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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 two fairly uncommon medical conditions: Cushing's syndrome and Addison's 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 health care provider suspects a medical problem caused by too much or too little cortisol.

A high cortisol level could be a sign of Cushing's syndrome. Symptoms of Cushing's 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 streaks on the stomach, 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's disease, also called primary adrenal insufficiency. It could also be a sign of another problem with your adrenal glands. This may cause these symptoms:

  • Weight loss

  • Muscle and joint pain

  • Fatigue, or extreme tiredness

  • Low blood pressure

  • Abdominal (belly) pain

  • Nausea and/or 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 health care provider may test the cortisol levels in your blood or saliva.

Your doctor 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 scan  

What do my test results mean?

Many things may affect your lab test results, including 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 health care provider.  

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's syndrome. If your cortisol levels are low, you may have Addison's disease. 

How is this test done?

This test requires a urine sample. If your doctor needs a 24-hour sample, he or she will give you detailed instructions about how to collect all of your urine over a 24-hour period.

Does this test pose any risks?

A urine 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.