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Dr. Betina Chandolia

BDS, MDS - Oral Pathology and Microbiology

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Dr. Ashish Ranjan

MBBS, MD (Pharmacology)

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Cortisol

You need to provide

Blood

This test is for

Male, Female

Test Preparation

No special preparation required

Overview

What is Cortisol?

Cortisol is a hormone secreted by the adrenal glands. Cortisol regulates nutrient metabolism. It also helps the body to maintain blood glucose and water balance, and a healthy immune system. Most of the cortisol in the blood remains bound to proteins, and only a small portion remains free and biologically active. The Blood Cortisol Test measures the total amount of cortisol hormone in the blood.

Why is Cortisol done?

· To diagnose Cushing’s syndrome caused due to high cortisol levels

· To diagnose Addison’s disease

· To detect and diagnose conditions of the adrenal glands or the pituitary glands

What does Cortisol Measure?

The Cortisol Test measures the total amount of cortisol hormone in the blood. Cortisol is a hormone secreted by the adrenal glands that helps in the metabolism of carbohydrates, fats, and proteins. It also plays a regulatory role in maintaining the blood sugar levels, water balance of the body. Cortisol also helps the body maintain a healthy immune system. Most of the cortisol found in the body is bound to proteins, only a small portion remains free and metabolically active.

Level of cortisol hormone rises and falls during the course of a day following a diurnal pattern. Cortisol levels reach highest in the early morning, drop slowly throughout the day reaching its lowest around midnight, and again increases slowly through the night to reach its highest early next morning. This diurnal pattern of cortisol secretion is maintained by the hypothalamus in the brain and the pituitary gland located just below the brain. Fall in the blood cortisol levels stimulates the production of Corticotropin Releasing Hormone (CRH) from the hypothalamus. CRH stimulates the pituitary gland to secrete the Adrenocorticotropic Hormone (ACTH), which in turn stimulates the production of cortisol from the adrenal glands to increase cortisol levels in the blood. Cortisol levels are regulated by a feedback mechanism. When cortisol levels rise to the required levels, CRH secretion from hypothalamus is stopped. This in turn stops ACTH secretion from the pituitary gland, thereby stopping cortisol secretion from the adrenal glands. Symptoms associated with increased or decreased levels of cortisol hormone appear when this feedback mechanism is disturbed due to diseases or lifestyle.

Interpreting Cortisol results

Interpretations

Normal cortisol levels may vary among individuals. Increased or decreased cortisol levels can be assessed only if the cortisol level in blood does not follow the diurnal pattern, as it should.

Cortisol levels may fall outside the normal range for the time of day due to diseases or due to lifestyle factors such as irregular sleeping times.

Causes of increased cortisol levels:

· Long term treatment with glucocorticosteroid hormones like prednisone, dexamethasone, etc.

· Pituitary tumors that increase ACTH production

· ACTH producing tumors in other parts of the body

· Adrenal tumors that increase cortisol secretion

· Congenital Adrenal Hyperplasia, a disease which causes excessive growth of adrenal gland cells

· Recent surgery, illness, injury, or sepsis

· CRH producing tumors in rare cases

Causes of decreased cortisol levels:

· Reduced cortisol production due to damage or diseases of the adrenal gland (primary adrenal insufficiency) like Addison’s disease

· Reduced ACTH production due to reduced activity of the pituitary gland or pituitary tumors (secondary adrenal insufficiency)

Answers to Patient Concerns & Frequently Asked Questions (FAQs) about Cortisol

Frequently Asked Questions about Cortisol

Q. How is this test performed?

This test is performed on a blood sample. A syringe with a fine needle is used to withdraw blood from a blood vessel in your arm. The healthcare provider will tie an elastic band around your arm to make the blood vessels swell with blood. This makes it easier to withdraw blood. You may be asked to tightly clench your fist. Once the veins are clearly visible, the area is cleaned with an antiseptic solution and then the needle is inserted into the blood vessel to collect the sample. You will feel a tiny pinprick during the procedure. Blood sample once collected will then be sent to the laboratory.

Q. Is there any risk associated with this test?

There is no risk associated with the test. However, since this test involves a needle prick to withdraw the blood sample, in very rare cases, a patient may experience increased bleeding, hematoma formation (blood collection under the skin), bruising or infection at the site of needle prick.

Q. Is there any preparation required before the test?

Inform the doctor about the medications you may be taking. No other specific preparations are usually required before this test.

Q. What factors can affect the cortisol test results?

The cortisol test results can be affected by a number of factors, including a lifestyle that does not allow a regular sleeping pattern, stress, certain medications like birth control pills, glucocorticoids, and steroid hormone-based medications, physical trauma, final trimester of pregnancy, high physical activity in trained athletes, alcoholism and malnutrition

Q. What additional tests can be prescribed by your doctor in case of abnormal cortisol test results?

Additional tests that may be prescribed by the doctor in case of abnormal cortisol test result are urine cortisol test, salivary cortisol test, dexamethasone suppression test, ACTH Stimulation Test, CT scan or MRI for suspected tumors.

Q. What is Cushing’s syndrome?

Cushing’s syndrome refers to a group of conditions caused due to a sustained increase in the levels of cortisol hormone in the body. Increased levels of cortisol are most commonly caused due to corticosteroid medications used to treat other diseases. These increased levels could also be due to overproduction of cortisol from the adrenal glands caused by ACTH-secreting tumor in the pituitary gland or elsewhere in the body, or adrenal gland diseases like adrenal hyperplasia. Cushing’s syndrome shows symptoms which include fat deposition between the shoulders (buffalo hump), puffy face, purple or pink stretch marks on the abdomen, high blood pressure. The other symptoms include loss of bone density, slow wound healing, increased body hair in females, weakness, fatigue, growth impairment, etc.

Q. What are the symptoms associated with increased cortisol levels?

Higher than normal cortisol levels in the blood can show symptoms such as High blood pressure (hypertension), high blood sugar (hyperglycemia), obesity, fragile skin, the appearance of purplish lines on the skin of the abdomen, weakness and muscular degeneration, osteoporosis and irregular menstruation.

Q. What are the symptoms associated with decreased cortisol levels?

Lower than normal cortisol levels in the blood can show symptoms such as rapid weight loss, fatigue and muscle weakness, low blood pressure, pain in the abdomen and dark patches of skin in Addison’s disease.

Q. What is Addison’s disease?

Addison’s disease is also called primary adrenal insufficiency. In this, the adrenal glands do not produce sufficient quantities of cortisol hormone due to the damage caused to the adrenal glands, diseases affecting the adrenal glands, or tumors in the adrenal glands. Symptoms include fatigue and weakness, rapid weight loss, the appearance of dark patches of skin, low blood pressure, diarrhea, nausea and vomiting, abdominal pain, etc. Addison’s disease can be life-threatening and can produce severe symptoms suddenly in a condition called Addisonian crisis or acute adrenal failure.

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