Cortisol Weight

Excessive Cortisol Levels

Cushing's Disease - The first step in diagnosis is to determine if
the symptoms are due to excessive cortisol levels. Demonstrating
excessive cortisol levels is somewhat complicated because cortisol
production in a normal individual varies from highest in the morning
to lowest at night. Excess Cortisol can also vary according to a
person’s health, stress level, and activity level. Therefore, simply
measuring the quantity of circulating cortisol and ACTH in a
patient's bloodstream in one blood test is not enough information
to diagnose Cushing's Disease.

Your endocrinologist may want to start with a few blood cortisol
tests that will require your help and ability to follow directions
precisely. One test is a 24-hour free cortisol urine collection. You
will use a kit to collect urine for 24 hours. This urine is analyzed in
a laboratory to determine the quantity of cortisol in the urine. The
Urine Free Cortisol test has a sensitivity of about 95%, but has the
disadvantage of relying on patient management for proper
collection

The 24-hour urine free cortisol (UFC) collection can be used with
the Dexamethasone Suppression Test. Dexamethasone is a
steroid drug taken by mouth. It is very similar to cortisol that the
adrenal glands produce. In a healthy patient who has taken
Dexamethasone, the endocrine system will recognize that plenty
of the steroid resembling excessive cortisol levels is in the blood
and will turn off cortisol production. The results in healthy
individuals will be low urine cortisol levels. In a patient with
Cushing’s Disease the dexamethasone does not suppress
excessive cortisol production and the amount of cortisol in the
urine will be high.

Another test that can be used with the 24 hour (UFC) is a salivary
cortisol screening test. It is a diagnostic tool that can be performed
by the patient to obtain late evening excessive cortisol levels
measured from saliva. It is convenient method to use when
obtaining PM cortisol levels (before bedtime). The test is done in
the convenience of one’s home with out causing stress which could
alter PM cortisol levels. This test can be repeated several days and
evenings in a row. Salivary cortisol screening test is also helpful in
diagnosing intermittent Cushing’s Disease.

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