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Cortisol (Urine)

Does this test have other names?

Urine-free cortisol test

What is this test?

A urine cortisol test may help in the diagnosis of 2 fairly uncommon health conditions: Cushing syndrome and Addison disease. The test also screens for other diseases that affect your pituitary and adrenal glands. It does so by measuring your urine level of a stress hormone called cortisol.

Cortisol is a steroid hormone made by your adrenal glands. It helps your body respond to stress, regulate blood sugar, and fight infections. In most people, cortisol levels are highest in the morning when they wake up and lowest around midnight. Your body also pumps out excess cortisol when you're anxious or under intense stress, which can affect your health if the levels stay too high for too long. If your cortisol levels are too high or too low, you may have a condition that needs treatment.

Why do I need this test?

You may need this test if your healthcare provider suspects a health problem caused by too much or too little cortisol.

A high cortisol level could be a sign of Cushing syndrome. Symptoms of Cushing syndrome include:

  • Obesity, especially in the torso, face, and neck, with thinner arms and legs

  • High blood pressure

  • High blood sugar

  • Thin skin that bruises easily

  • Pink or purple stretch marks on the stomach, breasts, hips, thighs, or buttocks

  • Muscle weakness

  • Osteoporosis

  • Acne

  • For women, irregular menstrual periods and excess hair on the face and chest

Too little cortisol could be a sign of Addison disease, also called primary adrenal insufficiency. It could also be a sign of another problem with your adrenal glands. You may have these symptoms:

  • Weight loss

  • Muscle and joint pain

  • Fatigue, or extreme long-lasting tiredness

  • Low blood pressure

  • Belly pain

  • Irritability and depression

  • Nausea, vomiting

  • Diarrhea

  • Dark patches of skin

  • For women, decreased armpit and pubic hair and decreased sexual desire

What other tests might I have along with this test?

Besides a urine test for cortisol, your healthcare provider may test the cortisol levels in your blood or saliva.

Your healthcare provider will likely order blood tests that measure your body's response to certain hormones to help determine the cause of your abnormal cortisol levels.

You may also have tests to look inside your body for abnormal growths or tumors. These can affect cortisol levels. Tests may include:

  • CT scan 

  • MRI 

What do my test results mean?

Test results may vary depending on your age, gender, health history, and other things. Your test results may be different depending on the lab used. They may not mean you have a problem. Ask your healthcare provider what your test results mean for you.

Normal values for cortisol in a urine test are 10 to 55 micrograms per day (mcg/day).

If your urine test reveals abnormally high levels of cortisol, you may be diagnosed with Cushing syndrome. If your cortisol levels are low, you may have Addison disease.

How is this test done?

This test needs a urine sample. It's often collected over 24 hours. Your healthcare provider will give you detailed directions about how to collect all your urine over a 24-hour period.

Does this test pose any risks?

This test poses no known risks.

What might affect my test results?

Cortisol levels may be high in people with psychiatric disorders, alcoholism, or morbid obesity. This may be called "pseudo-Cushing state."

How do I get ready for this test?

You don't need to prepare for this test. Be sure your healthcare 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. 

Online Medical Reviewer: Chad Haldeman-Englert MD
Online Medical Reviewer: Raymond Turley Jr PA-C
Online Medical Reviewer: Tara Novick BSN MSN
Date Last Reviewed: 9/1/2022
© 2000-2024 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.
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