What You Should Know About Cortisol Testing and Detecting Adrenal Fatigue

By: Michael Lam, MD, MPH

Cortisol test and adrenal fatigue/Today, people live in a world where stress is prevalent. It can constantly affect you to the point that you begin to struggle with your health. When this happens, you can become afflicted with adrenal fatigue. To determine this, you may want to consider undergoing certain medical tests, one of which is cortisol testing. Keep in mind, however, that any test is not definitive and having them done periodically is better than doing it only once.

What is Cortisol Testing?

Cortisol testing refers to a procedure that would test cortisol levels in your body. Today, clinicians generally use cortisol tests to diagnose adrenal gland disorders. These include Addison disease and Cushing’s syndrome.

Cortisol testing can be administered in several ways. The first is in the form of blood tests. Typically, blood is drawn from the patient in the morning and later in the afternoon as cortisol levels tend to vary throughout the day. On the other hand, cortisol levels can also be checked through a saliva or urine test.

Cortisol and Adrenal Fatigue

Cortisol is among the hormones that the adrenal glands produce in response to stress. The adrenals, along with several other organs and systems, play a critical role in the body’s NeuroEndoMetabolic (NEM) stress response system.

The NEM stress response system is composed of six circuits and the adrenal glands are primarily involved in the hormone circuit where it works with the reproductive system and the thyroid to handle stress. To address stress, the adrenals would produce hormones such as epinephrine and cortisol.

Cortisol is recognized as the body’s primary stress hormone. Once stress is detected, cortisol triggers actions in the body that allow it to initiate fight or flight. For starters, it floods the body with glucose so that it would have an immediate energy source. Meanwhile, it would also inhibit insulin production so that glucose would not be stored.

Aside from this, cortisol would also trigger an increase in heart rate, enabling you to become ready and more alert.

Once the stressful episode has passed, the adrenals’ production of cortisol would return to normal. The hormone circuit and the rest of the NEM stress system circuits would also resume normal function. At this point, the body gets to relax again and there would be no health repercussions from stress.

In the case of chronic stress, however, the adrenal glands are forced to keep producing cortisol to meet the body’s urgent demand. Over time, however, the adrenals become overworked to the point that it can no longer produce enough. At the same time, all the organs and systems involved in the NEM stress response system also become overworked and the entire NEM stress response is dysregulated.

Adrenal fatigue causes many effects in the body, a cortisol test may be able to help diagnosisAt this stage, the adrenals are no longer capable of producing enough cortisol and other stress hormones. This forces the body into a state of significant hormonal imbalance, which triggers adrenal fatigue syndrome (AFS).

At any point that your cortisol level is too high or too low, you will experience several uncomfortable symptoms. For instance, having high cortisol levels can lead to high blood pressure, muscle weakness, rapid weight gain, blood sugar imbalance, compromised thyroid function, poor immune system, slow wound healing, anxiety, mood swings and depression. Furthermore, having too much cortisol in your system may also affect your memory and learning ability. On the other hand, having low cortisol levels can cause fatigue, dizziness, unexplained weight loss, heart palpitations and prominent dark rings under your eyes.

As you can see, it is always necessary to maintain proper cortisol levels in your body. Keep in mind, however, that normal cortisol ranges tend to vary for each individual. In fact, a study in Australia conducted over a large population found that medium serum cortisol levels significantly vary by gender and age. Furthermore, older healthy participants were found to have higher median cortisol levels than younger participants.

Are Cortisol Tests Effective in Diagnosing Adrenal Fatigue?

Today, adrenal fatigue sufferers face a lot of challenges when it comes to getting the proper treatment for their condition. This is mainly because AFS is yet to become a recognized medical condition. Hence, there are no diagnostic protocols available that a clinician can refer to for a definitive diagnosis. Many rely on cortisol laboratory test as an investigative tool to help understand the body function.

If adrenal fatigue by history is suspected, the health practitioner must rely on knowledge and experience to help treat the patient as effectively as possible. During a consultation, the clinician may conduct an extensive review of the patient’s health history and ask questions such as how often the patient experiences stress.

Another aid that health practitioners can turn to is cortisol testing. Unfortunately, cortisol tests are not as straightforward as they appear to be. For starters, different types of cortisol tests produce varying results. In fact, saliva cortisol tests are able to check for bioavailable free cortisol while blood cortisol test measures both bioavailable and binded cortisol. Hence, results from a blood cortisol test would be less specific. In this regard, the saliva cortisol test is seen as a better option for testing hormone levels.

Furthermore, measuring a person’s cortisol levels can help indicate the state of adrenal fatigue that they are in. This can help determine the proper course of recovery for a patient. For instance, if a patient is still in the early stages of adrenal fatigue, a clinician may suggest making diet modifications and lifestyle changes to reduce stress. On the other hand, if a patient is in the advanced stages, a more aggressive approach may be taken. This could include an extensive recovery plan that comes with medication, therapy and more.

Important Things to Note About Cortisol Testing

Now that you have a better idea about how cortisol testing works, it’s important to keep some of these tips in mind when undergoing the procedure to ensure accurate results.

That said, here are some guidelines you can follow:

There would be some fasting required

For any type of cortisol test, patients are required to undergo fasting prior to collecting their specimen. For saliva tests, one must not eat or drink for at least 15 minutes prior to specimen collection. Meanwhile for blood tests, you should not eat or drink for 15 to 30 minutes prior to the test.

Multiple specimens are always needed

Cortisol test and Adrenal Fatigue SyndromeA proper cortisol test must be conducted more than once during the day to yield a more accurate result. In fact, your cortisol levels must be measured four times to allow a clinician to correctly map your daily curve of cortisol. This shows a better idea of the state of your adrenal function. This is because the shape of the curve may be correlated with symptoms you are experiencing. A single snapshot of one point in time is often inadequate for long term understanding of how the body works. Hence, serial studies are the best way to gain a clear interpretation of cortisol level and it should be conducted regularly, every 3 to 6 months, for comparative purposes.

In this regard, you need to provide a salivary specimen sample throughout the day, specifically at 8 AM, noontime, 5 PM and before bedtime. The morning free cortisol level would be indicative of your free cortisol output. Meanwhile, your cortisol levels during lunch time is an indication of cortisol adaptability. On the other hand, your mid-afternoon cortisol level can be associated with any metabolic issues, including a blood sugar imbalance. And finally, your evening cortisol level would indicate your baseline cortisol function. For a saliva cortisol test, you would be able to collect the specimen yourself using a saliva collection kit.

Keep these guidelines in mind when you are about to undergo your cortisol tests. Remember, you can develop adrenal fatigue without warning. This is because it is sometimes difficult for a person to realize that their stress has already become chronic and has started compromising their health.
At the same time, you must also keep in mind that experiencing stress at the time of your cortisol test may also affect your adrenal hormone levels. This can explain why your tested cortisol level after a quiet and relaxing morning would significantly differ from your tested cortisol level when facing a stressful situation.

Aside from this, it’s also best to make sure that you undergo laboratory tests for cortisol in a strict appropriate setting. Because of varying cortisol levels in your body throughout the day, a computerized laboratory interpretation would have limited value. Even worse, it can be rather misleading especially if you fail to match your different cortisol values along with your body’s symptoms and clinical state.
Beyond laboratory tests, however, keep in mind that the best way to assess your adrenal fatigue status is with the help of an experienced and astute clinician that would keep make an extensive review of your clinical history and utilize every cortisol lab test as a supporting tool.

If you suspect that you are suffering from adrenal fatigue, see a physician as soon as possible. Ideally, you want to be treated for this condition before it has a chance of getting worse.

© Copyright 2015 Michael Lam, M.D. All Rights Reserved.

Dr. Lam’s Key Question

Having cortisol testing done only once would lead to inaccurate results as cortisol levels vary throughout the day. Hence, it is important to conduct tests throughout the day to allow the clinician to plot your daily curve of cortisol. This would provide a better state of your adrenal function.

Cortisol test