Cortisol 24 Hour Urine Test

What Should I Do After The Test

When 24-hour urine collection is complete, close the container and seal the lid tightly. Return the sample in the urine container to the facility or healthcare worker as instructed. If you had the sample in an ice bath, return the sample within two hours after removing the container from the ice bath.

Where Can I Find A Cortisol Urine Test Near Me

Check our lab 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.

Requirements:

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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Description:

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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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.

What Is The Next Step

In our patient, the urinary cortisol level was elevated to six to seven times the upper limit of the normal range, which is generally diagnostic for Cushing syndrome. Her morning ACTH was not suppressed, suggesting an ACTH-dependent form of Cushing syndrome rather than an adrenal adenoma. Further differentiation between a pituitary source of ACTH and ectopic ACTH is needed.

This scenario shows how vaginal application of a topical cream containing hydrocortisone can cause falsely elevated urinary cortisol levels that mimic Cushing disease. Often such creams are used without a prescription. Patients may not regard topical lotions, creams and ointments as medicines or consider them relevant to an assessment for Cushing syndrome. Had the patients use of a steroid cream not been discovered, suspicion would have been high for a pituitary adenoma, and she likely would have undergone petrosal vein sampling, which is an invasive procedure. It is important to enquire specifically about the patients use of topical or other local therapies. Doing so could potentially prevent needless, costly testing and possible harm associated with invasive investigations or therapies.

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Questions For Your Doctor About Test Results

Your doctor is in the best position to help you understand your cortisol test results. It could be helpful to ask specific questions, such as:

• Is this cortisol test result within the reference range?
• What does the result of this cortisol test say about my health?
• Are you able to make a diagnosis based on this test result?
• Do you recommend any additional tests? Why or why not?

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.

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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

Different diseases, such as Cushing syndrome and Addison disease, can lead to either too much or too little production of cortisol. Measuring urine cortisol levels can help diagnose 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

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How To Do A 24

Please drop off the urine sample within 48 hours of the last urine collection.

Collection start time: __________________________

Please drop off the urine sample at the lab by: ___________________

Rev. 3/2018

What Follow Up Should I Do After This Test

Ask your healthcare worker how you will be informed of the test results. You may be asked to call for results, schedule an appointment to discuss results, or notified of results by mail. Follow up care varies depending on many factors related to your test. Sometimes there is no follow up after you have been notified of test results. At other times follow up may be suggested or necessary. Some examples of follow up care include changes to medication or treatment plans, referral to a specialist, more or less frequent monitoring, and additional tests or procedures. Talk with your healthcare worker about any concerns or questions you have regarding follow up care or instructions.

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How It Is Done

This test is usually done at home. You must collect all the urine you produce in a 24-hour period.

• When you first get up in the morning, urinate into the toilet. Donât save this urine. This marks the start of your 24-hour period.
• For the next 24 hours, collect all your urine. Your doctor or lab will give you a large container to store it in. Urinate into a separate small, clean container. Then pour the urine into the large container. Donât touch the inside of the containers with your fingers.
• Keep the large container in the refrigerator.
• Empty your bladder for the last time at or just before the end of the 24-hour period. Add this urine to the large container, and write down the time.
• Do not get toilet paper, pubic hair, stool , menstrual blood, or anything else in your urine sample.

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.

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What Your Cortisol 24

The cortisol 24-hour urine test involves the collection of all passed urine within a period of 24 hours. When you take the sterilized container, you will need to discard the first urine sample after waking up then, you start collecting all the passed urine. During the second day, and within the 24-hour framework, you will need to urinate straight into the container after waking up. This will constitute the last sample.

The 24-hour cortisol urine test results will be in the normal ranges if the cortisol level is between 3.5 and 45 mg for the 24 hours sample. These results might vary slightly. If the levels are below 3.5 mg then, your cortisol levels are low. This indicates that the adrenal glands are not making enough cortisol and, it may indicate that you have a condition referred to as Addison disease . Of the cortisol levels are above 45 mg then, the levels are high and you may have Cushing syndrome that can be caused by many factors. These include having a tumor at the adrenal gland, having drank alcohol or caffeine, being under a lot of stress, or being depressed.

Where Can I Get A Cortisol 24

A 24 hour urine collection container must be picked up from the lab before the collection process begins. On the day of the test, do not collect your first morning void. Collect all urine including the final specimen voided at the end of the 24-hour collection period.

Please use our Lab Locator to find find a convenient testing location.

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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 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

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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.

Why Is The Cortisol 24

The cortisol urine test helps diagnosing Cushing syndrome as well as primary and secondary adrenal insufficiency. It is also used to detect any conditions that may be altering the proper functioning of the pituitary and adrenal glands. The cortisol urine test is performed if you are having symptoms related to rise or fall in the levels of your cortisol.

High cortisol levels are accompanied by symptoms such as increased urination, intensive thirst, noticing fatty tissue deposits and the abdominal section of your body and upper back, gaining weight for no reason, being tired all the time, having a skin that bruises very easily, as well as having pink and purple stretch marks on your skin. Having irregular periods and a lot of facial hair are also experienced in women with high cortisol levels.

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What Are Normal Results For This Test

Laboratory test results may vary depending on your age, gender, health history, the method used for the test, and many other factors. If your results are different from the results suggested below, this may not mean that you have a disease. Contact your healthcare worker if you have any questions. The following are considered to be normal results for this test:

• Radioimmunoassay:

• Low dose dexamethasone suppression test

How The Test Is Performed

A 24-hour urine sample is needed. You will need to collect your urine over 24 hours in a container provided by the laboratory. Your health care provider will tell you how to do this. Follow instructions exactly.

Because cortisol production by the adrenal gland can vary, the test may need to be done three or more separate times to get a more accurate picture of average cortisol production.

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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 â 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