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Cortisol in Urine

Test Overview

A cortisol test is done to measure the level of the hormone cortisol in a 24-hour sample of urine. The cortisol level may show problems with the adrenal glands or the pituitary gland. Cortisol is made by the adrenal glands. Cortisol levels get higher 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.

Why It Is Done

A cortisol test is done to find problems of the pituitary gland or adrenal glands, such as making too much hormone, which happens in Cushing's syndrome.

How To Prepare

You may be asked to avoid strenuous physical activity the day before a cortisol test.

Be sure to drink enough fluids during the 24-hour urine test to prevent dehydration.

Many medicines may change the results of this test. 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

24 hour urine

  • You start collecting your urine in the morning. When you first get up, empty your bladder but do not save this urine. Write down the time that you urinated to mark the beginning of your 24-hour collection period.
  • For the next 24 hours, collect all your urine. Your doctor or lab will usually provide you with a large container that holds about 1 gal (4 L). The container has a small amount of preservative in it. Urinate into a small, clean container and then pour the urine into the large container. Do not touch the inside of the container with your fingers.
  • Keep the large container in the refrigerator for the 24 hours.
  • Empty your bladder for the final time at or just before the end of the 24-hour period. Add this urine to the large container and record the time.
  • Do not get toilet paper, pubic hair, stool (feces), menstrual blood, or other foreign matter in the urine sample.

How It Feels

There is no pain while collecting a 24-hour urine sample.

Risks

There is no chance for problems while collecting a 24-hour urine sample.

Results

A cortisol test is done to measure the level of the hormone cortisol in a 24-hour sample of urine.

Normal

The normal values listed here—called a reference range—are just a guide. These ranges vary from lab to lab, and your lab may have a different range for what’s normal. Your lab report should contain the range your lab uses. Also, your doctor will evaluate your results based on your health and other factors. This means that a value that falls outside the normal values listed here may still be normal for you or your lab.

Cortisol level in a 24-hour urine sample
Adult

Less than 100 micrograms (mcg) or less than 276 nanomoles (nmol)
Teen

5–55 mcg or 14–152 nmol
Child

2–27 mcg or 5–75 nmol

High values

  • One cause of Cushing's syndrome is 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.
  • ACTH can be made by other conditions, such as cancer of the lung. This high ACTH level causes the adrenal glands to make more cortisol.
  • The adrenal gland can develop tumors (benign or cancerous) that make cortisol and cause Cushing's syndrome.
  • A high blood cortisol level can be caused by severe liver or kidney disease, depression, hyperthyroidism, or obesity.
  • Conditions such as recent surgery, illness, injury, or whole body infection (sepsis) can cause high cortisol levels.

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 estrogen, amphetamines, or corticosteroids.
  • Not collecting exactly 24 hours of urine.

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 a cortisol blood test, see the topic Cortisol in Blood.
  • Other tests that can help determine if the pituitary gland or adrenal glands are working well include the adrenocorticotropic hormone (ACTH) and dexamethasone suppression tests. The ACTH stimulation test may be done when Addison's disease is suspected. For more information, see the topics 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.
  • Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Alan C. Dalkin, MD - Endocrinology
Last Revised July 9, 2010

Last Revised: July 9, 2010

Author: Healthwise Staff

Medical Review: E. Gregory Thompson, MD - Internal Medicine & Alan C. Dalkin, MD - Endocrinology

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