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Cortisol, Serum (Morning Sample)

Also known as CORTISOL

This test is for

Male, Female

Test Preparation

Do not eat or drink anything other than water for 8-12 hours before the test
Recommended Timings: Morning: 7-10 am.

Understanding Cortisol, Serum (Morning Sample)

What is Cortisol, Serum (Morning Sample)?

A cortisol test is done to measure the level of the hormone cortisol, a primary stress hormone which provides protective response to a perceived threat or danger. There are certain diseases, such as Addison’s disease and Cushing’s disease, which may affect the production of cortisol in the body.
This test is done to diagnose Cushing’s syndrome, Addison’s disease and to check the functioning of the adrenal gland.
The level of cortisol hormone rises and falls during the course of a day. These levels are highest in the early morning, drop slowly throughout the day reaching the lowest around midnight. Usually, the test involves drawing blood in the morning before 10 AM.

What is Cortisol, Serum (Morning Sample) used for?

The Blood Cortisol Test is performed:

· To diagnose Cushing’s syndrome caused due to high cortisol levels

· To diagnose Addison’s disease

· To detect and diagnose conditions of the adrenal glands or pituitary glands

What does Cortisol, Serum (Morning Sample) measure?

Cortisol is a hormone secreted by the adrenal glands that help in the metabolism of carbohydrates, fats, and proteins. It also plays a regulatory role in maintaining blood sugar levels, water balance of the body. It is also essential in the maintenance of a healthy immune system. Cortisol mainly remains bound to proteins, and only a small portion remains free and metabolically active.

Level of cortisol hormone rises and falls during the course of a day following a diurnal pattern (sleeping/rotational pattern). These levels are highest in the early morning, drops slowly throughout the day reaching its lowest around midnight, and again rises slowly through the night to reach its highest early next morning. This diurnal pattern of cortisol secretion is maintained by the hypothalamus in the brain and pituitary gland located just below the brain. Fall in the blood cortisol levels affects the production of Corticotropin-Releasing Hormone (CRH) from the hypothalamus. CRH stimulates the pituitary gland to secrete Adrenocorticotropic Hormone (ACTH), which in turn stimulates the production of cortisol from the adrenal glands to increase cortisol levels in the blood. Cortisol levels are regulated by a feedback mechanism. When cortisol levels rise to the required levels it stops the secretion of CRH which generates from the hypothalamus. This, in turn, stops ACTH secretion from the pituitary, thereby stopping cortisol secretion from the adrenal glands. Symptoms associated with increased or decreased levels of cortisol hormone appear when this feedback mechanism is disturbed due to diseases or lifestyle.

Interpreting Cortisol, Serum (Morning Sample) results

Interpretations

Normal cortisol levels in the blood:

· 6 to 8 a.m.: 10 to 20 µg/dL

· Around 4 p.m.: 3 to 10 µg/dL

· Around 12 a.m.: Less than 5 µg/dL

Normal cortisol levels may vary among individuals. Increased or decreased cortisol levels can be assessed only if the cortisol level in blood does not follow the diurnal pattern as it should.

Cortisol levels may fall outside the normal range for the time of day due to diseases or due to lifestyle factors such as irregular sleeping times.

Reference range may vary from lab to lab*

Causes of increased cortisol levels:

· Long-term treatment with glucocorticosteroid hormones like prednisone, dexamethasone, etc.

· Pituitary tumors that increase ACTH production

· ACTH-producing tumors in other parts of the body

· Adrenal tumors that increase cortisol secretion

· Congenital Adrenal Hyperplasia, a disease which causes excessive growth of adrenal gland cells

· Recent surgery, illness, injury, or sepsis

· CRH-producing tumors in rare cases

Causes of decreased cortisol levels:

· Reduced cortisol production due to damage or diseases of the adrenal gland (primary adrenal insufficiency) like Addison’s disease

· Reduced ACTH production due to reduced activity of the pituitary gland or pituitary tumors (secondary adrenal insufficiency)

Answers to Patient Concerns & Frequently Asked Questions (FAQs) about Cortisol, Serum (Morning Sample)

Frequently Asked Questions about Cortisol, Serum (Morning Sample)

Q. What additional tests can be prescribed by your doctor in case of abnormal cortisol test results?

Additional tests that may be prescribed by the doctor in case of abnormal cortisol test result are urine cortisol test, salivary cortisol test, dexamethasone suppression test, ACTH Stimulation Test, CT scan or MRI for suspected tumors.

Q. What is Cushing’s syndrome?

Cushing’s syndrome refers to a group of conditions caused due to a sustained increase in the levels of cortisol hormone in the body. Increased levels of cortisol are most commonly caused due to corticosteroid medications used to treat other diseases. These increased levels could also be due to overproduction of cortisol from the adrenal glands caused by ACTH-secreting tumor in the pituitary gland or elsewhere in the body, or adrenal gland diseases like adrenal hyperplasia. Cushing’s syndrome shows symptoms which include fat deposition between the shoulders (buffalo hump), puffy face, purple or pink stretch marks on the abdomen, high blood pressure. The other symptoms include loss of bone density, slow wound healing, increased body hair in females, weakness, fatigue, growth impairment, etc.

Q. What is Addison’s disease?

Addison’s disease is also called primary adrenal insufficiency. In this, the adrenal glands do not produce sufficient quantities of cortisol hormone due to the damage caused to the adrenal glands, diseases affecting the adrenal glands, or tumors in the adrenal glands. Symptoms include fatigue and weakness, rapid weight loss, the appearance of dark patches of skin, low blood pressure, diarrhea, nausea and vomiting, abdominal pain, etc. Addison’s disease can be life-threatening and can produce severe symptoms suddenly in a condition called Addisonian crisis or acute adrenal failure.

Q. What are the symptoms associated with increased cortisol levels?

Higher than normal cortisol levels in the blood can show symptoms such as High blood pressure (hypertension), high blood sugar (hyperglycemia), obesity, fragile skin, the appearance of purplish lines on the skin of the abdomen, weakness and muscular degeneration, osteoporosis and irregular menstruation.

Q. What are the symptoms associated with decreased cortisol levels?

Lower than normal cortisol levels in the blood can show symptoms such as rapid weight loss, fatigue and muscle weakness, low blood pressure, pain in the abdomen and dark patches of skin in Addison’s disease.

Q. How is the blood sample taken?

The healthcare provider takes a blood sample from the arm. The site from where the blood is to be withdrawn is cleaned with a swab of rubbing alcohol. This is then followed by inserting a small needle which has a tube attached to it for collecting blood. Once the sufficient blood for analysis is withdrawn, the needle is removed. The site is then covered with a gauze pad.

Q. Is there any risk associated with the withdrawal of blood sample procedure?

As such there is no risk but in few cases, bruising, bleeding, and infection at the puncture site can be seen. In very few cases, there can be swelling of the vein after the blood is withdrawn.

Q. What factors can affect the cortisol test results?

The cortisol test results can be affected by a number of factors, including a lifestyle that does not allow a regular sleeping pattern, stress, certain medications like birth control pills, glucocorticoids, and steroid hormone-based medications, physical trauma, final trimester of pregnancy, high physical activity in trained athletes, alcoholism and malnutrition

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