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A test that measures the amount of cortisol in urine.
Cortisol is a steroid hormone released from the adrenal cortex in response to
ACTH. Normally, cortisol levels rise and fall during the day (that is, diurnal
variation); highest levels are at about 6 to 8 A.M. and lowest levels occur at
Cortisol levels increase between meals, and increase the release of amino acids
from skeletal muscle and fatty acids from adipose tissue. The amino acids are absorbed by the liver and converted to glucose, which is subsequently secreted
into the blood to be used for energy by certain tissues such as brain cells and red blood cells. The fatty acids released from the adipose tissue are used for
energy by skeletal muscle, thus sparing the available glucose for use by the brain.
Cortisol (or other glucocorticoids) in pharmacological doses reduces
inflammation and inhibits the immune response. Even at physiological
concentrations, cortisol probably has an effect on the immune system and the
inflammatory response, especially in people subject to chronic stress. This is
because stress, in general, stimulates an increased release of ACTH and
secondarily releases cortisol, so that cortisol levels are chronically elevated.
Normally, cortisol and ACTH reciprocally regulate each other's concentration in
the blood, that is, cortisol levels decrease, which causes an increase in ACTH
secretion, which causes an increase in cortisol synthesis, which inhibits the
release of ACTH. Diseases of the pituitary and adrenal glands upset this
Some fraction of plasma cortisol is also metabolized by the liver and other
tissues to inactive products such as 17-OHCS, which are excreted by the body
in the urine. Some free cortisol also appears in urine, which is proportional to the
concentration in the blood. Urine measurements may be more reliable than serum since the amount accumulates over time and the variability of secretion
can be averaged out.
How the test is performed:
A 24-hour urine sample is needed.
The health care provider will instruct you, if necessary, to discontinue drugs that
may interfere with the test.
On day 1, urinate into the toilet upon arising in the morning.
Collect all subsequent urine (in a special container) for the next
On day 2, urinate into the container in the morning upon arising.
Cap the container.
Keep it in the refrigerator or a cool place during the collection period.
Label the container with your name, the date, the time of completion, and return it as instructed.
Deliver it to the laboratory or your health care provider as soon as possible upon
Thoroughly wash the area around the urethra.
Open a urine collection bag (a plastic bag with an adhesive paper on one end), and place it on your infant.
For males, the entire penis can be placed in the bag and the adhesive attached to
For females, the bag is placed over the labia.
Place a diaper over the infant (bag and all).
The infant should be checked frequently and the bag changed after the infant has urinated into the bag.
For active infants, this procedure may take a couple of attempts--lively infants can displace the bag,
causing an inability to obtain the specimen. The urine is drained into the
container for transport to the laboratory.
How to prepare for the test:
No special preparation is necessary for this test, but if the collection is being
taken from an infant, a couple of extra collection bags may be necessary.
Inform the health care provider of any medications that may affect this test (see
How the test will feel:
The test involves only normal urination, and there is no discomfort.
What the risks are:
There are no risks.
Why the test is performed:
The test is used to evaluate adrenocortical function.
The normal range is 10 to 100 mcg/24 h.
Note: mcg/24 h = micrograms per 24-hours
What abnormal results mean:
Increased levels of urine cortisol may indicate:
Decreased levels of urine cortisol may indicate:
Additional conditions under which the test may be performed:
congenital adrenal hyperplasia
Cushing's syndrome caused by adrenal tumor
pregnancy (increases urinary cortisol)
The estimated cost is $42.
severe emotional or physical stress
drugs that can affect test measurements include oral contraceptives and
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