The adrenal glands can be evaluated in several different ways and more than one of these may be required to fully understand the nature of the problem. Conventional physicians routinely test for adrenal function by measuring the levels of the adrenal hormone cortisol.
Because cortisol is secreted at different levels throughout the day (most in the morning, least around midnight), multiple samples (usually 4) should be taken through out the day at specific times. Individual samples can be taken by blood or saliva. A single serum or saliva cortisol by itself will usually not be very useful.
Alternatively, a 24-hour cumulative urine test can be done which will show how much cortisol was secreted during that period. This test, while very useful, does not reveal any information about the adrenal output at any specific time.
An ACTH (Cortrosyn) baseline and challenge may be the best tests to determine whether your adrenal glands are able to respond to signals from your brain. The pituitary may not be producing enough ACTH or – more likely – the adrenal glands may not be responding adequately to the brain’s signals. Some consider two 24-hour urine samples, one before and one after the ACTH injection, to be the best method of testing for adrenal weakness.
The dexamethasone test, along with baseline measurements, is usually performed only when adrenal hyperfunction is being evaluated. It can differentiate adrenal disease (altered response to ACTH ) from pituitary disorders (altered production of ACTH).
The secretion of ACTH from the pituitary gland is normally regulated by the level of cortisol in the blood. ACTH stimulates the adrenal cortex to produce cortisol. As plasma cortisol levels increase, ACTH secretion is suppressed; as cortisol levels decrease, ACTH increases. Dexamethasone is a synthetic steroid similar to cortisol, which suppresses ACTH secretion in normal individuals. Giving dexamethasone should reduce ACTH levels resulting in decreased cortisol levels.
With or without lab testing, if symptoms indicate adrenocortical deficiency, a low dose therapeutic trial of cortisol for several weeks may prove both informative and helpful.
Test Adrenal Function can help with the following
Upcoming Surgical Procedure
If blood tests show your adrenal gland reserves are very low, your doctor may consider the use of natural cortisol during and after a stressful procedure like surgery. Before surgery, you should confirm that adrenal fatigue is not a problem if you suspect it may be.
Low Adrenal Function / Adrenal Insufficiency
Adrenal function can be evaluated in several ways by blood, saliva, and/or urine testing. Your doctor should know the best test to use depending on the suspected severity of the condition.
Cushing's Syndrome / Hypercortisolism
A 24-Hour urinary free cortisol level is the most specific diagnostic test. Levels higher than 50 to100mcg a day for an adult suggest Cushing’s syndrome. Once Cushing’s syndrome has been diagnosed, other tests are used to find the exact location of the abnormality that leads to excess cortisol production. These tests could include dexamethasone suppression test, CRH stimulation test, direct visualization of the endocrine glands (radiologic imaging), petrosal sinus sampling and the dexamethasone-CRH test.
Hypothyroidism
Cortisol and DHEA are among the hormones produced by the adrenal glands. It is possible that these hormones can reduce the immune system dysfunction seen in Hashimoto’s thyroiditis. More studies are needed, but taking these medications appropriately carries little (if any) risk and can markedly improve the patient’s function and overall health.
Key
| May do some good |
| Highly recommended |
Glossary
Hormones
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Serum
The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.
Pituitary
The pituitary gland is small and bean-shaped, located below the brain in the skull base very near the hypothalamus. Weighing less than one gram, the pituitary gland is often called the "master gland" since it controls the secretion of hormones by other endocrine glands.
Steroid
Any of a large number of hormonal substances with a similar basic chemical structure containing a 17-carbon 14-ring system and including the sterols and various hormones and glycosides.