Cortisol blood testSerum cortisol
The cortisol blood test measures the level of cortisol in the blood. Cortisol is a steroid (glucocorticoid or corticosteroid) hormone produced by the adrenal gland.
The adrenal glands are two small triangle-shaped glands in the upper abdomen. One gland is located on top of each kidney.Read Article Now Book Mark Article
Cortisol can also be measured using a urine or saliva test.
The cortisol urine test measures the level of cortisol in the urine. Cortisol is a glucocorticoid (steroid) hormone produced by the adrenal gland. C...Read Article Now Book Mark Article
How the Test is Performed
Blood sample is needed
Venipuncture is the collection of blood from a vein. It is most often done for laboratory testing.Read Article Now Book Mark Article
How to Prepare for the Test
Your doctor will likely have you do the test early in the morning. This is important because cortisol level varies throughout the day.
You may be asked not to do any vigorous exercising the day before the test.
You may also be told to temporarily stop taking medicines that can affect the test, including:
- Anti-seizure drugs
- Human-made (synthetic) glucocorticoids, such as hydrocortisone, prednisone, and prednisolone
How the Test will Feel
When the needle is inserted to draw blood, some people feel moderate pain. Others feel only a prick or stinging. Afterward, there may be some throbbing or slight bruising. This soon goes away.
Why the Test is Performed
The test is done to check for increased or decreased cortisol production. Cortisol is a glucocorticoid (steroid) hormone released from the adrenal gland in response to adrenocorticotropic hormone (ACTH). ACTH is a hormone released from the pituitary gland in the brain.
Cortisol affects many different body systems. It plays a role in:
- Bone growth
- Blood pressure control
- Immune system function
- Metabolism of fats, carbohydrates, and protein
- Nervous system function
- Stress response
Different diseases, such as Cushing syndrome and Addison disease, can lead to either too much or too little production of cortisol. Measuring blood cortisol level can help diagnose these conditions. It is also measured to evaluate how well the pituitary and adrenal glands are working.
Cushing syndrome is a disorder that occurs when your body has a high level of the hormone cortisol.Read Article Now Book Mark Article
Addison disease is a disorder that occurs when the adrenal glands do not produce enough hormones.Read Article Now Book Mark Article
The test is often done before and 1 hour after injection of a medicine called ACTH (cosyntropin). This part of the test is called an ACTH stimulation test. It is an important test that helps check the function of the pituitary and adrenal glands.
ACTH stimulation test
The ACTH stimulation test measures how well the adrenal glands respond to adrenocorticotropic hormone (ACTH). ACTH is a hormone produced in the pitu...Read Article Now Book Mark Article
The test is often done in the morning after taking 1 milligram (mg) of dexamethasone the night before the test.
Other conditions for which the test may be ordered include:
- Acute adrenal crisis, a life-threatening condition that occurs when there is not enough cortisol
Acute adrenal crisis
Acute adrenal crisis is a life-threatening condition that occurs when there is not enough cortisol. This is a hormone produced by the adrenal glands...Read Article Now Book Mark Article
- Sepsis, an illness in which the body has a severe response to bacteria or other germs
Sepsis is an illness in which the body has a severe, inflammatory response to bacteria or other germs.Read Article Now Book Mark Article
- Low blood pressure
Low blood pressure
Low blood pressure occurs when blood pressure is much lower than normal. This means the heart, brain, and other parts of the body do not get enough ...Read Article Now Book Mark Article
Normal values for a blood sample taken at 8 in the morning are 5 to 25 mcg/dL or 140 to 690 nmol/L.
Normal values depend on the time of day and the clinical context. Normal ranges may vary slightly among different laboratories. Some labs use different measurements or may test different specimens. Talk to your doctor about the meaning of your specific test results.
The expected result can be outside the normal range if done as part of a cosyntropin stimulation test or dexamethasone suppression test.
What Abnormal Results Mean
A higher than normal level may indicate:
- Cushing disease, in which the pituitary gland makes too much ACTH because of excess growth of the pituitary gland or a tumor in the pituitary gland
Cushing disease is a condition in which the pituitary gland releases too much adrenocorticotropic hormone (ACTH). The pituitary gland is an organ of...Read Article Now Book Mark Article
- Ectopic Cushing syndrome, in which a tumor outside the pituitary or adrenal glands makes too much ACTH
Ectopic Cushing syndrome
Ectopic Cushing syndrome is a form of Cushing syndrome in which a tumor outside the pituitary gland produces a hormone called adrenocorticotropic hor...Read Article Now Book Mark Article
- Tumor of the adrenal gland that is producing too much cortisol
- Acute illness
A lower than normal level may indicate:
- Addison disease, in which the adrenal glands do not produce enough cortisol
- Hypopituitarism, in which the pituitary gland does not signal the adrenal gland to produce enough cortisol
Hypopituitarism is a condition in which the pituitary gland does not produce normal amounts of some or all of its hormones.Read Article Now Book Mark Article
- Suppression of normal pituitary or adrenal function by glucocorticoid medicines including pills, skin creams, eye drops, inhalers, joint injections, chemotherapy
There is little risk involved with having your blood taken. Veins and arteries vary in size from one person to another and from one side of the body to the other. Taking blood from some people may be more difficult than from others.
Other risks associated with having blood drawn are slight, but may include:
- Excessive bleeding
- Fainting or feeling lightheaded
- Multiple punctures to locate veins
- Hematoma (blood accumulating under the skin)
- Infection (a slight risk any time the skin is broken)
Chernecky CC, Berger BJ. Cortisol - plasma or serum. In: Chernecky CC, Berger BJ, eds. Laboratory Tests and Diagnostic Procedures. 6th ed. St Louis, MO: Elsevier Saunders; 2013:388-389.
Newell-Price JDC, Auchus RJ. The adrenal cortex. In: Melmed S, Auchus, RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 15.
Review Date: 5/13/2021
Reviewed By: Brent Wisse, MD, Board Certified in Metabolism/Endocrinology, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.