Adrenal Corticoids Profile
Doctor's Data
Sample type: Urine
Requires fasting: No
At home test
Details
The Adrenal Corticoids profile is a consideration for baseline or follow up testing for patients with concerns that are particular to HPA axis and corticoid health. This non-invasive test requires only 4 or 5 separate urine collections.
- Cortisone Night
- Cortisone Evening
- Cortisol Evening
- Cortisol Night
- Cortisol Waking
- Cortisone Waking
- Tetrahydrodehydrocorticosterone
- 5b-Tetrahydrocortisol
- 5b-Tetrahydrocorticosterone
- 5a-Tetrahydrocortisol
- 5a-Tetrahydrocorticosterone
- Tetrahydrocortisone
- Dehydroepiandrosterone Sulfate
- Creatinine/day
- Cortisol waking +2 hours
- Cortisol/day
- Cortisone waking +2 hours
- Cortisone/day
- Corticosterone
- 11-Deoxycortisol
Estimated days for results: Results should arrive 5 to 7 days after the lab receives samples.
Corticoids
The major site of cortisol metabolism is the liver. There it is reduced, oxidized or hydroxylated. The enzymes that directly metabolize cortisol are 11 beta hydroxysteroid dehydrogenase 1 and 2 (11-B HSD1 and 11B HSD2), the A-ring reductases (5 alpha and 5 beta reductases), 3 alpha hydroxysteroid dehydrogenase and 20 alpha and 20 beta hydroxysteroid dehydrogenases.
Cortisone protects the tissues from effects of cortisol, therefore if 11 B HSD activity is functioning properly, there should be twice as much cortisone as cortisol, measured in the cortisone (E)/cortisol (F) ratio. This ratio indicates 11B HSD 2 activity and infers tissue-specific concentrations of cortisol (which normally cannot be measured without a biopsy). A lower ratio suggests decreased cortisol clearance which may be associated with hypothyroidism (but isn’t associated with elevated free cortisol).
Cortisone protects the tissues from effects of cortisol, therefore if 11 B HSD activity is functioning properly, there should be twice as much cortisone as cortisol, measured in the cortisone (E)/cortisol (F) ratio. This ratio indicates 11B HSD 2 activity and infers tissue-specific concentrations of cortisol (which normally cannot be measured without a biopsy). A lower ratio suggests decreased cortisol clearance which may be associated with hypothyroidism (but isn’t associated with elevated free cortisol).
HSD 11B (1 and 2)
The primary function of 11B-HSD2 is to limit the cortisol effects upon cells with mineralocorticoid receptors (MR). Since cortisol has the same affinity for MR as aldosterone and is present in much higher concentrations, the conversion of cortisol to cortisone through the liver via 11B-HSD2 protects these cells from glucocorticoid intrusion on the mineralocorticoid system. It has been shown that the effects of excessive glucocorticoid activation in many of these tissues result from the actions of 11B-HSD1 due to the re-conversion of cortisone back to cortisol, rather than merely the excessive production of cortisol through classic HPA axis processes. In fact, the human liver/splanchnic bed is responsible for 20-40% of the daily cortisol production making the inactive cortisone pool a major reservoir for systemic cortisol availability.
Thyroid hormone plays a role in this conversion process. Increased cortisol metabolism is associated with hyperthyroidism while hypothyroidism has been shown to slow cortisol metabolism, resulting in lower levels of metabolized cortisol.
Thyroid hormone plays a role in this conversion process. Increased cortisol metabolism is associated with hyperthyroidism while hypothyroidism has been shown to slow cortisol metabolism, resulting in lower levels of metabolized cortisol.
5–7 business days
- Add-on: Comprehensive Neurotransmitter Profile
- Add-on: DNA Oxidative Damage Assay
- Add-on: NeuroBasic Profile
- Add-on: Urine Amino Acids
BEFORE YOU START: Please read all of the instructions in the sample collection kit carefully.
Collect urine on days that are determined by you and your provider. We recommend that you adhere to your most common sleep schedule and collect your urine samples as close as possible to the times specified on page 5 of the instructions included in the sample collection kit. Shift workers should adapt the collection times in accordance with sleep schedule.
Never discontinue prescription medications without first consulting your provider. Please do not send any medications with your kit.
Collection Schedule Summary
Please follow instructions included in sample collection kit.
Day 1 Collection
#1 Dinnertime: collect within 1-2 hours prior to eating dinner
#2 Bedtime: collect within 1 hour prior to sleep
Mid Sleep
Midsleep: collect only if you wake to urinate while sleeping
Day 2 Collection
#3 Waking: collect within 10 mins of waking
#4 Post-waking: collect after 2-4 hours
What days of the month should I collect?
- Men, post-menopausal women, and those testing only corticoids: collect any day.
- Women with menstrual cycles: begin the collection between days 19 and 23 of a 28-day cycle, counting the first day of your period as day 1.
- If cycles are irregular, contact your provider for clarity about the timing of your collection.
Recommendations for women and men on hormones
- 72 hours prior and during collection: Discontinue oral and sublingual hormones.
- 72 hours prior and during collection: Do not use hormones vaginally, as this may directly contaminate the urine.
- Other hormones such as topical creams and gels, injectables, and patches can be used on your regular schedule.
- Do not skip doses of oral birth control pills unless instructed by your healthcare provider.
A baseline hormone level may require supplement usage to stop for a longer period of time. Call your provider with questions.
Additional Recommendations
- Cortisol/glucocorticoid supplementation: Consult with your health care provider if you are taking glucocorticoids. Certain medications such as asthma inhalers and hydrocortisone contain cortisol. To evaluate natural cortisol production, it is recommended to stop cortisol containing products 5 days prior to sample collection.
- 24 hours prior and during collection: avoid alcohol, caffeine, tobacco or nicotine-containing products and strenuous exercise.
- 24 hours prior and during collection: for best results, minimize fluid intake (between 4-8 cups/1-2L).
The intent of this collection method is to create a urine test that closely represents a 24-hour collection. With this in mind, we want you to include as much urine as possible that is produced throughout a day and night. During the time period that urine is being collected it is important to collect urine from a full bladder as much as possible. It is more important to get a good representation of urine than it is to collect at a precise time.
State restrictions:
Patient can't order this test if they are located in Hawaii, Puerto Rico, New Jersey, New York, or Rhode Island
