Saliva
Adrenal stress index
Adrenal Stress Index
€ 285,00
All tests
Hormones · Saliva
Cortisol
Free cortisol in saliva; measured late in the evening, a test when too much cortisol is suspected.
At a glance
- Measured in saliva
- In 4 test panels
- Check the preparation
Explanation
Cortisol: what is measured?
Cortisol is made by the adrenal glands, controlled by ACTH from the pituitary gland. Saliva contains the free, active part of cortisol, which is not bound to proteins in the blood. Cortisol has a strong daily rhythm: high shortly after waking up and low around midnight. With saliva, it can be measured without a needle at a fixed time, for example late in the evening or at several moments across the day (a daily profile).
What can it detect?
- Cushing's syndrome (too much cortisol): a raised value in saliva around midnight is one of the standard tests for this
- Suppression of the body's own cortisol production by corticosteroids, although a morning cortisol measurement in the blood is more usual for this
Result
What does the result mean?
Cortisol too high
A raised value is often due to the way the sample was collected: brushing your teeth, eating, drinking or smoking shortly beforehand, bleeding gums, or hydrocortisone cream on the hands or around the mouth. Tension, lack of sleep, night shifts, jet lag, illness, heavy exercise and alcohol also raise the value; in the morning, the value is supposed to be high. A repeatedly raised value around midnight may fit Cushing's syndrome, with symptoms such as weight gain around the trunk with thin arms and legs, a round and red face, thin skin with bruises, muscle weakness, high blood pressure and high blood sugar. Overweight, depression and a lot of alcohol can also give a raised cortisol without Cushing's; that is why the hospital repeats the measurements at several moments.
Cortisol too low
A low value around midnight is normal. A low value in the morning is usually because the sample was collected later than shortly after waking up, or due to use of corticosteroids (tablets, inhaler, nasal spray, skin cream or injection), which suppress the body's own production. A true deficiency due to a disease of the adrenal glands or the pituitary gland is rare and goes with symptoms such as severe tiredness, weight loss, low blood pressure, nausea and salt craving; it is diagnosed with a blood test, not with saliva. A low or 'flat' daily profile is no proof of 'adrenal fatigue': that is not a recognized condition.
After an abnormal result
With a raised value around midnight and matching symptoms, the measurement is repeated, usually together with a dexamethasone suppression test or cortisol in 24-hour urine, and if an abnormality is confirmed, referral to an internist-endocrinologist follows. With symptoms that fit a cortisol deficiency, a cortisol measurement in the blood early in the morning follows and, if needed, measurement of ACTH. With an abnormal daily profile without such symptoms, there is usually no further hormone testing.
Reliability
How reliable is the test?
Cortisol in saliva around midnight is one of the standard tests for detecting too much cortisol, alongside the dexamethasone suppression test and cortisol in 24-hour urine; the hospital repeats these measurements at different moments because Cushing's syndrome is difficult to prove. Outside that question, the meaning of saliva cortisol is not well supported. A daily profile to measure stress, burnout or 'adrenal fatigue' is not supported by evidence: adrenal fatigue is not recognized in mainstream medicine and there is no validated test for it. The symptoms people experience are real, but often have another cause, such as an underactive thyroid, sleep apnea or depression.
What can affect the result?
- Collection: do not eat, drink, smoke or brush your teeth just before collecting; brushing your teeth can strongly distort the result. Rinse your mouth with water about ten minutes beforehand.
- Timing: only a sample taken at the agreed time can be compared with the reference values; with night shifts, jet lag or an irregular sleep pattern, the daily rhythm is shifted.
- Corticosteroids in any form lower the body's own production; hydrocortisone on the skin or in the mouth can contaminate the sample and give a falsely high result.
- Tension, illness, heavy exercise, alcohol and lack of sleep temporarily raise the value. Reference values differ between laboratories and measurement methods.
Preparation
- Fill the first tube straight after waking up and the next ones after 30 and 60 minutes. For the day profile, further tubes follow 2, 5, 8 and 12 hours after waking up, each at least 30 minutes after eating or drinking. Choose a normal day and get up at your usual time.
- Do not eat, drink, smoke or brush your teeth until after the third tube. Do not use mouthwash or dental floss that day.
- Do you use hormone preparations such as hydrocortisone or progesterone? Then stop 48 hours beforehand, in consultation with your doctor.
Who it is for
Who is the test useful for?
Useful for
Useful with symptoms that fit too much cortisol, such as weight gain around the trunk with thin arms and legs, a round and red face, thin skin with bruises and muscle weakness, with a sample late in the evening and in consultation with a doctor. Not useful for measuring stress, burnout, tiredness or 'adrenal fatigue', or for choosing a treatment or supplement based on it: a daily profile is not supported by evidence for this, and in healthy people under a lot of tension, the result cannot be interpreted.
How common is it?
Cushing's syndrome due to a tumor of the pituitary or adrenal gland is rare: in the Netherlands, about 50 people per year are given this diagnosis, and the Netherlands has an estimated 150 to 200 people with this condition. The most common cause of too much cortisol is the use of corticosteroids such as prednisone or dexamethasone. Tiredness and stress symptoms are much more common and usually do not fit an adrenal disease.
Maastricht UMC+, Department of Endocrinology and GP brochure on adrenal diseases (Dutch adrenal patient association NVACP)
Drawbacks and risks
- An abnormal daily profile can wrongly be seen as proof of adrenal fatigue or chronic stress and lead to expensive supplements or hormone products; some of these contain steroids and can harm your health.
- A falsely raised value due to incorrect collection can cause unnecessary worry about Cushing's syndrome and unnecessary follow-up tests.
Get tested
Cortisol: test panels
Cortisol is part of these test panels. You order online and have your blood drawn at a collection point or collect the sample at home.
Saliva
Cortisol day profile
Measures daily cortisol profile. Provides insight into adrenal function and stress response.
€ 135,00
Saliva
Cortisol
Analyzes the stress hormone cortisol via saliva. Optimal for a snapshot of adrenal function.
€ 95,00
Saliva
Large male hormone profile
This profile measures oestradiol, testosterone, and DHEA in men via saliva testing.
€ 200,00
Evidence
Sources
This explanation is based on Dutch guidelines and independent information. It is general information, not a diagnosis. Discuss an abnormal result with your GP.
More about risks and results