This test determines how much cortisol is present in your urine. Chemical messengers called hormones move through your bloodstream. Your body uses proteins, lipids, and carbs more efficiently when cortisol is present. It supports immune system regulation, blood pressure maintenance, and blood sugar (glucose) control. The adrenal glands, located above the kidneys, produce and release it. Adrenocorticotropic hormone (ACTH), a different hormone, regulates the release of cortisol. The pituitary gland, located at the base of the brain, produces and releases ACTH. Since cortisol is released at different periods throughout the day, collecting all of your pee over a 24-hour period is the most accurate approach to detect it. Why do I need this test? You may need this test if your healthcare provider suspects a problem with your pituitary gland or your adrenal glands. Too much cortisol (Cushing syndrome) causes symptoms such as: Weight gain in the upper part of your body High blood pressure High blood sugar Fragile skin Osteoporosis A round face Bruising and stretch marks on your skin Weakness and fatigue Too little cortisol (adrenal insufficiency or Addison disease) causes symptoms such as: Weight loss Weakness and fatigue Low blood pressure Darkening of your skin Belly (abdominal) pain Vomiting and diarrhea. This can cause dehydration. What other tests might I have along with this test? Your provider may also order an ACTH blood test. By comparing the results of both tests, your doctor will be better able to diagnose a problem with your adrenal glands or your pituitary gland.

Addison’s disease, Cushing’s syndrome, Tumor affecting the production of cortisol

Normal range is less than 45 mcg/24 hours (124 nmol/24 hours) for women and less than 60 mcg/24 hours (165 nmol/24 hours).

A healthy adult's urine free cortisol measurement during a 24-hour period should fall between 30 and 145 nanomoles per liter, according to certain reference ranges Trusted Source. However, because typical levels naturally differ between people, interpreting the findings of a 24-hour cortisol urine test can be challenging. Various reference ranges or cut-offs are used by various organizations and health authorities to determine whether cortisol levels are normal or pathological. Elevated amounts of free cortisol in the urine could be a sign of Cushing's syndrome or another associated illness. A disorder like Addison's disease or secondary adrenal insufficiency may be indicated by low levels.

This test requires a 24-hour urine sample. For this type of urine sample, you must collect all the urine you produce for 24 hours. Empty your bladder completely first thing in the morning without collecting it and note the time. Then collect your urine every time you go to the bathroom for the next 24 hours.