The Cortisol Test and other Adrenal Fatigue Technology

By: Michael Lam, MD, MPH

Cortisol test and adrenal fatigueAdrenal Fatigue Syndrome (AFS) is a neuroendocrine disorder in which the adrenal glands have become fatigued due to chronic stress. Unfortunately, there is no single adrenal fatigue test to definitively confirm AFS; and many laboratory tests in fact, do not show anything wrong when it is clear to the sufferer that something is very wrong. Standard laboratory tests are generally designed to determine if there are extraordinary deviations in biomarkers; but with AFS and other subclinical conditions, they are severely limited in detecting subtle disorders. Even so, there are some specific tests, such as the cortisol test, that may help provide evidence of AFS. Knowing which laboratory tests to use and when is a clinical art more than a science because they are not very accurate.

Adrenal Fatigue Test Efficacy

Serum or saliva laboratory tests of cortisol and DHEA (measured as DHEA-S) can reveal if the body is in an anabolic or catabolic state. The saliva cortisol test is generally more accurate than serum for these. However, neither one is absolutely definitive. There are many factors that can alter the laboratory results. Normal results does not mean that there is no AFS. Similarly, abnormal results does not mandate the presence of AFS. Laboratory tests must be correlated with clinical history and present symptoms to make complete sense.

The Cortisol Test

Also importantly, a single cortisol test does not have any value; cortisol should be measured 4 times throughout the day (8 am, noon, 5 pm, before bedtime) to map the daily curve of cortisol versus DHEA and give a clearer picture of adrenal function. The shape of this curve can be correlated with symptoms experienced as evidence for suboptimal adrenal function. Serial tests over a period of time should also be considered to give enough accurate data to draw any clinical conclusions.

The levels of a variety of other internal indicators are affected by AFS as well, and testing for these can sometimes give more clues to determining the state of the body. They include:

  • Adrenal fatigue causes many effects in the body, a cortisol test may be able to help diagnosisIntracellular magnesium
  • Free T3 and free T4
  • Food allergy tests
  • Serum essential fatty acids
  • Serum vitamins A, C, E
  • Hair mineral analysis
  • Vitamin B complex levels
  • Estrogen and progesterone levels

Some functional tests also have some value if AFS is suspected, but even many of these do not give a definite answer and may only be useful in combination with other tests, medical history, and current symptoms:

  • Organic acids urinary analysis
  • Brain Chemicals and Neurotransmitter levels
  • Digestive stool analysis
  • Small Intestinal Bacterial Overgrowth (SIBO) test
  • Intestinal permeability analysis
  • Liver detoxification tests
  • Immunoglobulin testing
  • Dry blood analysis
  • Lyme disease testing
  • ATP/cell energy tests
  • Bone resorption assessment
  • Melatonin profile
  • Amino acid analysis
  • Fatty acids analysis
  • Urinary iodine levels
  • Helicobacter pylori specific antigen

There is obviously a huge variety of testing available, each specific to a narrow part of the inner workings of the body from a single perspective. Even then, normal values for any of these tests do not rule out dysfunction, and abnormal values need to be correlated to make sense. So testing can be done, but in many cases it is more expensive, time consuming, and in the end, does not give us much in return.

Stress and Adrenal Fatigue

Cortisol test and Adrenal Fatigue SyndromeAn evaluation by a clinician experienced in AFS and able to review a thorough medical history, is truly the best way to determine if Adrenal Fatigue Syndrome is present. If you have a history of stress in conjunction with AFS symptoms, or otherwise suspect you may be suffering from AFS, it is best to find and consult an expert who will know what symptoms and signs to look out for.

Stress and adrenal fatigue syndrome can be correlated when it is approached with a holistic perspective. The neuroendometabolic (NEM) stress response is a model that networks systems and organs in the body to form a safety net for our biological response to stressful influences. In some ways it can be described like an electrical circuit board with multiple parts. There are two main compartments being the neuroendocrine and the metabolic response partitions both working non-stop throughout the day and night. Consisted of the neuroendocrine, is the thyroid, heart, brain, GI track, adrenals and autonomic nervous system, all part of the body’s response to stress with the hypothalamic pituitary adrenal axis being activated. Along with the neuroendocrine circuit, the metabolic half is also called into action in response to stress.

Cortisol test