Pituitary Adenomas Cushings Disease
Pituitary adenomas are benign tumors of the pituitary gland that secrete increased amounts of ACTH causing excessive cortisol production. Most patients have a single adenoma. First described in 1912 by neurosurgeon Harvey Cushing, MD, in his book The Pituitary Body and Its Disorders, Cushings disease is the most common cause of spontaneous Cushings syndrome, accounting for 60-70 percent of all cases.
What Is This Test
This test measures the level of the hormone cortisol in your urine. Hormones are chemical messengers that travel through your blood. Cortisol helps your body use proteins, fats and carbohydrates. It helps maintain blood pressure, control blood sugar levels, and regulate the immune system. It’s made and released by the adrenal glands, which sit atop the kidneys.
Another hormone, adrenocorticotropic hormone , controls the release of cortisol. ACTH is made and released by the pituitary gland, which is at the base of your brain.
Cortisol is released at different times during the day, so the best way to measure it is to collect all the urine you produce over a 24-hour period.
Cortisol/cortisone Free 24 Hour Urine
Suggests clinical disorders or settings where the test may be helpful
Screening test for Cushing syndrome
Assisting in diagnosing acquired orinherited abnormalities of 11-beta-hydroxy steroid dehydrogenase
Diagnosis of pseudo-hyperaldosteronism due to excessive licorice consumption
This test has limited usefulness in the evaluation of adrenal insufficiency.
A short description of the method used to perform the test
Liquid Chromatography-Tandem Mass Spectrometry
NY State Available Indicates the status of NY State approval and if the test is orderable for NY State clients.
Lists a shorter or abbreviated version of the Published Name for a test
Lists additional common names for a test, as an aid in searching
Cortisol
Describes the specimen type validated for testing
Urine
| Urine Volume |
Specimen Required Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Supplies: Urine Tubes, 10-mL
Submission Container/Tube: Plastic, urine tube
Specimen Volume: 5 mL
1. Collect urine for 24 hours.
2. Add 10 g of boric acid as preservative at start of collection.
Specimen Minimum Volume Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory
3 mL
Identifies specimen types and conditions that may cause the specimen to be rejected
| Specimen Type |
|---|
Suggests clinical disorders or settings where the test may be helpful
Screening test for Cushing syndrome
CORTISOL
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What Happens During A Cortisol Test
A cortisol test often uses a sample of blood drawn at a lab. But the test may also be done on urine or saliva collected at home. Normally, cortisol levels vary during the day, so your provider may order more than one type of test to get more information about your cortisol levels.
For a blood test, a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
Blood samples are usually taken twice during the day–once in the morning when cortisol levels are at their highest, and again around 4 p.m., when levels are much lower.
For a cortisol urine test, your provider may ask you to collect all your urine during a 24-hour period. This is called a “24-hour urine sample test.” For this test, you’ll be given a special container and instructions for how to collect and store your urine sample. Your provider will tell you what time to start. The test usually includes the following steps:
In certain cases, a urine test for cortisol may be done on one sample of urine collected in the morning.
A cortisol saliva test is usually done at home with a kit to collect a saliva sample. Your provider will tell you what time to collect your sample. It’s often done at night before you go to bed when cortisol levels are normally lower.
What Is A Cortisol Urine Test
A cortisol urine test is also called a urinary free cortisol test or UFC test. It measures the amount of cortisol in your urine.
Cortisol is a hormone produced by the adrenal glands, which are located on top of the kidneys. Cortisol is often released in response to physical or emotional stress.
Cortisol functions by:
- playing a role in mood regulation
- playing a role in the metabolism of carbohydrates, fats, and proteins
Cortisol levels naturally rise and fall throughout the day. Theyre usually highest in the morning and lowest around midnight, but there are also variations that depend on the person.
When this 24-hour cycle is disrupted, however, the body can produce too much or too little cortisol. A cortisol test can be performed to determine the underlying cause of abnormal cortisol levels.
There are different types of cortisol tests that may be performed, including blood, saliva, and urine tests. The urine test is done over a period of 24 hours.
The cortisol urine test tends to be more comprehensive than the other types of cortisol tests. It measures the total amount of cortisol excreted into the urine over a 24-hour period.
Blood tests or saliva tests, however, only measure cortisol levels at a particular time of day. Some people also find blood tests to be stressful, and since the body releases more cortisol during times of stress, the results may not be as precise.
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Treatment Of Cushings Disease
Microsurgical resection of an ACTH-secreting pituitary adenoma is the optimum treatment for Cushings disease with cure rates of 80-90 percent if a tumor is found. Surgery is most often done through a transnasal transsphenoidal approach, which will not leave a visible scar. This type of surgery may be performed, per the surgeons preference, using either a minimally invasive operating microscope or with the use of an endoscope. Partial removal of the pituitary gland may be used in patients without clearly identifiable adenomas.
In patients to whom a remission is not obtained after surgery, the use of various medications that can inhibit cortisol production may be used, such as:
These agents are not as effective as surgery and are considered a secondline course of treatment. In some patients who are particularly resistant to all forms of therapy, removal of the adrenal glands bilaterally may be considered.
Post-surgery, with successful tumor removal, the production of ACTH drops below normal. This decrease is natural and temporary, and patients are prescribed a synthetic form of cortisol such as hydrocortisone or prednisone to compensate this change. Most patients can discontinue replacement therapy within six to 12 months, but others may require the use of oral steroids for several years to, possibly, their lifetime. Patients who need adrenal surgery may also require steroid replacement therapy.
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. Talk with your doctors office and health insurance provider for detailed information about the costs of cortisol testing.
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 if you are uninsured.
A cortisol test costs $69 from Testing.com.
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Why The Test Is Performed
The test is done to check for increased or decreased cortisol production. Cortisol is a glucocorticoid hormone released from the adrenal gland in response to adrenocorticotropic hormone . This is a hormone released from the pituitary gland in the brain. Cortisol affects many different body systems. It plays a role in:
- Metabolism of fats, carbohydrates, and protein
- Nervous system function
and Addison disease , can lead to either too much or too little production of cortisol. Measuring urine cortisol level can help diagnose these conditions.
What Is A Urine Cortisol Test
Definition:A cortisol urine test measures the amount of cortisol in the urine.
Alternative Names: 24-hour urinary free cortisol
How the test is performed:A 24-hour urine sample is needed. The health care provider will instruct you, if necessary, to discontinue drugs that may interfere with the test.
On day 1, urinate into the toilet when you get up in the morning. Afterwards, collect all urine in a special container for the next 24 hours. Keep the container in a cool place during the test period.On day 2, urinate into the container when you get up in the morning.Cap the container. Label the container with your name, the date, the time of completion, and return it as instructed. Keep it in the refrigerator or a cool place until returned to the laboratory.FOR INFANTS
This procedure may take a couple of attempts — lively infants can displace the bag. The infant should be checked frequently and the bag changed after the infant has urinated into the bag. The urine is drained into the container for transport to the laboratory.
Deliver it to the laboratory or your health care provider as soon as possible upon completion.
How to prepare for the test:No special preparation is necessary for this test, but if the collection is being taken from an infant, a couple of extra collection bags may be necessary.
How the test will feel:The test involves only normal urination, and there is no discomfort.
Note: mcg/24 h = micrograms per 24 hours
- ACTH-secreting tumor
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Treatment Of Cushing’s Syndrome
Treatment of Cushings syndrome depends on the underlying cause of excess cortisol but may perhaps include surgery, radiation, chemotherapy or the use of cortisol-inhibiting drugs. If the cause is iatrogenic, from long-term use of glucocorticoid hormones to treat another disorder, the physician will gradually reduce the dose of the externally administered steroid to the lowest dose adequate for control of that disorder. Once control is established, the dose of glucocorticoid hormones may be given on alternate days to lessen side effects for the patient.
Prevalence Of Cushings Syndrome
- An estimated 10-15 per million people are affected every year.
- Pituitary adenomas account for more than 70 percent of cases in adults and about 60-70 percent of cases in children and adolescents.
- Cushings syndrome most commonly affects adults ages 20-50 and is more prevalent in females, accounting for about 70 percent of all cases.
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Symptoms Of High Cortisol Levels
Cushing syndrome is a collection of symptoms associated with high cortisol levels. The most common symptoms include:
- increased urination
- fatty tissue deposits, especially in the midsection and upper back
- pink or purple stretch marks on the skin
- tricyclic antidepressants
Your doctor may instruct you to stop taking medications that could affect the results. However, you should never stop taking your medications unless your doctor tells you to do so.
What Is It Used For
A cortisol test is used to help diagnose medical conditions that cause too much or too little cortisol. These conditions include disorders that affect the adrenal glands:
- Cushing’s syndrome is a disorder that happens when your body has too much cortisol over a long period of time.
- Addison disease is a condition in which your adrenal glands are damaged and can’t make enough cortisol.
- Secondary adrenal insufficiency is a condition in which your adrenal glands don’t make enough cortisol because your pituitary gland isn’t working properly.
Cortisol testing is also used to monitor treatment for these conditions.
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When To Suspect Cushing Syndrome
A complete history and physical examination are critical in determining the pretest likelihood of a diagnosis of Cushing syndrome. Patients present with a wide range of clinical features ,2 and no single symptom is necessary to the diagnosis. A high positive likelihood ratio for Cushing syndrome has been found in the presence of ecchymoses , osteopenia or fracture , proximal muscle weakness and hypertension .3 Many of the signs and symptoms of Cushing syndrome are common in the general population. But if they occur at an unusual stage of life or if multiple and progressive features are present , then a diagnosis of Cushing syndrome should be considered.2
Cortisol Free 24 Hour Urine
Suggests clinical disorders or settings where the test may be helpful
Preferred screening test for Cushing syndrome
Diagnosis of pseudo-hyperaldosteronism due to excessive licorice consumption
Test may not be useful in the evaluation of adrenal insufficiency
Special Instructions
A short description of the method used to perform the test
Liquid Chromatography-Tandem Mass Spectrometry
NY State Available Indicates the status of NY State approval and if the test is orderable for NY State clients.
Lists a shorter or abbreviated version of the Published Name for a test
Lists additional common names for a test, as an aid in searching
Cortisol Free Urine
Describes the specimen type validated for testing
Urine
| Urine Volume |
Specimen Required Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Supplies: Urine Tubes, 10-mL
Submission Container/Tube: Plastic, urine tube
Specimen Volume: 5 mL
1. Collect urine for 24 hours.
2. Add 10 g of boric acid as preservative at start of collection.
Urine Preservative Collection Options
Note: The addition of preservative must occur prior to the start of the collection or application of temperature controls must occur during collection.
|
Ambient |
Specimen Minimum Volume Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory
3 mL
| Specimen Type |
|---|
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What Does It Mean If Your 24hr Free Cortisol Result Is Too Low
In the DUTCH test it is important to compare the 24hr Free Cortisol with the Metabolized Cortisol , as the metabolized cortisol number is a good indication of how much cortisol was produced in total.
The amount of cortisol produced and the amount of free cortisol availablecan be very different in some scenarios.Measuring both allows for insight into the rate of cortisol clearance/metabolism. The metabolized cortisol and free cortisol markers are important to use both together and separately in order to tell a more detailed story.
Here are a two different scenarios:
Free cortisol Low
How Does A Cortisol Test Work
Cortisol can be measured in the blood, urine, saliva or a combination. Your healthcare provider will tell you which test they recommend for you.
- Blood test: In an office, clinic or lab, a healthcare provider inserts a thin needle into a vein in your arm. The needle collects a small sample of blood into a tube. You might feel a slight sting when the needle goes in.
- Saliva test: You or a healthcare provider puts a swab in your mouth and waits a few minutes until the swab is saturated with spit. If you do the test yourself at home, your healthcare provider will give you a special kit. Theyll tell you what time to perform the test and how to return the sample.
- Urine test: Your healthcare provider gives you a container to collect your pee. Most urinary cortisol tests collect all the pee you produce in 24 hours. Your healthcare provider may ask you to store the urine in a cold place, then return it to their office or a lab.
You may need to repeat cortisol testing twice in one day or multiple times over several days because cortisol levels vary.
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What Do My Test Results Mean
Many things may affect your lab test results. These include the method each lab uses to do the test. Even if your test results are different from the normal value, you may not have a problem. To learn what the results mean for you, talk with your healthcare provider.
Urinary cortisol is measured in micrograms per 24 hours . The normal range varies between labs. Your provider can give you normal reference values.
When cortisol and ACTH are measured together:
-
High ACTH with high cortisol may mean a problem in your pituitary gland.
-
High ACTH with low cortisol may mean a problem with your adrenal gland.
-
Low ACTH with high cortisol may mean a problem in your adrenal glands.
-
Low ACTH with low cortisol may mean a problem in your pituitary gland.
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 test be conducted at a specific time, depending on the tests purpose.
Blood samples for cortisol tests are often collected early in the morning when the cortisol level 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 home. When testing for high cortisol, your doctor may instruct you to collect a saliva sample late at night while at home.
For a cortisol urine test, you will be provided with containers and detailed instructions on collecting all the urine you produce in 24 hours, after which you will return it to a lab. For convenience, you may choose a 24-hour period when you expect to be at home.
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