Test Overview

A cortisol test is done to measure the level of the hormone cortisol in the blood. The cortisol level may show problems with the adrenal glands or pituitary gland. Cortisol is made by the adrenal glands. Cortisol levels go up when the pituitary gland releases another hormone called adrenocorticotropic hormone (ACTH).

Cortisol has many functions. It helps the body use sugar (glucose) and fat for energy (metabolism), and it helps the body manage stress. Cortisol levels can be affected by many conditions, such as physical or emotional stress, strenuous activity, infection, or injury.

Normally, cortisol levels rise during the early morning hours and are highest about 7 a.m. They drop very low in the evening and during the early phase of sleep. But if you sleep during the day and are up at night, this pattern may be reversed. If you do not have this daily change (diurnal rhythm) in cortisol levels, you may have overactive adrenal glands. This condition is called Cushing's syndrome.

The timing of the cortisol test is very important because of the way cortisol levels vary throughout a day. If your doctor thinks you might make too much cortisol, the test will probably be done late in the day. If your doctor thinks you may not be making enough, a test is usually done in the morning.

Why It Is Done

A cortisol test is done to find problems of the pituitary gland or adrenal glands, such as making too much or too little hormones.

How To Prepare

You may be asked to avoid strenuous physical activity the day before a cortisol test. You may also be asked to lie down and relax for 30 minutes before the blood test.

Some medicines, such as steroids, can affect cortisol levels for some time even after you stop taking the medicine.

How It Is Done

A health professional uses a needle to take a blood sample, usually from the arm.

How It Feels

When a blood sample is taken, you may feel nothing at all from the needle. Or you might feel a quick sting or pinch.

Risks

There is very little chance of having a problem from this test. When a blood sample is taken, a small bruise may form at the site.

Results

Normal

Each lab has a different range for what's normal. Your lab report should show the range that your lab uses for each test. The normal range is just a guide. Your doctor will also look at your results based on your age, health, and other factors. A value that isn't in the normal range may still be normal for you.

High values

• A high level of cortisol in the blood can mean Cushing's syndrome, a disorder that can be caused by overactive adrenal glands, an adrenal gland tumor, some types of cancer, or long-term use of corticosteroids.
• A high blood cortisol level can be caused by severe liver or kidney disease, depression, hyperthyroidism, or obesity.
• Pregnancy or birth control pills can also cause a high blood cortisol level.
• Conditions such as recent surgery, illness, injury, or whole-body infection (sepsis) can cause high cortisol levels.

Low values

• A low level of cortisol in the blood can be caused by:
  • Problems that affect the adrenal glands directly, such as Addison's disease or a tuberculosis infection of the adrenal glands.
  • Problems with the pituitary gland that affect the adrenal glands, such as cancer or a head injury.