How Is This Test Done
This test requires a 24-hour urine sample. For this type of urine sample, you must collect all the urine you produce for 24 hours. Empty your bladder completely first thing in the morning without collecting it and note the time. Then collect your urine every time you go to the bathroom for the next 24 hours.
Your healthcare provider will probably give you specific instructions. Follow them carefully.
How Do I Get Ready For A 24
- Your healthcare provider will explain the procedure and you can ask questions.
- Make sure you understand if you need to stay away from certain foods while collecting your urine.
- You will be given large containers to store your urine and a container to urinate into. Make sure you know how to use them. Have a cold place to store the urine while youre collecting it. For instance, a refrigerator or in a cooler on ice.
- You may be told to start the collection at a specific time.
- If possible, choose a 24-hour period when you will be at home so you do not have to transport your urine.
- If you are pregnant or think you may be, tell your healthcare provider.
- Make sure your provider has a list of all medicines , herbs, vitamins, and supplements that you are taking.
Based on your health condition, your healthcare provider may request otherspecific preparation.
Treatment Of Cushings 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.
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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
When And How Often Should I Have This Test
When and how often laboratory tests are done may depend on many factors. The timing of laboratory tests may rely on the results or completion of other tests, procedures, or treatments. Lab tests may be performed immediately in an emergency, or tests may be delayed as a condition is treated or monitored. A test may be suggested or become necessary when certain signs or symptoms appear.
Due to changes in the way your body naturally functions through the course of a day, lab tests may need to be performed at a certain time of day. If you have prepared for a test by changing your food or fluid intake, lab tests may be timed in accordance with those changes. Timing of tests may be based on increased and decreased levels of medications, drugs or other substances in the body.
The age or gender of the person being tested may affect when and how often a lab test is required. Chronic or progressive conditions may need ongoing monitoring through the use of lab tests. Conditions that worsen and improve may also need frequent monitoring. Certain tests may be repeated to obtain a series of results, or tests may need to be repeated to confirm or disprove results. Timing and frequency of lab tests may vary if they are performed for professional or legal reasons.
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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.
What Happens During A 24
A 24-hour urine collection may be done on an outpatient basis. This meansyou go home the same day. Or it may be done during a hospital stay.Procedures may vary depending on your condition and your healthcareprovider’s practices.
Generally, a 24-hour urine collection follows this process:
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Where Can I Find A Cortisol Urine Test Near Me
Check ourlab finder to locate a collection site in your area.
Note: Result turn around times are an estimate and are not guaranteed. Our reference lab may need additional time due to weather, holidays, confirmation/repeat testing, or equipment maintenance.
Before beginning collection for this test, the person must receive a specimen container from the lab. Begin by urinating at 8:00 am and discarding the specimen. Then, collect all urine for a 24 hour period. Keep the specimen container at room temperature. After 24 hours, return the container to the lab.
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Will I Need To Do Anything To Prepare For The Test
The preparations will depend on the type of test you are having. Be sure to follow all the instructions that your provider gives you.
Stress can raise your cortisol levels, so you may need to rest before your test. A blood test will require you to schedule two appointments at different times of the day. Before a saliva test, you may need to stop using certain medicines. Let your provider know about all medicines you use, including skin creams. But dont stop using any medicines without talking with your provider first.
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How Does Dutch Compare To Other Hormone Tests
DUTCH vs. Saliva Testing
While the free cortisol pattern in saliva has clinical value, there is a significant missing piece to surveying a patients HPA-Axis function with saliva testing measuring cortisol metabolites. To properly characterize a patients cortisol status, free and metabolized cortisol should be measured to avoid misleading results when cortisol clearance is abnormally high or low. Likewise with sex hormones, measuring estrogen and androgen metabolites gives a fuller picture for more precise clinical diagnosis of hormonal imbalances and HRT monitoring.
DUTCH vs. Serum Testing
While the most universally accepted testing method , serum testing is lacking in some areas. Adrenal hormones cannot be effectively tested in serum because free cortisol cannot be tested throughout the day. There is also a lack of extensive metabolite testing .
DUTCH vs. 24-Hour Urine Testing
There are two primary drawbacks to 24-hour urine testing of hormones. First, the collection is cumbersome, and as many as 40% of those who collect, do so in error . Secondly, dysfunction in the diurnal pattern of cortisol cannot be ascertained from a 24-hour collection. Some providers add saliva for daily free cortisol. DUTCH eliminates the need for two tests.
Do dried samples compromise the analysis? Dried samples are accurate for hormone testing, and values correlate to liquid samples. Samples are stable once they are dried and easier to ship than liquid samples.
How To Prepare For The Test
You may be asked not to do any vigorous exercising the day before the test.
You may also be told to temporarily stop taking medicines that can affect the test, including:
- Anti-seizure drugs
- Human-made glucocorticoids, such as hydrocortisone, prednisone, and prednisolone
- Metabolism of fats, carbohydrates, and protein
- Nervous system function
- Stress response
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What Abnormal Results Mean
A higher than normal level may indicate:
- Cushing disease , in which the pituitary gland makes too much ACTH because of excess growth of the pituitary gland or a tumor in the pituitary gland
- Ectopic Cushing syndrome , in which a tumor outside the pituitary or adrenal glands makes too much ACTH
- Severe depression
- Tumor of the adrenal gland that is producing too much cortisol
A lower than normal level may indicate:
- Addison disease in which the adrenal glands do not produce enough cortisol
- Hypopituitarism in which the pituitary gland does not signal the adrenal gland to produce enough cortisol
- Suppression of normal pituitary or adrenal function by glucocorticoid medicines including pills, skin creams, eyedrops, inhalers, joint injections, chemotherapy
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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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
Case Study: Mary Smith
Estriol is considered a protective estrogen because it binds to Estrogen Receptor , which increases differentiation of cells and decreases proliferation of cells. E1 and E2 have important benefits, but also have potentially carcinogenic metabolites. The Estrogen Quotient 7 is calculated by dividing E3 by the total of E1+E2, and should ideally be > 1.5. Some practitioners prefer to see it > 2.0. Marys EQ is lower than optimal. We do not expect the EQ on the 24-hr urine profile and the Dry Urine profile to be identical, but we do expect them to be consistent in what they are telling us, and both EQs are significantly lower than 1.5. Supplemental Iodine may be helpful in improving Marys EQ.
Phase I and Phase II estrogen metabolites also give insight into the health of Marys estrogen metabolism. The Phase I metabolite, 2-Hydroxyestrone , is considered a protective estrogen 4-Hydroxyestrone and to a lesser extent, 16-Hydroxyestrone , are considered carcinogenic. We dont want to see these estrogen metabolites too high, even when staying within the reference range. 16OHE1 serves an important role in maintaining bone density, and when it is too low, women may be at increased risk for osteopenia and osteoporosis. Mary has healthy levels of 2OHE1, at 91% and 92.4% of the reference range median for the 24-hour and the Dry Urine samples, respectively.
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How Do I Get Ready For This Test
Ask your provider whether you need to restrict food, medicine, or activity before this test. Plan to be home for the 24 hours you do the test so you can store the urine sample properly. Be sure your provider knows about all medicines, herbs, vitamins, and supplements you are taking. This includes medicines that don’t need a prescription and any illegal drugs you may use.
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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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
Describes the specimen type validated for testing
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
Identifies specimen types and conditions that may cause the specimen to be rejected
Suggests clinical disorders or settings where the test may be helpful
Screening test for Cushing syndrome
What Does A 24 Hour Urine Cortisol Test Show
A cortisol test measures the level of the hormone cortisol in a 24-hour sample of urine. The cortisol level may show problems with the adrenal glands or the pituitary gland. Cortisol is made by the adrenal glands. Cortisol levels get higher when the pituitary gland releases adrenocorticotropic hormone .
What does a high 24 hour urine protein mean?
Protein in the urine may signify kidney damage or disease. Protein levels may also rise temporarily due to factors such as infection, stress, or excess exercise. If the protein is caused by kidney damage, the test results will help to determine the extent of that damage.
What are normal results for a 24 hour urine test?
The normal range for 24-hour urine volume is 800 to 2,000 milliliters per day .
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