adrenal hyperplasia, a hereditary disorder characterized by decreased adrenal cortisol and aldosterone production and increased male sex hormone production.

Cholesterol is the source of 17-OHP. It is a precursor of active steroid hormones, rather than an active steroid hormone.

Cortisol is a hormone produced by the adrenal glands that aids in the breakdown of protein, carbohydrates, and fats, regulates the immune system, and maintains blood pressure. Other steroid hormones produced by the adrenal glands include aldosterone, which helps regulate salt levels and blood pressure, and androgens, which, like testosterone, cause male sexual characteristics and other consequences.

The processes in the synthesis of cortisol necessitate the use of several enzymes. Inadequate levels of cortisol are produced when one or more of these enzymes are insufficient or malfunctioning, as is the case with CAH. CAH is caused by a partial or total loss of the enzyme 21-hydroxylase, which accounts for around 90% of cases.

The adrenal gland grows in size because a low level of cortisol induces an increase in the level of a specific pituitary hormone that drives adrenal growth and hormone production. The increased size and activity, however, are insufficient to overcome the cortisol production bottleneck. Other chemicals that do not require the faulty enzyme, such as 17-hydroxyprogesterone and androgens, are created in excess. This is why 17-OHP testing can aid in the detection of CAH.

CAH is a set of hereditary illnesses characterized by cortisol-related enzyme deficits and caused by particular gene mutations. A mutation in the 21-hydroxylase gene causes around 90% of CAH cases, which can be diagnosed by an increase in 17-OHP in the blood. When both genes, one from each parent, contain mutations that reduce or cease the activity of the enzyme for which the gene codes, the disease is caused. Parents could be carriers, and carriers could not show any symptoms.

CAH with 21-hydroxylase deficiency can be inherited in two forms: severe and mild.

Severe forms can result in kids being born with severe aldosterone and cortisol deficits, necessitating medical treatment. This severe variant is most commonly found in infancy or early childhood through regular newborn screening. It may manifest in early childhood with signs and symptoms such as vomiting, listlessness, lack of energy, not eating properly, failure to thrive, dehydration, and low blood pressure if it is not found through screening, especially with severe sickness.

Excess male sex hormones can cause the development of male characteristics in females. Female babies' sex organs may not be obviously male or female, making it difficult to tell their gender at first. During childhood and adolescence, females may have excessive hair development on the face and body, as well as other male secondary sexual traits such as irregular menstruation. Men with this disorder may not appear different at birth, but they might develop sexual traits early in life, putting them at risk for fertility problems later in life.

Only partial lack of the enzyme may be present in the milder, though more prevalent type of CAH caused by 21-hydroxylase deficiency. This kind of CAH, also known as late-onset or non-classical CAH, can manifest symptoms at any age during childhood, adolescence, or adulthood. Symptoms might be nonspecific, develop slowly over time, and differ from one person to the next. Though this type of CAH is rarely life-threatening, it can cause growth, development, and puberty issues in children, as well as infertility in adults.

Lab tests often ordered with a 17-Hydroxyprogesterone test:

  • Cortisol
  • ACTH
  • Testosterone
  • Androstenedione
  • Pregnenolone

Conditions where a 17-Hydroxyprogesterone test is recommended:

  • Congenital Adrenal Hyperplasia
  • Polycystic Ovary Syndrome
  • Adrenal Insufficiency
  • Addison Disease
  • Endocrine Syndromes
  • Infertility

How does my health care provider use a 17-Hydroxyprogesterone test?

The 17-hydroxyprogesterone test is used to detect congenital adrenal hyperplasia and can be used in the conjunction with other tests to diagnose and track CAH.

In the United States, the 17-OHP test is frequently ordered as part of newborn screening to detect CAH caused by a lack of 21-hydroxylase.

The 17-OHP test can be used to screen for CAH in older children and adults before symptoms develop, or to confirm a CAH diagnosis in persons who are already experiencing symptoms.

Diagnosis

The presence of 17-OHP in the blood can help doctors diagnose CAH in older children and people who have a milder, "late-onset" variant of the disease.

A 17-OHP test, along with plasma renin activity, androstenedione, and testosterone assays, may be used to evaluate the success of treatment if someone is diagnosed with 21-hydroxylase insufficiency.

In women with symptoms such as abundant face and body hair and irregular periods, a 17-OHP test, along with other hormone testing, may be done to help rule out CAH. Women with probable polycystic ovarian syndrome and infertility, as well as those with suspected adrenal or ovarian malignancies, fall under this category.

False-positive results have been reported with 17-OHP testing, particularly the newborn screening test. Other tests may be performed if the level is higher but not to the point where it is indicative of CAH.

As a follow-up test, an ACTH test may be ordered. ACTH stimulation causes a significant increase in 17-OHP levels in CAH.

CYP21A2 gene mutations that cause the disorder may be detected by genetic testing.

A karyotype test may be ordered as a follow-up test to discover chromosome problems and to assist in determining the gender of a newborn.

Electrolytes may be ordered to determine the sodium and potassium levels of a person.

What do my 17 Hydroxyprogesterone test results mean?

If a newborn or infant has highly elevated 17-OHP levels, he or she is most likely suffering from CAH. If a person's levels are somewhat elevated, he or she may have a milder case of CAH or an 11-beta-hydroxylase deficiency.

The absence of CAH due to a 21-hydroxylase deficit is most often shown by normal 17-OHP findings.

In a person with CAH, low or declining amounts suggest a positive response to treatment. High or rising levels may suggest that treatment has to be changed.

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


Most Popular

Description: A pregnenolone test is used to measure the amount of pregnenolone in the blood. This is used to detect a rare genetic condition that affects the production of steroid hormones.

Also Known As: Pregnenolone blood Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a Pregnenolone test ordered?

When an infant's outward sex organs are not obviously male or female, as well as indicators of adrenal insufficiency, excessive sodium and fluid loss, or high blood pressure, pregnenolone is prescribed. It's frequently requested after 17-OHP testing.

This test is typically given when a doctor suspects or wants to rule out a CAH other than 21-hydroxylase deficit or 11-beta-hydroxylase deficiency as the cause of symptoms. Among the indications and symptoms that an affected individual may experience are:

Both males and females may show indications of adrenal insufficiency and "salt wasting" when they have 3-beta-hydroxysteroid dehydrogenase deficiency.

What does a Pregnenolone blood test check for?

Pregnenolone is a molecule that serves as a precursor to all steroid hormones. This test detects rare forms of congenital adrenal hyperplasia by measuring the amount of pregnenolone in the blood.

CAH is a set of hereditary illnesses characterized by enzyme defects in the steroid hormone synthesis process. CAH can be caused by a variety of factors, including:

The most frequent cause of CAH is a 21-hydroxylase deficiency.

Deficiency of 11-beta-hydroxylase

Two rare manifestations of the condition are 3-beta-hydroxysteroid dehydrogenase and 17-alpha-hydroxylase deficits.

Cholesterol is converted to pregnenolone in the adrenal glands for regular steroid hormone production, and subsequently many enzymes finish the creation of several hormones, including:

Cortisol is a hormone that aids in the metabolism of proteins, fats, and carbohydrates, as well as maintaining blood pressure and immune system regulation.

Aldosterone helps regulate blood pressure and volume by keeping normal levels of sodium and potassium in the circulation.

The growth and upkeep of male and female secondary sexual characteristics are regulated by steroid hormones known as androgens, or "male hormones," such as testosterone, and estrogens, or "female hormones," such as estrogen and progesterone.

One or more enzymes are defective or malfunctioning in congenital adrenal hyperplasia, resulting in insufficient levels of one or more end products. The adrenal gland grows in size as the level of a pituitary hormone that encourages adrenal growth and hormone production rises due to a low cortisol level. The increased size and activity, however, are insufficient to overcome the cortisol production bottleneck. Other compounds will be created in excess that do not require the faulty enzyme.

The enzyme deficit in CAH can result in a drop in cortisol and/or aldosterone, as well as an increase or decrease in androgens in rare situations. Androgen deficiency can result in male neonates having external sex organs that aren't unmistakably male or female, as well as affecting the development of secondary sexual characteristics in both males and females during puberty.

Laboratory testing can assess pregnenolone, various intermediate precursors, and one or more steroid hormones to determine which enzyme is inadequate or malfunctioning, based on which products have been created and how much.

If both 21- and 11-hydroxylase defects have been ruled out, pregnenolone analyses, as well as testing for other precursors, may be utilized to assist determine if the patient has 3-beta-hydrosteroid dehydrogenase or 17-alpha-hydroxylase deficit.

Lab tests often ordered with Pregnenolone test:

  • 17-Hydroxyprogesterone
  • Cortisol
  • ACTH
  • Aldosterone
  • Testosterone
  • Androstenedione
  • 11-Deoxycortisol
  • 17-Hydoxypregnenolone
  • Estrogen
  • Estradiol

Conditions where a Pregnenolone test is recommended:

  • PCOS
  • Adrenal Insufficiency
  • Endocrine Syndromes
  • Infertility
  • Congenital Adrenal Hyperplasia

How does my health care provider use a Pregnenolone test?

Pregnenolone is usually ordered as part of a panel of tests to diagnose, monitor, and/or rule out two of the more uncommon forms of congenital adrenal hyperplasia. After the more prevalent causes of CAH have been ruled out, the test is usually used.

CAH is a category of hereditary illnesses caused by a defect in one of the enzymes involved in steroid hormone synthesis. The following are two of the most common causes of CAH:

  • Deficiency of the enzyme 21-hydroxylase
  • Deficiency of 11-beta-hydroxylase

CAH comes in two types, both of which are extremely rare:

  • Deficiency of 3-beta-hydroxysteroid dehydrogenase
  • Deficiency of 17-alpha-hydroxylase

A test that evaluates 17-hydroxyprogesterone is used to screen all neonates for the most prevalent cause of CAH. If the results of this test are aberrant, ACTH testing may be performed, followed by groups or panels of precursors and hormones to determine which enzyme deficits are present. To assist diagnose 11-beta-hydroxylase deficiency, 11-deoxycorticosterone and 11-deoxycortisol tests are used.

If the two most frequent types of CAH have been ruled out, particularly if a baby's external sex organs aren't obviously male or female, the following tests may be requested to rule out the rare variants as the origin of a person's symptoms:

  • Pregnenolone
  • 11-deoxycorticosterone
  • DHEA
  • 17-hydroxypregnenolone
  • corticosterone

What do my pregnenolone test results mean?

In general, if an enzyme deficit occurs somewhere in the steroid hormone synthesis process, pregnenolone levels will rise mildly to significantly. The extent of the rise is determined on the enzyme deficiency and the severity of the deficiency. Pregnenolone results must be read in conjunction with those of other precursors and hormones.

Pregnenolone, 17-hydroxypregnenolone, and DHEA are frequently high in 3-beta-hydroxysteroid dehydrogenase insufficiency, and 17-OHP may also be elevated. Cortisol and aldosterone levels are likely to be low if they are measured.

Pregnenolone and progesterone, as well as 11-deoxycorticosterone, may be high in 17-alpha-hydroxylase deficiency. Other hormones and precursors, if measured, could be low, including:

  • 17-OHP
  • 17-hydroxypregnenolone
  • 11-deoxycortisol
  • DHEA-S
  • Androstenedione
  • Cortisol
  • Testosterone
  • Estrogens
  • Aldosterone

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


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

Most Popular

Description: Aldosterone is a blood test often ordered to test patients with low potassium or high blood pressure.

Also Known As: Aldosterone Plasma Test

Collection Method: Blood Draw

Specimen Type: Plasma

Test Preparation: No preparation required

When is an Aldosterone test ordered?

When someone has high blood pressure, a blood aldosterone test is generally requested, especially if the person also has low potassium. Even if potassium levels are within normal limits, testing may be necessary if hypertension develops at a young age or if standard drugs fail to control high blood pressure. Because primary aldosteronism is a potentially curable form of hypertension, it’s critical to catch it early and effectively treat it.

When a healthcare practitioner suspects adrenal insufficiency or Addison disease, aldosterone levels, along with additional testing, are occasionally recommended.

What does an Aldosterone blood test check for?

Aldosterone is a hormone that helps to maintain proper sodium and potassium levels in the circulation as well as regulate blood volume and blood pressure.

The adrenal glands, which are positioned on the top and outside portions of each kidney, create aldosterone. Aldosterone increases sodium retention and potassium elimination via the kidneys.

Aldosterone overproduction or underproduction can be caused by a number of factors. Because renin and aldosterone are so closely associated, they’re frequently examined jointly to figure out what’s causing an aberrant aldosterone level.

Lab tests often ordered with an Aldosterone test:

  • Electrolytes
  • Potassium
  • Cortisol
  • Aldosterone
  • Plasma Renin Activity

Conditions where an Aldosterone test is recommended:

  • Adrenal Insufficiency
  • Addison Disease
  • Hypertension
  • Endocrine Syndromes
  • Conn Syndrome

How does my health care provider use an Aldosterone test?

Aldosterone and renin tests are performed to determine whether the adrenal glands are producing enough aldosterone and to differentiate between potential causes of excess or insufficiency. Aldosterone can be detected in the blood or in a 24-hour urine sample, which determines how much aldosterone is excreted in the urine over the course of a day.

Primary aldosteronism, commonly known as Conn syndrome, is a condition that produces high blood pressure and can be detected with these tests. If the test is positive, stimulation and suppression testing can be used to further examine aldosterone production.

The highest levels of aldosterone are in the morning, and they fluctuate throughout the day. The position of the body, stress, and a number of prescribed medications all have an impact on them.

What do my aldosterone test results mean?

Conn syndrome is characterized by the adrenal glands overproducing aldosterone, which is usually caused by a benign tumor in one of the glands. A high aldosterone level causes increased salt reabsorption and potassium loss by the kidneys, resulting in an electrolyte imbalance. High blood pressure, headaches, and muscle weakness are signs and symptoms, especially if potassium levels are very low.

When someone has hypertension and their blood potassium is lower than usual, it's time to look for aldosteronism. Blood is drawn from both of the adrenal veins and tested to see whether there is a difference in the amount of aldosterone produced by both of the adrenal glands to establish whether only one or both are impacted.

Secondary aldosteronism, which is more prevalent than primary aldosteronism, is caused by anything other than an adrenal gland condition that causes excess aldosterone. Any disorder that restricts blood flow to the kidneys, lowers blood pressure, or lowers sodium levels could cause aldosteronism. Congestive heart failure, liver cirrhosis, kidney illness, and pregnancy toxemia can all cause secondary aldosteronism. It's also typical when you're dehydrated. The cause of aldosteronism is usually clear in these circumstances.

The most common cause of secondary aldosteronism is renal artery stenosis, which is a constriction of the blood arteries that supply the kidney. High aldosterone levels produce high blood pressure, which can be treated with surgery or angioplasty. A catheter is introduced via the groin and blood is collected straight from the veins draining the kidney to see if only one kidney is damaged. If one side's result is much higher than the other, this suggests that the artery is narrowed.

Adrenal insufficiency is the most common cause of low aldosterone. Dehydration, low blood pressure, a low salt level in the blood, and a high potassium level are all symptoms. Congenital adrenal hyperplasia, a disorder in which babies lack an enzyme needed to create cortisol, can reduce aldosterone production in some circumstances.

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


Description: Aldosterone and Renin tests are blood tests often ordered together to test patients with low potassium or high blood pressure.

Also Known As: Aldosterone Test, Renin Test, Aldosterone and Renin Ratio Test, Aldosterone and Renin Activity Test, PRA Test, Plasma Renin Activity Test

Collection Method: Blood Draw

Specimen Type: Plasma

Test Preparation: No preparation required

When is an Aldosterone and Plasma Renin Activity test ordered?

When someone has high blood pressure, a blood aldosterone test and a renin test are generally requested together, especially if the person also has low potassium. Even if potassium levels are within normal limits, testing may be necessary if standard drugs fail to control high blood pressure or if hypertension develops at a young age. Because primary aldosteronism is a potentially curable form of hypertension, it’s critical to catch it early and effectively treat it.

When a healthcare practitioner suspects adrenal insufficiency or Addison disease, aldosterone levels, along with additional testing, are occasionally recommended. The aldosterone stimulation test, also known as ACTH stimulation, measures aldosterone and cortisol levels to identify whether a person has Addison disease, reduced pituitary function, or a pituitary tumor. After ACTH stimulation, a natural outcome is an increase in cortisol and an increase in aldosterone.

What does an Aldosterone and Plasma Renin Activity blood test check for?

Aldosterone is a hormone that helps to maintain proper sodium and potassium levels in the circulation as well as regulate blood volume and blood pressure. Renin is an enzyme that regulates the production of aldosterone. The levels of aldosterone and renin in the blood and/or the amount of aldosterone in the urine are measured in these tests.

The adrenal glands, which are positioned on the top and outside portions of each kidney, create aldosterone. Aldosterone increases sodium retention and potassium elimination via the kidneys. Renin is a protein generated by the kidneys that regulates the activity of the hormone angiotensin, which stimulates the production of aldosterone by the adrenal glands.

Renin is released by the kidneys when blood pressure drops or the sodium chloride concentration in the tubules of the kidney decreases. Renin breaks down the blood protein angiotensinogen to produce angiotensin I, which is then transformed to angiotensin II by a second enzyme. Angiotensin II constricts blood vessels and increases the synthesis of aldosterone. Overall, this boosts blood pressure while maintaining appropriate salt and potassium levels.

Aldosterone overproduction or underproduction can be caused by a number of factors. Because renin and aldosterone are so closely associated, they’re frequently examined jointly to figure out what’s causing an aberrant aldosterone level.

Lab tests often ordered with an Aldosterone and Plasma Renin Activity test:

  • Electrolytes
  • Potassium
  • Cortisol
  • Aldosterone
  • Plasma Renin Activity

Conditions where an Aldosterone and Plasma Renin Activity test is recommended:

  • Adrenal Insufficiency
  • Addison Disease
  • Hypertension
  • Endocrine Syndromes
  • Conn Syndrome

How does my health care provider use an Aldosterone and Plasma Renin Activity test?

Aldosterone and renin tests are performed to determine whether the adrenal glands are producing enough aldosterone and to differentiate between potential causes of excess or insufficiency. Aldosterone can be detected in the blood or in a 24-hour urine sample, which determines how much aldosterone is excreted in the urine over the course of a day. Renin is always counted in milligrams per milliliter of blood.

Primary aldosteronism, commonly known as Conn syndrome, is a condition that produces high blood pressure and can be detected with these tests. If the test is positive, stimulation and suppression testing can be used to further examine aldosterone production.

The highest levels of aldosterone and renin are in the morning, and they fluctuate throughout the day. The position of the body, stress, and a number of prescribed medications all have an impact on them.

What do my aldosterone and plasma renin activity test results mean?

Conn syndrome is characterized by the adrenal glands overproducing aldosterone, which is usually caused by a benign tumor in one of the glands. A high aldosterone level causes increased salt reabsorption and potassium loss by the kidneys, resulting in an electrolyte imbalance. High blood pressure, headaches, and muscle weakness are signs and symptoms, especially if potassium levels are very low.

When someone has hypertension and their blood potassium is lower than usual, it's time to look for aldosteronism. Blood is drawn from both of the adrenal veins and tested to see whether there is a difference in the amount of aldosterone produced by both of the adrenal glands to establish whether only one or both are impacted.

Secondary aldosteronism, which is more prevalent than primary aldosteronism, is caused by anything other than an adrenal gland condition that causes excess aldosterone. Any disorder that reduces blood flow to the kidneys, lowers blood pressure, or lowers sodium levels could cause it. Congestive heart failure, liver cirrhosis, kidney illness, and pregnancy toxemia can all cause secondary aldosteronism. It's also typical when you're dehydrated. The cause of aldosteronism is usually clear in these circumstances.

The most common cause of secondary aldosteronism is renal artery stenosis, which is a constriction of the blood arteries that supply the kidney. High renin and aldosterone levels produce high blood pressure, which can be treated with surgery or angioplasty. A catheter is introduced via the groin and blood is collected straight from the veins draining the kidney to see if only one kidney is damaged. If one side's result is much higher than the other, this suggests that the artery is narrowed.

Adrenal insufficiency is the most common cause of low aldosterone. Dehydration, low blood pressure, a low salt level in the blood, and a high potassium level are all symptoms. Congenital adrenal hyperplasia, a disorder in which babies lack an enzyme needed to create cortisol, can reduce aldosterone production in some circumstances.

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

 


Description: An antinuclear antibody screening is a blood test that is going to look for a positive or negative result. If the result comes back as positive further test will be done to look for ANA Titer and Pattern. Antinuclear antibodies are associated with Lupus.

Also Known As: ANA Test, ANA Screen IFA with Reflex to Titer and pattern IFA Test, ANA with Reflex Test, Antinuclear Antibody Screen Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

IMPORTANT Reflex Information: If ANA Screen, IFA is positive, then ANA Titer and Pattern will be performed at an additional charge of $13.00

When is an ANA Screen test ordered?

When someone exhibits signs and symptoms of a systemic autoimmune illness, the ANA test is requested. Symptoms of autoimmune illnesses can be vague and non-specific, and they can fluctuate over time, steadily deteriorate, or oscillate between periods of flare-ups and remissions.

What does an ANA Screen blood test check for?

Antinuclear antibodies are a type of antibody produced by the immune system when it is unable to differentiate between its own cells and foreign cells. Autoantibodies are antibodies that attack the body's own healthy cells, causing symptoms like tissue and organ inflammation, joint and muscle discomfort, and weariness. The moniker "antinuclear" comes from the fact that ANA specifically targets chemicals located in a cell's nucleus. The presence of these autoantibodies in the blood is detected by the ANA test.

The presence of ANA may be a sign of an autoimmune process, and it has been linked to a variety of autoimmune illnesses, the most common of which being systemic lupus erythematosus.

One of the most common tests used to detect an autoimmune disorder or rule out other conditions with comparable signs and symptoms is the ANA test. As a result, it's frequently followed by other autoantibody tests that can help establish a diagnosis. An ENA panel, anti-dsDNA, anti-centromere, and/or anti-histone test are examples of these.

Lab tests often ordered with an ANA Screen test:

  • ENA Panel
  • Sed Rate (ESR)
  • C-Reactive Protein
  • Complement
  • AMA
  • Centromere antibody
  • Histone Antibody

Conditions where an ANA Screen test is recommended:

  • Autoimmune Disorders
  • Lupus
  • Rheumatoid Arthritis
  • Sjogren Syndrome
  • Scleroderma

How does my health care provider use an ANA Screen test?

One of the most often performed tests to diagnose systemic lupus erythematosus is the antinuclear antibody test. It serves as the first step in the evaluation process for autoimmune diseases that might impact various body tissues and organs.

When a person's immune system fails to discriminate between their own cells and foreign cells, autoantibodies called ANA are created. They attack chemicals found in a cell's nucleus, causing organ and tissue damage.

ANA testing may be utilized in conjunction with or after other autoantibody tests, depending on a person's indications and symptoms and the suspected condition. Antibodies that target specific compounds within cell nuclei, such as anti-dsDNA, anti-centromere, anti-nucleolar, anti-histone, and anti-RNA antibodies, are detected by some of these tests, which are considered subsets of the general ANA test. In addition, an ENA panel can be utilized as a follow-up to an ANA.

These further tests are performed in addition to a person's clinical history to assist diagnose or rule out other autoimmune conditions such Sjögren syndrome, polymyositis, and scleroderma.

To detect ANA, various laboratories may employ different test procedures. Immunoassay and indirect fluorescent antibody are two typical approaches. The IFA is regarded as the gold standard. Some labs will test for ANA using immunoassay and then employ IFA to confirm positive or equivocal results.

An indirect fluorescent antibody is created by mixing a person's blood sample with cells attached to a slide. Autoantibodies in the blood bind to the cells and cause them to react. A fluorescent antibody reagent is used to treat the slide, which is then inspected under a microscope. The existence of fluorescence is observed, as well as the pattern of fluorescence.

Immunoassays—these procedures are frequently carried out using automated equipment, however they are less sensitive than IFA in identifying ANA.

Other laboratory tests linked to inflammation, such as the erythrocyte sedimentation rate and/or C-reactive protein, can be used to assess a person's risk of SLE or another autoimmune disease.

What do my ANA test results mean?

A positive ANA test indicates the presence of autoantibodies. This shows the presence of an autoimmune disease in someone who has signs and symptoms, but more testing is needed to make a definitive diagnosis.

Because ANA test results can be positive in persons who have no known autoimmune disease, they must be carefully assessed in conjunction with a person's indications and symptoms.

Because an ANA test can become positive before signs and symptoms of an autoimmune disease appear, determining the meaning of a positive ANA in a person who has no symptoms can take some time.

SLE is unlikely to be diagnosed with a negative ANA result. It is normally not required to repeat a negative ANA test right away; however, because autoimmune illnesses are episodic, it may be desirable to repeat the ANA test at a later date if symptoms persist.

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


Description: A Comprehensive Metabolic Panel or CMP is a blood test that is a combination of a Basic Metabolic Panel, a Liver Panel, and electrolyte panel, and is used to screen for, diagnose, and monitor a variety of conditions and diseases such as liver disease, diabetes, and kidney disease. 

Also Known As: CMP, Chem, Chem-14, Chem-12, Chem-21, Chemistry Panel, Chem Panel, Chem Screen, Chemistry Screen, SMA 12, SMA 20, SMA 21, SMAC, Chem test

Collection Method: 

Blood Draw 

Specimen Type: 

Serum 

Test Preparation: 

9-12 hours fasting is preferred. 

When is a Comprehensive Metabolic Panel test ordered:  

A CMP is frequently requested as part of a lab test for a medical evaluation or yearly physical. A CMP test consists of many different tests that give healthcare providers a range of information about your health, including liver and kidney function, electrolyte balance, and blood sugar levels. To confirm or rule out a suspected diagnosis, abnormal test results are frequently followed up with other tests that provide a more in depth or targeted analysis of key areas that need investigating. 

What does a Comprehensive Metabolic Panel blood test check for? 

The complete metabolic panel (CMP) is a set of 20 tests that provides critical information to a healthcare professional about a person's current metabolic status, check for liver or kidney disease, electrolyte and acid/base balance, and blood glucose and blood protein levels. Abnormal results, particularly when they are combined, can suggest a problem that needs to be addressed. 

The following tests are included in the CMP: 

  • Albumin: this is a measure of Albumin levels in your blood. Albumin is a protein made by the liver that is responsible for many vital roles including transporting nutrients throughout the body and preventing fluid from leaking out of blood vessels. 

  • Albumin/Globulin Ratio: this is a ratio between your total Albumin and Globulin  

  • Alkaline Phosphatase: this is a measure of Alkaline phosphatase or ALP in your blood. Alkaline phosphatase is a protein found in all body tissues, however the ALP found in blood comes from the liver and bones. Elevated levels are often associated with liver damage, gallbladder disease, or bone disorder. 

  • Alt: this is a measure of Alanine transaminase or ALT in your blood. Alanine Aminotransferase is an enzyme found in the highest amounts in the liver with small amounts in the heart and muscles. Elevated levels are often associated with liver damage. 

  • AST: this is a measure of Aspartate Aminotransferase or AST. Aspartate Aminotransferase is an enzyme found mostly in the heart and liver, with smaller amounts in the kidney and muscles. Elevated levels are often associated with liver damage. 

  • Bilirubin, Total: this is a measure of bilirubin in your blood. Bilirubin is an orange-yellowish waste product produced from the breakdown of heme which is a component of hemoglobin found in red blood cells. The liver is responsible for removal of bilirubin from the body. 

  • Bun/Creatinine Ratio: this is a ratio between your Urea Nitrogen (BUN) result and Creatinine result.  

  • Calcium: this is a measurement of calcium in your blood. Calcium is the most abundant and one of the most important minerals in the body as it essential for proper nerve, muscle, and heart function. 

  • Calcium: is used for blood clot formation and the formation and maintenance of bones and teeth. 

  • Carbon Dioxide: this is a measure of carbon dioxide in your blood. Carbon dioxide is a negatively charged electrolyte that works with other electrolytes such as chloride, potassium, and sodium to regulate the body’s acid-base balance and fluid levels.  

  • Chloride: this is a measure of Chloride in your blood. Chloride is a negatively charged electrolyte that works with other electrolytes such as potassium and sodium to regulate the body’s acid-base balance and fluid levels. 

  • Creatinine: this is a measure of Creatinine levels in your blood. Creatinine is created from the breakdown of creatine in your muscles and is removed from your body by the kidneys. Elevated creatinine levels are often associated with kidney damage. 

  • Egfr African American: this is a measure of how well your kidneys are functioning. Glomeruli are tiny filters in your kidneys that filter out waste products from your blood for removal while retaining important substances such as nutrients and blood cells. 

  • Egfr Non-Afr. American: this is a measure of how well your kidneys are functioning. Glomeruli are tiny filters in your kidneys that filter out waste products from your blood for removal while retaining important substances such as nutrients and blood cells. 

  • Globulin: this is a measure of all blood proteins in your blood that are not albumin. 

  • Glucose: this is a measure of glucose in your blood. Glucose is created from the breakdown of carbohydrates during digestion and is the body’s primary source of energy. 

  • Potassium: this is a measure of Potassium in your blood. Potassium is an electrolyte that plays a vital role in cell metabolism, nerve and muscle function, and transport of nutrients into cells and removal of wastes products out of cells. 

  • Protein, Total: this is a measure of total protein levels in your blood. 
    Sodium: this is a measure of Sodium in your blood. Sodium is an electrolyte that plays a vital role in nerve and muscle function. 

  • Sodium: this is a measure of sodium in your blood's serum. Sodium is a vital mineral for nerve and muscle cell function.

  • Urea Nitrogen (Bun): this is a measure of Urea Nitrogen in your blood, also known as Blood UreaNitrogen (BUN). Urea is a waste product created in the liver when proteins are broken down into amino acids. Elevated levels are often associated with kidney damage. 

Lab tests often ordered with a Comprehensive Metabolic Panel test: 

  • Complete Blood Count with Differential and Platelets
  • Iron and Total Iron Binding Capacity
  • Lipid Panel
  • Vitamin B12 and Folate
  • Prothrombin with INR and Partial Thromboplastin Times
  • Sed Rate (ESR)
  • C-Reactive Protein

Conditions where a Comprehensive Metabolic Panel test is recommended: 

  • Diabetes
  • Kidney Disease
  • Liver Disease
  • Hypertension

Commonly Asked Questions: 

How does my health care provider use a Comprehensive Metabolic Panel test? 

The comprehensive metabolic panel (CMP) is a broad screening tool for assessing organ function and detecting diseases like diabetes, liver disease, and kidney disease. The CMP test may also be requested to monitor known disorders such as hypertension and to check for any renal or liver-related side effects in persons taking specific drugs. If a health practitioner wants to follow two or more separate CMP components, the full CMP might be ordered because it contains more information. 

What do my Comprehensive Metabolic Panel test results mean? 

The results of the tests included in the CMP are usually analyzed together to look for patterns. A single abnormal test result may indicate something different than a series of abnormal test findings. A high result on one of the liver enzyme tests, for example, is not the same as a high result on several liver enzyme tests. 

Several sets of CMPs, frequently performed on various days, may be examined to gain insights into the underlying disease and response to treatment, especially in hospitalized patients. 

Out-of-range findings for any of the CMP tests can be caused by a variety of illnesses, including kidney failure, breathing issues, and diabetes-related complications, to name a few. If any of the results are abnormal, one or more follow-up tests are usually ordered to help determine the reason and/or establish a diagnosis. 

Is there anything else I should know? 

A wide range of prescription and over-the-counter medications can have an impact on the results of the CMP's components. Any medications you're taking should be disclosed to your healthcare professional. Similarly, it is critical to provide a thorough history because many other circumstances can influence how your results are interpreted. 

What's the difference between the CMP and the BMP tests, and why would my doctor choose one over the other? 

The CMP consists of 14 tests, while the basic metabolic panel (BMP) is a subset of those with eight tests. The liver (ALP, ALT, AST, and bilirubin) and protein (albumin and total protein) tests are not included. If a healthcare provider wants a more thorough picture of a person's organ function or to check for specific illnesses like diabetes or liver or kidney disease, he or she may prescribe a CMP rather than a BMP. 

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

Please note the following regarding BUN/Creatinine ratio: 

The lab does not report the calculation for the BUN/Creatinine Ratio unless one or both biomarkers’ results fall out of the published range. 

If you still wish to see the value, it's easy to calculate. Simply take your Urea Nitrogen (BUN) result and divide it by your Creatinine result.  

As an example, if your Urea Nitrogen result is 11 and your Creatinine result is 0.86, then you would divide 11 by 0.86 and get a BUN/Creatinine Ratio result of 12.79. 


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.

Most Popular

Description: A cortisol test measures the amount of cortisol in the blood. These levels will start off high in the morning and throughout the say they become lower. At midnight they are typically at their lowest level. Someone who works a night shift or has an irregular sleep schedule may have a different pattern. This test can be used to determine Cushing's or Addison's Disease.

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

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: Specimen must be drawn between 7 a.m. and 9 a.m. Test is not recommended for patients receiving prednisone/prednisolone therapy due to cross reactivity with the antibody used in this test.

When is a Cortisol AM 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 AM 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. A certain amount of cortisol must be produced for normal adrenal, pituitary gland, and brain function.

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 AM test:

  • Cortisol PM
  • ACTH
  • Aldosterone
  • 17-Hydroxyprogesterone
  • Growth Hormone

Conditions where a Cortisol AM test is recommended:

  • Addison’s Disease
  • Cushing’s Syndrome
  • Endocrine Syndromes
  • Hypertension
  • Pituitary Disorders

How does my health care provider use a Cortisol AM 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. Among other things, the hormone cortisol controls how proteins, lipids, and carbohydrates are metabolized. 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. Cortisol production and release are triggered by ACTH in the adrenal glands. A certain amount of cortisol must be produced for normal brain, pituitary, and adrenal gland function.

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.

The purpose of ACTH stimulation is to compare the levels of cortisol in a person's blood before and after receiving an injection of synthetic ACTH. If the adrenal glands are healthy, the reaction to ACTH stimulation will be an increase in cortisol levels. Low amounts of cortisol will result if they are broken or not functioning properly. To distinguish between adrenal and pituitary insufficiency, a lengthier variant of this test can be used.

What do my Cortisol AM 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 subject of the examination reacts to an ACTH stimulation test and has insufficient cortisol levels, the issue is most likely brought on by the pituitary's insufficient production of ACTH. The adrenal glands are most likely the source of the issue if the subject does not react to the ACTH stimulation test.

 

An additional test, like as a CT scan, may be used by the medical professional to evaluate the degree of any gland damage once an irregularity has been identified and related to the pituitary gland, the adrenal glands, or another cause.

Important: Patient needs to have the specimen collected between 7 a.m.-9 a.m.

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


Most Popular

Description: A cortisol test measures the amount of cortisol in the blood. These levels will start off high in the morning and throughout the say they become lower. At midnight they are typically at their lowest level. Someone who works a night shift or has an irregular sleep schedule may have a different pattern. This test can be used to determine Cushing's or Addison's Disease.

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

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: Test not recommended when patient is on prednisone/prednisolone therapy due to cross reactivity with the antibody used in this test

When is a Cortisol Total 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 Total 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 Total test:

  • Cortisol PM
  • Cortisol AM
  • Cortisol Saliva
  • ACTH
  • Aldosterone
  • 17-Hydroxyprogesterone
  • Growth Hormone

Conditions where a Cortisol Test is recommended:

  • Addison’s Disease
  • Cushing’s Syndrome
  • Endocrine Syndromes
  • Hypertension
  • Pituitary Disorders

How does my health care provider use a Cortisol Total 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 Total 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.

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


Description: A cortisol test measures the amount of cortisol your body. These levels will start off high in the morning and throughout the say they become lower. At midnight they are typically at their lowest level. Someone who works a night shift or has an irregular sleep schedule may have a different pattern. This test can be used to determine Cushing's or Addison's Disease.

Also Known As: Cortisol Total Test, Cortisol Saliva Test, Cortisol 4 Specimen Test, 4 Specimen Cortisol Test, Cortisol Free Test, Cortisol Kit Test

Collection Method: Saliva Collection Kit. [For instructions, scroll down to the bottom]

Specimen Type: Saliva

Test Preparation: No preparation required

When is a Cortisol 4 Sample 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 4 Sample Saliva 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 4 Sample Saliva test:

  • Cortisol PM
  • Cortisol AM
  • Cortisol Total
  • ACTH
  • Aldosterone
  • 17-Hydroxyprogesterone
  • Growth Hormone

Conditions where a Cortisol 4 Sample test is recommended:

  • Addison’s Disease
  • Cushing’s Syndrome
  • Endocrine Syndromes
  • Hypertension
  • Pituitary Disorders

How does my health care provider use a Cortisol 4 Sample 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.

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

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.

Collection Instructions

  1.  Remove the swab from the Salivette.
  2. Follow times to collect as told by your physician
    a. Place the swab in the mouth, e.g. in your cheek, where it should remain for 2 minutes without chewing. If an extremely small amount of saliva is produced, leave the swab in the mouth for longer.

b. Return the swab with the absorbed saliva to the Salivette.
c. Replace the stopper.

  1. Label each saliva collection tube with the following information

              a. patient name

              b. date of birth (DOB)

              c. date and time of collection

Refrigerate the Salivette immediately after collection

Return Collected Samples & Patient Requisition Directly to Patient Service Center within 48hrs of collection

Storage instructions

  1. Specimen should be stored at refrigerated temperature prior to returning to the Patient Service Center .
  2. Do not use this kit on children under 3 years of age or any patient with increased risk of swallowing or choking.

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

Most Popular

Description: A cortisol test measures the amount of cortisol in the blood. These levels will start off high in the morning and throughout the say they become lower. At midnight they are typically at their lowest level. Someone who works a night shift or has an irregular sleep schedule may have a different pattern. This test can be used to determine Cushing's or Addison's Disease.

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?

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 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:

  • Cortisol Total
  • Cortisol AM
  • Cortisol Saliva
  • ACTH
  • Aldosterone
  • 17-Hydroxyprogesterone
  • Growth Hormone

Conditions where a Cortisol PM test is recommended:

  • Addison’s Disease
  • Cushing’s Syndrome
  • Endocrine Syndromes
  • Hypertension
  • Pituitary Disorders

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.

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.



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