Among the hormones that are often discussed and rather feared is cortisol, our stress hormone. It is often believed that cortisol is responsible for all the negative effects on one’s skin and body but this perception is not fully true. A normal range of blood cortisol levels is necessary for our health. The problem only starts when these levels become either too high or too low. But how does that happen? In which conditions a person is likely to face cortisol alterations? Which cortisol test can help estimate the level of stress hormone in the body? Let us answer these frequently asked questions regarding cortisol in this article.
What is Cortisol?
Cortisol hormone, also called stress hormone, is an endogenous i.e. a chemical released inside the body by adrenal glands. It is particularly responsible for managing the body during the conditions of stress. Once released into the blood, a large concentration of cortisol is attached to the plasma proteins while the rest is present in the saliva and urine in its unbound form and therefore, is called free cortisol.
Why do Blood Cortisol Levels Matter?
When released at the time of physical or psychological stress, cortisol prepares the body to respond to it by positively adjusting some bodily parameters. This is done by doing the following:
● Cortisol reduces the inflammation in the body.
● It is also responsible for controlling the blood pressure.
● The blood sugar level is also regulated by cortisol.
● The stress hormone also manages the rate of metabolism in the body.
Factors Affecting Cortisol Release from Adrenal Glands
In normal conditions, our body keeps on fluctuating the level of cortisol. Usually, blood cortisol levels are higher at the start of the day i.e. 140 to 690 nanomoles per liter (nmol/L) 5 to 25 micrograms per deciliter (mcg/dL), and diminish slowly throughout.
However, it is not a standard condition as cortisol release is also affected by a person’s routine or sleep-wake cycle among other factors. Some of these factors which are responsible for impacting the release of cortisol from adrenal glands are given as follows:
● Exercise
● Physical stress
● Psychological or emotional stress
● Obesity
● Pregnancy
● Presence of an infection in the body
● Administration of medications such as prednisolone, hydrocortisone, birth control pills, etc.
● Injury or trauma
● Hypothyroidism i.e. lower than normal thyroxine levels
What is a Cortisol Test?
A cortisol test has been designed to measure blood cortisol levels. A cortisol test lets you know if your cortisol level is either more or less than normal. For this purpose, a sample of saliva, blood, or urine is taken which is then subjected to testing.
Significance of Cortisol Test
A cortisol test is important as it helps healthcare providers in the diagnosis of the following conditions:
● Addison’s Disease
Addison’s disease is a condition in which the adrenal glands release less than normal cortisol into the body. The condition is also referred to as hypocortisolism as well as primary adrenal insufficiency.
● Cushing’s Syndrome
Cushing’s syndrome is opposite to Addison’s disease as in this condition, the adrenal glands produce higher than normal cortisol, thus the name hypercortisolism.
● Tumorous Mass in the Adrenal Glands
In some cases, tumors may also be present at the adrenal gland which can become the cause of alterations in the blood cortisol levels.
● Secondary Adrenal Insufficiency
In the case of secondary adrenal insufficiency, the function of the pituitary gland situated in the brain is affected. As a result, the level of cortisol produced by the adrenal gland is also reduced.
Who Needs a Blood Cortisol Levels Test?
A person who is experiencing the following symptoms should contact a healthcare practitioner who might prescribe a blood cortisol levels test right away:
If there is too much cortisol in the body:
● Round face
● Unexplained weight gain
● Frequent bruising
● Weakness of muscles
● Appearance of purple-colored streaks under the arms, on breasts, stomach, as well as hips
● Thickening of skin around the neck and between shoulder blades
● Thin appearance of limbs
If there is too little cortisol in the body:
● Unexplained and lasting fatigue
● Abdominal pain
● Muscle weakness
● Loss of appetite and, in turn, body weight
How to Conduct a Cortisol Test?
A cortisol test conducted using a person’s blood, urine, or saliva sample is a way to estimate the blood levels of cortisol, the stress hormones, secreted by the adrenal glands. These tests are performed as follows:
Cortisol Blood Test
For performing a cortisol test using blood, a sample is drawn from a vein in the arm with a small needle. Usually, the process is slightly painful and the person might feel a mild sensation of burning and pain. To assess blood cortisol levels, it is often preferred to take two blood samples within a day i.e. one in the morning to check the higher levels of cortisol in the blood and another one in the evening when the concentration falls. The test is easy to conduct and does not consume much time.
Cortisol Urine Test
A urine test for the quantification of blood cortisol levels is done over a period of 24 hours which is why it is often called a “24-hour urine sample test”. The patient is provided with special containers and is asked to collect urine for one day. Before starting the process, proper instructions are given regarding how to collect and store urine samples. Parameters which are required to be focused include the following:
● The time at which the patient has urinated throughout the day.
● Sample containers are to be stored in a refrigerator or in an ice cooler.
● The last urine sample collected should be exactly 24 hours after the start of the test.
● The sample containers should be labeled with the time at which they were collected.
Cortisol Saliva Test
Cortisol saliva test is a home-based procedure for measuring blood cortisol levels,. Its kits include a swab to collect the sample as well as a container for its storage. The sample is collected at night time right before going to bed. The swab is thrown into the oral cavity without touching it. The patient is asked to roll it for at least 2 minutes. During this period, an ample amount of saliva is soaked by the swab which is then spit into the container and labeled.
Cortisol Test Kits
A wide range of cortisol test kits are available in the US market which is not only easy to use, and affordable, but also highly sensitive and reliable. Some of these include the following:
| Cortisol Test Kit | Sample Required | Result Obtaining Duration (Days) | Price (USD) |
| Rx Home Test Diurnal Cortisol Test | Saliva | 2 to 5 | $119.99 |
| MyLAB Box Adrenal Stress Test | Saliva | 2 to 5 | $149 |
| LetsGetChecked Cortisol Test | Blood | 2 to 5 | $99 |
| HRT.org Cortisol Saliva Test | Saliva | 5 to 7 | $86 |
| GSL Blood Serum Cortisol Home Test Kit | Blood | 2 to 7 | $74.99 |
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Conclusion
Cortisol is a hormone that is released by adrenal glands in the blood during times of stress. This hormone effectively manages the body by making certain changes. However, in some cases, blood cortisol levels can become extremely high or extremely low due to certain reasons. Therefore, a cortisol test is performed to estimate blood cortisol levels which then helps the physician to identify the underlying causes of this hormonal fluctuation. Cortisol tests are simple to conduct and do not take much time.
PhD Scholar (Pharmaceutics), MPhil (Pharmaceutics), Pharm D, B. Sc.
Uzma Zafar is a dedicated and highly motivated pharmaceutical professional currently pursuing her PhD in Pharmaceutics at the Punjab University College of Pharmacy, University of the Punjab. With a comprehensive academic and research background, Uzma has consistently excelled in her studies, securing first division throughout her educational journey.
Uzma’s passion for the pharmaceutical field is evident from her active engagement during her Doctor of Pharmacy (Pharm.D) program, where she not only mastered industrial techniques and clinical case studies but also delved into marketing strategies and management skills.
