Cortisol in Blood

Test Overview

A cortisol test is done to measure the level of the hormone cortisol in the blood. The cortisol level may show problems with the adrenal glands or pituitary gland. Cortisol is made by the adrenal glands. Cortisol levels go up when the pituitary gland releases another hormone called adrenocorticotropic hormone (ACTH).

Cortisol has many functions. It helps the body use sugar (glucose) and fat for energy (metabolism), and it helps the body manage stress. Cortisol levels can be affected by many conditions, such as physical or emotional stress, strenuous activity, infection, or injury.

Normally, cortisol levels rise during the early morning hours and are highest about 7 a.m. They drop very low in the evening and during the early phase of sleep. But if you sleep during the day and are up at night, this pattern may be reversed. If you do not have this daily change (diurnal rhythm) in cortisol levels, you may have overactive adrenal glands. This condition is called Cushing's syndrome.

Two blood samples may be taken: one in the morning and another in the afternoon.

Why It Is Done

A cortisol test is done to find problems of the pituitary gland or adrenal glands, such as making too much or too little hormones.

How To Prepare

You may be asked to avoid strenuous physical activity the day before a cortisol test. You may also be asked to lie down and relax for 30 minutes before the blood test.

Many medicines may change the results of this test. Some medicines, such as steroids, can affect cortisol levels for some time even after you stop taking the medicine. Be sure to tell your doctor about all the nonprescription and prescription medicines you take.

Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form(What is a PDF document?) .

How It Is Done

The health professional drawing your blood will:

  • Wrap an elastic band around your upper arm to stop the flow of blood. This makes the veins below the band larger so it is easier to put a needle into the vein.
  • Clean the needle site with alcohol.
  • Put the needle into the vein. More than one needle stick may be needed.
  • Attach a tube to the needle to fill it with blood.
  • Remove the band from your arm when enough blood is collected.
  • Put a gauze pad or cotton ball over the needle site as the needle is removed.
  • Put pressure to the site and then a bandage.

How It Feels

The blood sample is taken from a vein in your arm. An elastic band is wrapped around your upper arm. It may feel tight. You may feel nothing at all from the needle, or you may feel a quick sting or pinch.

Risks

There is very little chance of a problem from having blood sample taken from a vein.

  • You may get a small bruise at the site. You can lower the chance of bruising by keeping pressure on the site for several minutes.
  • In rare cases, the vein may become swollen after the blood sample is taken. This problem is called phlebitis. A warm compress can be used several times a day to treat this.
  • Ongoing bleeding can be a problem for people with bleeding disorders. Aspirin, warfarin (Coumadin), and other blood-thinning medicines can make bleeding more likely. If you have bleeding or clotting problems, or if you take blood-thinning medicine, tell your doctor before your blood sample is taken.

Results

A cortisol test is done to measure the level of the hormone cortisol in the blood.

Normal

Normal results may vary from lab to lab.

Cortisol
Adult Morning

5–23 micrograms per deciliter (mcg/dL) or 138–635 nanomoles per liter (nmol/L)

Afternoon

3–13 mcg/dL or 83–359 nmol/L

Child Morning

3–21 mcg/dL or 83–580 nmol/L

Afternoon

3–10 mcg/dL or 83–276 nmol/L

Newborn  

1–24 mcg/dL or 27–663 nmol/L

High values

  • A high level of cortisol in the blood can mean Cushing's syndrome, a disorder that can be caused by overactive adrenal glands, a pituitary or adrenal gland tumor, some types of cancer, or long-term use of corticosteroids.
  • A high cortisol level can happen with Cushing's disease, a condition caused by a noncancerous tumor of the pituitary gland (adenoma). An adenoma causes the pituitary gland to make too much of the hormone adrenocorticotropic hormone (ACTH), which in turn causes the adrenal glands to make too much cortisol.
  • A high blood cortisol level can be caused by severe liver or kidney disease, depression, hyperthyroidism, or obesity.
  • Pregnancy or birth control pills can also cause a high blood cortisol level.
  • Conditions such as recent surgery, illness, injury, or whole-body infection (sepsis) can cause high cortisol levels.

Low values

  • A low level of cortisol in the blood can mean Addison's disease, which is caused by damage to the adrenal glands. If the pituitary gland is not working well, it can cause low levels of the hormone ACTH, which in turn causes low levels of cortisol. Conditions that can damage the adrenal glands or pituitary gland include some infections, head injury, and some autoimmune diseases.
  • A low level of cortisol can be caused by internal bleeding that leads to shock. For example, severe bleeding during childbirth that causes damage to the pituitary gland of the mother (Sheehan's syndrome) can cause a low level of ACTH, which then leads to a low level of cortisol.

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include:

  • Having physical or emotional stress.
  • Being pregnant. This can cause urine cortisol levels to be high.
  • Having low blood sugar (hypoglycemia).
  • Eating, drinking, or exercising before the test.
  • Taking medicines, such as birth control pills, estrogen, amphetamines, or corticosteroids.
  • Having a radioactive scan within 1 week of a cortisol test.

What To Think About

  • A 24-hour urine test is used more often than a cortisol blood test to diagnose Cushing's syndrome. For more information on cortisol in urine, see the medical test Cortisol in Urine.
  • Other tests that can help determine if the pituitary gland or adrenal glands are functioning properly include the adrenocorticotropic hormone (ACTH) stimulation test and dexamethasone suppression tests. The ACTH stimulation test may be done when Addison's disease is suspected. For more information, see the medical tests Adrenocorticotropic Hormone and Overnight Dexamethasone Suppression Test.

References

Other Works Consulted

  • Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
  • Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
  • Pagana KD, Pagana TJ (2006). Mosby’s Manual of Diagnostic and Laboratory Tests, 3rd ed. St. Louis: Mosby.

Credits

Author Caroline Rea, RN, BS, MS
Editor Maria Essig
Associate Editor Tracy Landauer
Primary Medical Reviewer Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer Alan C. Dalkin, MD - Endocrinology
Last Updated July 28, 2008

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