Stress and Fatigue Tests

This hub is for people with persistent tiredness, low energy, brain fog, or poor stress tolerance; those with snoring/daytime sleepinesspost-viral fatigueheavy periodsrestricted diets, or new mood changes—and for clinicians organizing workups.


Core domains: Foundations (CBC; iron panel—ferritin/iron/TIBC/TSATTSH ± FT4CMP/BMP—electrolytes, creatinine/eGFRAST/ALT/ALP/GGT, bilirubin, albumin; A1c ± fasting glucoseB12 ± MMA/homocysteineFolate ± RBC folateVitamin D), Inflammation (CRP/ESR), Adrenal/HPA (AM cortisolACTHlate-night salivary cortisol (LNSC)24-hr urine free cortisol (UFC)1-mg DST [clinician-directed], DHEA-S), Autoimmune & Celiac(TPO AbtTG-IgA total IgA), Infectious (EBV panel ± CMV), Muscle (CK ± aldolase), and targeted sex-hormone tests (AM TT/FT SHBG in men; estradiol/progesterone, LH/FSH in women) with hCG when relevant.
Results help rule-in/out common causestriage endocrine/hematologic/infectious contributors, and monitorclinician-guided care.


What It Tests

  • Screening/Early detection: Basic causes of fatigue (anemia, iron/B12/folate deficiency; thyroid; glycemia; liver/kidney; vitamin D; inflammation).

  • Diagnosis/Triage: When symptoms/history suggest HPA-axis disordersceliac/autoimmune thyroidviral triggers, or myopathy/overtraining.

  • Monitoring: Follow-up of abnormal or borderline labs, trend-tracking during clinician-guided care, and contextfor sleep/mental-health management.

Principles: Prefer patterns and trends over single values; interpret with timing (AM/PM; cycle phase)medicationsillness, and collection quality.


Key Tests

Test Also Called (Synonyms) What It Measures Typical Prep (fasting?) Specimen Turnaround Related Panels Use Type (Screen / Dx / Mon / Risk) Timing Notes / Caveats
CBC with indices Hemogram; MCV/RDW Anemia pattern, platelets None Blood Same–1 d Fatigue Essentials/Advanced Screen/Dx/Mon Microcytosis → iron; macrocytosis → B12/folate (but confirm)
Iron Panel Ferritin, Iron, TIBC, TSAT Iron stores & transport Morning preferred Blood 1–2 d Fatigue Essentials/Advanced Screen/Dx/Mon Ferritin ↑ with inflammation; pair with CRP
TSH ± FT4 (± FT3) Thyroid screen Thyroid dysfunction None Blood 1–2 d Thyroid Adrenal Snapshot Screen/Dx/Mon Biotin can interfere in some assays
CMP Electrolytes, eGFR, liver enzymes, albumin Metabolic, renal, hepatic context None Blood 1–2 d Fatigue Essentials Screen/Dx/Mon Review Na/K/Cl/CO2AST/ALT/ALP/GGTalbumin
A1c ± Fasting Glucose Glycemia Chronic & fasting glucose status A1c: none; Glucose: per lab Blood 1–2 d Fatigue Advanced Screen/Dx/Mon A1c not affected by fasting
Vitamin B12 ± MMA/Hcy Cobalamin; methylmalonic acid B12 deficiency confirmation None Blood (± serum/urine MMA) 1–3 d Fatigue Advanced Dx/Mon Use MMA if B12 borderline; CKD may raise MMA
Folate (± RBC folate) Folate status (short/long term) None Blood 1–3 d Fatigue Advanced Dx/Mon RBC folate reflects longer-term status
Vitamin D (25-OH) 25-hydroxyvitamin D D status None Blood 1–3 d Fatigue Essentials Screen/Mon Interpret with calcium/phosphate if needed
CRP / ESR Inflammation markers Inflammatory context None Blood Same–1 d Post-Viral, Advanced Screen/Dx/Mon Illness/exertion can transiently elevate CRP
AM Serum Cortisol HPA axis snapshot AM 7–10 a.m. Blood 1–2 d Thyroid Adrenal Dx/Mon CBG ↑ with estrogens/pregnancy → higher total
ACTH Pituitary drive None (chilled tube per lab) Blood 1–2 d Thyroid Adrenal Dx Draw with AM cortisol when suspecting AI
Late-Night Salivary Cortisol LNSC Night cortisol None Saliva (home collection) 1–3 d Thyroid Adrenal Dx 2 samples late evening; circadian/shift work matters
24-hr Urine Free Cortisol UFC Integrated cortisol Usual fluids; avoid excess 24-hr urine 2–4 d Thyroid Adrenal Dx/Mon Completeness critical; illness/stress can confound
Dexamethasone Suppression Test 1-mg DST Cushing screening Clinician-directed Blood (AM post-DST) 1–2 d Thyroid Adrenal Dx OCPs/pregnancy → false-positive (↑ CBG)
DHEA-S Adrenal androgen None Blood 1–2 d Thyroid Adrenal Dx/Mon Age-/sex-specific ranges
TPO Antibodies Anti-TPO Autoimmune thyroid None Blood 1–3 d Women’s Fatigue Focus Dx Indicates autoimmunity, not severity
Celiac screen tTG-IgA total IgA (± DGP) Gluten-sensitive enteropathy None Blood 1–3 d Post-Viral / Nutrition Dx Ensure adequate gluten intake before testing
EBV panel VCA IgM/IgG, EBNA Acute vs past EBV None Blood 1–3 d Post-Viral Fatigue Dx Patterns differentiate stages; correlate clinically
CMV IgM/IgG CMV status (risk-based) None Blood 1–3 d Post-Viral Fatigue Dx Order per risk/clinical context
CK ± Aldolase Creatine kinase Myopathy/overtraining Avoid hard exercise pre-draw Blood Same–1 d Athlete Overtraining Dx/Mon Retest after 48–72 hof rest if elevated
Testosterone total/free SHBG (men) TT/FT SHBG Androgen status Morning draw Blood 1–2 d Men’s subset Dx/Mon Repeat if low; meds/illness can affect values
Estradiol ± Progesterone, LH/FSH (women) E2, P4, LH/FSH Cycle-aware hormones Per lab; cycle timing Blood 1–3 d Women’s Fatigue Focus Dx/Mon Align to cycle phase if indicated
Pregnancy test hCG Pregnancy status First-morning urine ideal Blood/urine Same–1 d Women’s Fatigue Focus Dx Test if possibility of pregnancy exists

When to Test

  • Persistent fatigue ≥2–4 weeks affecting daily function. (Screening → Foundations, CRP/ESR)

  • Heavy menstrual bleeding or restricted diets (vegan/vegetarian). (Iron/B12/folate focus)

  • Daytime sleepiness/snoring. (Labs while clinician evaluates for OSA)

  • Recent viral illness/post-viral fatigue. (CBC, CRP/ESR, ferritin, B12, Vit D, TSH)

  • Weight change, cold/heat intolerance, hair loss. (Thyroid panel)

  • Orthostasis, salt craving, skin darkening. (AM cortisol ± ACTH with clinician)

  • Central weight gain, wide purple striae, easy bruising. (Cushing screening—LNSC/UFC/DST via clinician)

  • Athletes/high training load. (CK, ferritin, Vit D)

  • Pregnancy/postpartum. (Anemia/thyroid focus with clinician)


How to Prepare

  • Fasting: Usually not required; follow requisition for glucose/insulin.

  • Timing: AM cortisol (7–10 a.m.); men’s testosterone in the morning; LNSC late evening; align sampling with your sleep schedule if you work nights. Repeat abnormal results to confirm.

  • Biotin: Avoid high-dose biotin for 24–48 h (per lab) before immunoassays.

  • Exercise/Alcohol: Avoid strenuous exercise before CK; maintain usual routines for trending.

  • Medications: Disclose steroids, thyroid meds, OCPs/estrogens, supplements; do not stop prescribed meds without clinician guidance.

  • Urine collections: Follow 24-hr urine instructions exactly for UFC (completeness matters).


Interpreting Results

  • Anemia patterning: MCV/RDW helps separate iron (microcytic) from B12/folate (macrocytic). Ferritin rises with inflammation—interpret alongside CRP.

  • Thyroid: TSH is the primary screen; confirm with FT4TPO Ab indicates autoimmunity (Hashimoto context) but not severity.

  • Cortisol suite: Strong diurnal rhythmAM cortisol alone is context-dependent; LNSC/UFC/DST screen for Cushing when indicated. Estrogens/pregnancy ↑ CBG, increasing total cortisol. Acute illness/pain/stress can transiently raise cortisol.

  • Adrenal insufficiency: Low cortisol with suggestive symptoms needs clinician-directed evaluation (e.g., cosyntropin test).

  • CK: Can rise with exercise/injectionsretest after 48–72 h of rest if elevated.

  • Normal labs, ongoing fatigue: Consider sleep, mental health, medications, pain, rehabilitation, and lifestylecontributors with your clinician.


Related Conditions

  • Thyroid Disorders 

  • Anemia & Blood Disorders 

  • Hormone & Adrenal 

  • Diabetes & Metabolic Health 

  • Infectious Disease Testing 

  • Nutrition Tests 

  • Sleep & Breathing 


Bundles & Panels

  • Fatigue Basic Panel – Examines common contributors to ongoing tiredness including thyroid function, basic hormonal balance, and nutrient deficiency markers.

  • Fatigue Test Panel – A more comprehensive set of tests designed to identify underlying causes of fatigue across multiple physiological systems.

  • Stress Impact Assessment Panel – Ideal for detecting adrenal dysfunction, with emphasis on cortisol and DHEA balance as well as thyroid-related dysfunction.

  • WHHC – Fatigue Panel – Contains 5 tests encompassing 64 biomarkers, offering a mid-level look into fatigue-related factors including inflammation, hormonal status, and metabolic markers.

  • Chronic Fatigue Syndrome – Comprehensive – The most extensive panel, including 15 tests with 96 biomarkers to provide a wide-ranging view into immune, metabolic, endocrine, and inflammatory contributors to chronic fatigue.


FAQs

Is “adrenal fatigue” real?
No. It’s not a recognized diagnosis. Evaluate for adrenal insufficiency or Cushing syndrome only when clinically suspected.

When should I check cortisol?
AM (7–10 a.m.) for serum cortisol; late-night for salivary cortisol; follow the collection instructions carefully.

Can biotin or estrogen affect my results?
Yes. Biotin can interfere with some immunoassays; oral estrogens/pregnancy raise CBG and total cortisol.

How soon can I retest after starting iron or B12?
Often 4–8 weeks for iron/B-vitamins—confirm timing with your clinician.

Why am I tired if my labs are “normal”?
Fatigue is multifactorial—sleep quality/OSA, mood, medications, pain, and lifestyle are common contributors.

Are saliva cortisol tests reliable?
They’re useful for Cushing screening when done correctly; timing and technique matter.

Do I need to fast?
Usually no—except when glucose/insulin testing is requested.

What if I work nights?
Align “morning” sampling to your wake time; discuss with your clinician.


References

  • Endocrine Society / AACE — evaluation of Cushing syndromeprimary adrenal insufficiencyhypothyroidism

  • ACP / AAFP / NICE — primary-care evaluation of fatigue

  • AASM — obstructive sleep apnea screening/diagnostic context

  • CDC — EBV testing interpretation resources

  • NIH Office of Dietary Supplements (ODS) — iron, B12, folate, vitamin D fact sheets (testing context & confounders)

  • Mayo Clinic Laboratories / ARUP Consult — cortisol testing (LNSC/UFC/DST), biotin interferenceCKpre-analytics


Last reviewed: September 2025 — Medical reviewer: Ulta Lab Tests Medical Review Team

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Did you know that 55 percent of Americans are stressed during the day? This means that about one in two people is experiencing regular stress.

Considering the impact that stress has on our bodies, this statistic is more than worrying. 

If you feel like stress is taking over your life, you may need a test for stress. By looking for different biomarkers, we can determine whether or not your stress level is making a big impact on your health and wellness.

To learn more about reaching your level of optimal health, keep reading. We're going to cover everything you need to know about testing for stress.

What Is Stress?

Stress is the reaction that your body has when internal or external stimuli place you under pressure. In response to stressful stimuli, your body may elicit you to have a physical, mental, or emotional response.

At some point in their lives, every single person deals with stress. It may have been a death in the family, a lost job, or some other kind of change that caused your body to set off a stress response.

On the other hand, stress doesn't have to be a negative thing. You could have been stressed because of a new job, the birth of a child, a move, or another positive event. These kinds of stressors expand your mind and make you more aware of your surroundings.

Nonetheless, stress does affect our bodies. Whether it's negative or positive, stress can cause our bodily hormones to fall outside normal limits.

Risk Factors for Stress

Everyone is at risk for developing stress. As we mentioned, it's a normal part of life. 

With that in mind, researchers and scientists have been looking at the top stressors in patients' lives right now. Here are the top ten stressors that may put you at risk for developing stress-related illness:

  1. Death of a spouse
  2. Divorce
  3. Marriage separation
  4. Imprisonment
  5. Death of a close family member
  6. Injury or illness
  7. Marriage
  8. Job loss
  9. Marriage reconciliation
  10. Retirement

If you've recently gone through or are currently going through one of these scenarios, you should pay extra attention to the amount of stress you may be accumulating. If you become too stressed out, it could be harmful to your health.

Be sure to watch out for the signs and symptoms of having too much stress. We'll discuss these a little bit later.

Causes of Stress

Everyone experiences stress in different ways. Some people become chronically ill after experiencing one stressor, while others can take on five without any change.

Whatever major life change has happened is the cause of whatever stress you may be feeling. However, the true cause of your stress is your body's response to the change.

When we become stressed, our bodies send out a stress signal, and it travels all over the body to let every cell know that something has happened or is happening.

Each organ system in your body responds to this signal: your cardiovascular system, your nervous system, your endocrine system, your respiratory system, and more. The response for your body has the same changes that we see with the 'flight-or-fight response.'

When you're stressed, your body undergoes a series of chemical reactions. So, the reaction you may have to all of the changes in your life is normal.

Your body is making changes to adjust to the stressor(s), and you're feeling the effects of those changes.

If your body stays in this state for long periods of time, you can experience further symptoms and even develop illnesses.

What Are the Signs and Symptoms of Stress?

Since stress affects all of the organ systems within your body, there are a plethora of symptoms that you may feel if you're stressed:

  • Moody behavior
  • Feeling overwhelmed
  • Difficulty relaxing
  • Feeling lonely and/or depressed
  • Avoiding friends and family
  • Fatigue
  • Headaches
  • Nausea
  • Muscle aches
  • Chest pain
  • Trouble sleeping
  • Frequent illness
  • Low libido
  • Feeling nervous
  • Dry mouth
  • Clenched jaw
  • Worrying constantly
  • Forgetfulness
  • Loss of ability to focus
  • Pessimism
  • Poor judgment
  • Change in appetite
  • Procrastination
  • Alcohol or drug dependence

As you can see, the symptoms of stress come from every organ system, and this list only scratched the surface of some of the symptoms that people feel. Some stressed individuals progress to heart attacks and strokes.

If you want to avoid weakening your immune system or causing other health issues, you need to get your stress under control.

How Is Stress Diagnosed?

If you feel like your stress is too much for you to handle, you should see a specialist. They can get you the help that you need to avoid being overcome by stress.

To diagnose the presence of too much stress, your physician can assess your current social situation. They may ask you about recent changes or difficult situations.

They can even run lab tests to see whether or not your body has initiated a strong stress response.

The Lab Tests to Monitor the Impact of Stress on One's Health

The number one test to check for chronic stress is cortisol. Cortisol is known as the stress hormone. It's the signal that your body sends off when stressors become too much for it to handle.

Your health provider may also want to check your DHEA sulfate levels and testosterone levels. These are both male sex hormones that both male and female bodies produce. When we undergo too much stress, these levels can increase and cause other problems inside of our bodies.

Test for Stress With Ulta Labs Today!

If you're looking to test for stress in your body, you should try our stress testing. We check for the biomarkers that indicate that stress is taking over your body and your health. With Ulta Lab Tests, you get:

  • Accurate and reliable results available in 24 to 48 hours for most tests
  • Results that are secure and confidential
  • No insurance or doctor’s referral required
  • Affordable pricing for all tests
  • 100% satisfaction guarantee

Remember, if stress goes on too long in the body, it can affect your health and wellness long term. You could develop an immunodeficiency and contract acute and chronic illnesses.

Take control of your health today with Ulta Lab Tests. We can help you get the answers that you need so you can stop stressing.