Primus Pathology Laboratory

Cortisol Test

Last Updated on August 1, 2022 by Dr. Neeraj Gujar

Cortisol test Overview

Cortisol Test is done to measure the amount of Cortisol, a hormone, that affects nearly every organ and tissue of your body. It is essential in your ability to:

  • Manage stress
  • Combat infection
  • Regulate blood sugar
  • Keep your blood pressure at a healthy level
  • Regulate metabolism

Your adrenal glands are two glands just above your kidneys that make cortisol. Cortisol tests measure the amount of cortisol found in blood, urine, and saliva. The most commonly used method of measuring cortisol is through blood tests. Your adrenal glands may be suffering from a disorder if your cortisol levels are abnormally high or low. If not treated, these disorders can lead to serious consequences.

Cortisol level tests, also known as blood cortisol, are done using a blood sample. This is to determine the cortisol levels in your blood.

What is Cortisol?

The adrenal glands produce cortisol, a steroid hormone. Your brain releases a chemical called adrenocorticotropic hormone (ACTH) whenever you feel threatened by something, such as a large dog barking at your face. Your adrenal glands release adrenaline and cortisol as a result.

Cortisol, the main hormone that causes stress and the fight, flight, or freeze response, is responsible. This is a protective and natural response to perceived danger or threat. Cortisol levels increase, which can lead to a surge of energy and strength.

Cortisol suppresses functions that are not necessary or harmful to the fight, flight, or freeze response. You can have the following functions during a fight, flight, or freeze response:

  • Rapid heart rate
  • Stomach upset
  • Panic
  • Dry mouth
  • Diarrhea

Cortisol release also causes:

  • Suppressing your growth
  • Your reproductive system is suppressed
  • Suppresses your digestive system
  • Modifying how your immune system reacts

Why Test Is Done?

To diagnose adrenal gland disorders, a cortisol test can be used. These include Cushing’s syndrome which causes your body too much cortisol and Addison’s disorder which causes your body not to produce enough cortisol.

Cortisol level testing checks whether your cortisol levels are too high, low, or both. Some conditions like Addison’s and Cushing’s can affect how much cortisol your adrenal glands make.

This test can be used to diagnose these diseases as well as to evaluate the functioning of the adrenal glands and pituitary.

Cortisol is involved in many systems of the body, including:

  • Stress responses
  • Skeletal system
  • Immune system
  • Circulatory system
  • Nervous system
  • The breakdown of carbohydrates, fats, proteins

Also Read: Everything About a Blood Test

When To Get Tested?

If you have Addison disease or Cushing’s syndrome, you may need to take a cortisol test.

Cushing’s syndrome symptoms include:

  • Obesity in the torso
  • High blood sugar
  • High blood pressure
  • Bristles easily on the skin
  • Purple streaks on your stomach
  • Women might have irregular periods or excessive hair.
  • Muscle weakness

Addison disease symptoms include:

  • Weight loss
  • Muscle weakness
  • Low blood pressure
  • Fatigue
  • Abdominal pain
  • Dark patches on the skin
  • Diarrhea
  • Nausea and vomiting
  • Reduced body hair

If you are experiencing symptoms of an adrenal crisis, which can be life-threatening and dangerous, you may need to have a cortisol test. An adrenal crisis can be characterized by:

  • Low blood pressure
  • Severe diarrhea
  • Dehydration
  • Severe vomiting
  • Sudden, severe pain in the stomach, lower back, or legs
  • Perception loss
  • Confusion

How To Get Tested?

Cortisol can be increased by stress, so it is a good idea to take a break before you go for your test. You will need to schedule two appointments for a blood test. Home saliva and urine tests can be done for twenty-four hours. Follow all instructions provided by your provider.

Although cortisol levels can vary throughout the day, they are most high in the morning. The test will be performed in the morning by your doctor. Cortisol tests don’t require you to fast.

Certain drugs affect cortisol levels. These drugs may be prescribed by your doctor to prevent you from taking them before the test. Sometimes, cortisol levels can be increased by:

  • Drugs containing estrogen
  • Pregnancy
  • Synthetic glucocorticoids such as prednisone

Sometimes, Cortisol levels can be decreased by:

  • Phenytoin
  • Drugs containing androgens

Cortisol levels can be affected by illness and physical stress. This is because of the increased release of ACTH from the pituitary during stress.

cortisol test

The image represents samples of blood that are collected for cortisol test

Also Read: Thyroid Panel Test – The Purpose And What Diseases Does It Detect

During the Test

A blood test is the most common form of cortisol testing. A blood test is when a doctor will draw blood from your arm using a small needle. Once the needle has been inserted, small amounts of blood will then be taken and stored in a vial or test tube. The needle may cause a slight stinging sensation when it is inserted or removed. It usually takes less than five minutes.

Cortisol levels can fluctuate throughout the day so it is important to know when a cortisol test should be performed. Cortisol blood tests are usually performed twice daily. One in the morning, when cortisol levels rise to their highest; and another around 4 p.m. when they drop to lower levels.

A saliva or urine test may be used to measure cortisol. Your health care provider might ask you to take all your urine within 24 hours to perform a cortisol urine testing. This is known as a “24-hour urine test.” Because cortisol levels can fluctuate throughout the day, this test is useful. Your health care provider, or a laboratory professional, will provide you with a container for collecting your urine and instructions on how best to store it. The following steps are usually included in a 24-hour urine test:

  • In the morning, empty your bladder and flush out any urine. Keep track of the time.
  • Keep your urine in the provided container for the next 24 hours.
  • Keep your urine container in the fridge or a cooler filled with ice.
  • As instructed, return the container to your doctor’s office or laboratory.

Cortisol saliva tests are usually performed at home at night when cortisol levels drop. This test will be recommended by your healthcare provider. Most likely, the kit will include a swab for collecting your sample and a container for storing it. The following steps are common:

  • Avoid eating, drinking, or brushing your teeth for at least 15-30 minutes before the test.
  • The sample should be collected between 11 p.m. and midnight or as directed by your provider.
  • Place the swab in your mouth.
  • For about two minutes, roll the swab into your mouth so that it is covered in saliva.
  • Do not touch the tip of your swab using your fingers.
  • Place the swab in the container and send it back to your provider according to the instructions.

To measure cortisol levels, a blood sample must be taken. This is how most blood samples are taken.

  • Wrapping an elastic band around the upper arm will stop blood flow. The elastic band will also make your veins more visible, making it easier for you to insert the needle.
  • To clean the area where the needle is to be inserted, alcohol can be used.
  • Insert the needle into the vein. The needle is inserted into the vein.
  • The needle is attached to a tube that holds your blood. You may need more than one tube.
  • After enough blood has been collected, the elastic band can be removed.
  • After the needle has been removed from the skin, cotton or gauze should be placed at the site of needle insertion.
  • Apply pressure to the area with cotton or gauze. To secure the cotton/gauze, a bandage is applied.

After The Test

A blood test is not a risky procedure. Although you may feel a little bit of pain or bruise around the site where the needle was inserted, most symptoms disappear quickly. There are no known risks of a saliva or urine test.

Test Results

A standard result for a blood sample taken at 8.30 a.m. is between 6 and 23 micrograms/deciliter (mcg/dL). Different laboratories use different methods of measuring blood, so what is considered to be standard could vary.

Cortisol levels that are higher than usual could indicate:

  • Your pituitary is producing too much ACTH because of a tumor or excessive growth.
  • You have an adrenal tumor, which can lead to excess cortisol.
  • You have a tumor in another part of your body that is involved in cortisol production

Lower than usual cortisol levels could indicate:

  • Addison’s Disease is a condition in which your adrenal glands produce too little cortisol.
  • Hypopituitarism is a condition in which the adrenal glands produce too little cortisol because the pituitary gland does not send the proper signals.

Also Read: Renal Function Test

Interpreting Results

Cushing’s syndrome may be characterized by high levels of cortisol. Low levels could indicate Addison disease or another type of adrenal disease. Your cortisol levels may not be normal. This does not necessarily mean that you need to seek medical treatment. Your results can also be affected by infection, stress, or pregnancy. Cortisol levels can also be affected by birth control pills or other medications. Talk to your doctor about your results.


Does anxiety raise cortisol levels?

Cortisol, also known as the stress hormone, is made in the adrenal glands. It is produced when we experience heightened anxiety or stress, and it is lowered when we are in a relaxed state.

What foods increase cortisol?

Some of the foods that increase the levels of cortisol include processed meats, high sugar foods, alcohol, and caffeine.

What is the treatment for high cortisol?

Your doctor may prescribe you medication to control the excessive production of cortisol in the adrenal glands. The medicinal drugs may include ketoconazole, metyrapone (Metopirone), or mitotane (Lysodren).

Does cortisol cause weight gain?

High levels of cortisol can lead to weight gain. It stimulates your fat and carbohydrate metabolism, thus, creating a surge of energy in your body. It increases your appetite as well as can cause cravings for salty, sweet, and fatty foods.

by Dr. Neeraj Gujar

Dr. Neeraj Gujar has done his M.D. in Pathology from Government Medical College. He has worked at various organisations such as Breach Candy Hospital and Tata Memorial Hospital along with many other private organisations. During his working career, he realised the pressing need for exceptional quality diagnostic services. A diagnostic centre that can consistently give accurate results verified by a consultant doctor (M.D. Pathologist) on which your doctor can depend. This has been the founding principle of Primus Pathology and Diagnostics.

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