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  • Also Known As:
  • Cortisol Blood Test
  • Cortisol Urine Test
  • Salivary Cortisol Test
  • 24-Hour Urinary Cortisol Excretion
  • Late-Night Salivary Cortisol
  • Late-Night Serum Cortisol
  • Serum Cortisol
  • Cortisol Radioimmunoassay
  • Cortisol Competitive Protein Binding Assay
  • Cortisol Fluorometric Assay
  • 24-Hour Urinary Free Cortisol (UFC)
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Test Quick Guide

Cortisol is a hormone made in the adrenal glands, which are small glands located near the top of each kidney. Cortisol affects many processes in the body and influences the immune system, nervous system, and metabolism. It also plays a role in helping the body respond to stress and is sometimes called “the stress hormone.”

Cortisol can be measured in a person’s blood, urine, or saliva. Testing measures the amount of cortisol in these body fluids and is used to diagnose and monitor health conditions that affect the adrenal glands.

About the Test

Purpose of the test

Cortisol testing helps your doctor determine whether the adrenal glands are producing an appropriate amount of cortisol. Measurements of cortisol may be used to diagnose or monitor certain health conditions.

Diagnostic testing describes tests used to find the cause of symptoms. Cortisol testing can help diagnose or rule out conditions that cause abnormal cortisol levels, such as:

  • Cushing’s syndrome, a condition characterized by high levels of cortisol
  • Cushing’s disease, a type of Cushing’s syndrome in which an excess amount of a hormone called adrenocorticotropic hormone (ACTH) causes the overproduction of cortisol
  • Addison disease, a disorder in which the adrenal glands don’t produce sufficient hormones like cortisol

Monitoring tests are used to understand how your health changes over time. Cortisol testing is used to monitor the effectiveness of treatment in patients with unusually low or high cortisol levels.

What does the test measure?

Cortisol testing measures the amount of the hormone cortisol in the blood, urine, or saliva. Cortisol is one of several glucocorticoid hormones, which are hormones that help the body control blood sugar levels, regulate the immune system, and assist the body in responding to stress.

It is normal for cortisol levels to change over the course of the day and in reaction to various stressors. The body’s process of producing cortisol requires several steps:

  • An area of the brain called the hypothalamus produces the hormone corticotropin-releasing hormone (CRH).
  • CRH travels to another part of the brain called the pituitary gland and triggers the secretion of corticotropin, which is also called adrenocorticotropic hormone (ACTH).
  • Finally, ACTH is transported to the adrenal glands where it stimulates the production of cortisol.

In this way, cortisol levels reflect whether these different steps are being carried out normally in the body. Additional information may be gathered by conducting a cortisol test along with other tests like the adrenocorticotropic hormone (ACTH) test.

When should I get cortisol testing?

Your doctor may recommend cortisol testing if they think that you may have a condition that affects your cortisol levels.

Doctors may initiate cortisol testing if you have a health problem that is unusual for people of your age, such as young adults with hypertension or osteoporosis. They may also recommend cortisol testing if you have a severe health condition that can affect cortisol levels or if your doctor finds an adrenal tumor during imaging tests conducted for an unrelated concern.

Your doctor may recommend cortisol testing based on your symptoms, especially if you have more than one symptom of high cortisol that worsens with time. Symptoms of high cortisol include:

  • Unexplained weight gain, particularly in children
  • Fat accumulation around the base of the neck
  • A hump-like pad of fat between the shoulders
  • Slow growth in children
  • Unexplained growth of facial or body hair
  • Menstrual periods that are irregular or stop entirely
  • Erectile dysfunction
  • Lowered fertility and decreased interest in sex in men or people assigned male at birth
  • High blood pressure
  • High blood sugar

Cortisol testing may also be recommended if you’re experiencing symptoms of low cortisol, if doctors suspect that you may be experiencing acute adrenal crisis, which is a medical emergency due to insufficient cortisol. Symptoms of low cortisol include:

  • Chronic fatigue
  • Muscle weakness
  • Appetite loss
  • Unexplained weight loss
  • Abdominal pain

Conditions that cause high and low cortisol levels are rare, and these symptoms are most often caused by other diseases. Thus, a doctor may test for more common conditions before initiating cortisol testing.

In addition to diagnostic testing, cortisol may be tested as a type of monitoring if you have been previously diagnosed with high cortisol and are taking medications to lower your cortisol levels.

Finding a Cortisol Test

How to get tested

Cortisol testing is prescribed by a doctor and performed in a medical setting, like a doctor’s office, hospital, or laboratory.

Can I take the test at home?

There are commercially available at-home cortisol tests. These tests involve collecting a sample or blood, urine, or saliva and mailing it to a laboratory for analysis. Because cortisol levels change throughout the day, some tests require a sample to be collected in the morning, while others use samples taken at several different times during the day.

At-home cortisol tests may also be called at-home stress and sleep panels and measure other substances that can affect sleep and the body’s stress responses.

At-home tests can provide a snapshot of cortisol levels, but they are not able to replace physician-ordered tests. A doctor’s evaluation of your symptoms is very important when investigating potential problems with cortisol levels.

How much does the test cost?

The cost of a cortisol test depends on several factors, including:

  • Whether the test uses blood, urine, or saliva
  • Whether the test is done alone or in combination with other tests
  • Whether the test is repeated
  • Where the test is performed
  • Whether you have health insurance and, if so, the details of your health insurance coverage

Total charges for cortisol testing can include fees for office visits, blood draws, and/or laboratory analysis. Insurance may cover all or some of these charges, but you may be responsible for deductibles or copayments. For detailed information about the costs of cortisol testing, talk with your doctor’s office and health insurance provider.

If you do not have health insurance, talk with your doctor or a hospital administrator about cost estimates and whether any programs are available to reduce testing costs for people who are uninsured.

Taking a Cortisol Test

Cortisol can be measured in the blood, saliva, or urine. Because cortisol levels change throughout the day, your doctor will likely recommend that your cortisol test be conducted at a specific time, depending on the purpose of the test.

Blood samples for cortisol tests are most often collected early in the morning when the level of cortisol in your blood should be at its highest. The blood sample is usually taken from your arm at a medical office, hospital, or lab.

Saliva for a cortisol test may be collected at a medical office or at home. When testing for high cortisol, your doctor may instruct you on how to collect a sample of saliva late at night while you are at home.

For a cortisol urine test, you will be provided with containers and detailed instructions about how to collect all of the urine you produce in 24 hours. You will collect this urine yourself and then return it to a lab. For convenience, you may wish to choose a 24-hour period when you expect to be at home.

Before the test

Because cortisol levels can vary throughout the day, it is important to inform your doctor if you have an atypical sleep schedule.

Your doctor may ask you to temporarily stop taking certain medications that can interfere with getting an accurate test result. You may also be asked to refrain from vigorous exercise in the day leading up to the test.

During the test

For blood testing, a sample is usually taken from a vein in your arm. The person taking the sample will increase blood in the veins by tying an elastic band around your upper arm. They will clean the skin with an antiseptic, then insert a needle into your vein and draw a small amount of blood into a tube attached to the needle. A blood draw can cause a stinging sensation when the needle pierces the skin, but the whole process usually takes less than five minutes.

For saliva testing, you will be asked to start by rinsing your mouth. In some cases, you may be told to chew on gum or cotton in order to stimulate saliva production. You will then spit into a collection container or use a swab to collect saliva. Collecting a saliva sample usually takes just a few minutes and may be done at a laboratory or at home. Some patients may be asked to take multiple saliva samples over the course of several days, then return all of them to the testing facility at the same time.

Urine cortisol testing typically requires a 24-hour urine sample. You will collect all the urine you produce over a span of 24 hours. The laboratory will provide you with one or more containers and instructions on how to collect your urine. Follow the instructions you are given exactly as they are written. This process typically starts on one morning and ends the following morning.

After the test

After a blood sample is collected, the place where the needle entered your arm will be bandaged. After this, you can usually resume your normal activities. You may feel some soreness or have some light bruising, but this should go away quickly.

If saliva samples for cortisol testing are being collected at home, return the samples to the testing facility within the recommended time period.

After the last urine sample in the 24-hour period is collected, seal the container and bring it to the laboratory or your health care provider.

There are no side effects or restrictions on activity after a urine or saliva cortisol test is complete.

Cortisol Test Results

Receiving test results

Depending on the purpose of testing, you may receive your cortisol test results through a secure online platform or through a letter in the mail. Your doctor may call to share your results or discuss them during a follow-up appointment. Cortisol test results are typically available within a few business days.

It is important to keep in mind that you may be asked to repeat cortisol tests several times or to take additional follow-up tests before any diagnosis is reached.

Interpreting test results

Cortisol test reports will show the amount of cortisol measured in the test sample and include reference ranges, which are the expected level of cortisol in healthy people. However, a patient’s individual circumstances must be taken into consideration when interpreting a cortisol test.

For some patients, a single cortisol test with results that fall within the normal range is sufficient evidence that their body produces the correct amount of cortisol. For other patients, multiple cortisol tests are needed to determine if the amount of cortisol in their body is normal or abnormal.

Conditions that can cause high cortisol levels, also known as hypercortisolism, include:

  • Cushing’s syndrome, a hormonal disorder often caused by high dosages or prolonged use of steroid medications, such as prednisone, dexamethasone, and prednisolone
  • Ectopic Cushing’s syndrome, a condition in which the hormone ACTH is made in a tumor in another part of the body
  • Cushing’s disease, a condition in which noncancerous tumors on the pituitary gland make too much ACTH
  • Rare genetic syndromes
  • A tumor in the adrenal gland that produces cortisol
  • Other health conditions like pregnancy, obesity, physical and psychological stress, depression, diabetes, alcoholism, and sleep apnea.

Conditions that can cause low cortisol levels include:

  • Addison’s disease, also called primary adrenal insufficiency, in which the adrenal glands are damaged and cannot produce enough cortisol and other adrenal hormones
  • Secondary adrenal insufficiency, a condition in which the pituitary gland makes insufficient ACTH
  • Tertiary adrenal insufficiency, which describes a problem with the part of the brain that produces corticotropin-releasing hormone (CRH)

Abnormal cortisol levels and the conditions that cause them can be challenging to diagnose because the symptoms of low and high cortisol are common in other diseases.

Are test results accurate?

Cortisol tests are likely to accurately reflect your cortisol level at the time the test was taken, though ​​no test is without some potential for error.

Accurate testing requires proper sample collection, and some patients who are collecting 24-hour urine samples may find it difficult to follow collection instructions precisely. If too little or too much urine is collected, test results can be affected.

To try to get the most accurate results, a doctor will make careful selection of initial and, if needed, repeat or follow-up testing. To interpret your results, your doctor will take individual factors into account, including your symptoms, the medications you take, and your sleep schedule.

Cortisol tests are complex to interpret, so any questions about their accuracy or significance should always be addressed in consultation with a medical professional.

Do I need follow-up tests?

Most patients getting their cortisol tested will undergo multiple tests. A patient may be asked to repeat the same cortisol test more than once or have their cortisol tested in more than one sample type.

Because there are many potential reasons for cortisol levels that are too high or too low, further testing is often needed to help assess the underlying cause. To better understand the situation, it is common for cortisol tests to be done in combination with other tests, such as the adrenocorticotropic hormone (ACTH) test or the overnight dexamethasone suppression test.

Questions for your doctor about test results

Your doctor is in the best position to help you understand your cortisol test results. It could be helpful to ask specific questions, such as:

  • Is this cortisol test result within the reference range?
  • What does the result of this cortisol test say about my health?
  • Are you able to make a diagnosis based on this test result?
  • Do you recommend any additional tests? Why or why not?

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