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The cortisol symptoms list continues and as you may understand by now, cortisol and healthy adrenal glands are extremely important to our health. It is important to test cortisol levels to obtain a full clinical picture of each person’s case. There a different modes of testing cortisol:


  1. Serum cortisol test: this is a blood test that assess the cortisol level found in the blood. This test may include free, total and morning cortisol. This test provides a quick snapshot without the circadian rhythm.
  2. Saliva cortisol test: This test checks the circadian rhythm of cortisol via four samples of saliva collected throughout a day. Ideally, cortisol should peak in the morning. Patients who are deficient will usually present without a peak in the morning cortisol; and those who are severely deficient may present with a flat line
  3. 24-hour urine test: this test reflects cortisol production during a 24-hour period. This type of test typically measures cortisol and its metabolites or breakdown products. The urine collection needs to occur during a stress-free, relaxed and sedentary period over the course of 24-hours to avoid excretion of excessive cortisol metabolites that may not be representative of the true data.


Treatment of adrenal insufficiency requires a delicate balance between anabolic (sex hormones) and catabolic hormones (cortisol), therefore, regardless of the selection of the cortisol test, it is also important to order measurements of protective anabolic hormones such as DHEA and sex hormones.

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