What Should I Do After The Test
When 24-hour urine collection is complete, close the container and seal the lid tightly. Return the sample in the urine container to the facility or healthcare worker as instructed. If you had the sample in an ice bath, return the sample within two hours after removing the container from the ice bath.
Cortisol Free 24 Hour Urine
Suggests clinical disorders or settings where the test may be helpful
Preferred screening test for Cushing syndrome
Diagnosis of pseudo-hyperaldosteronism due to excessive licorice consumption
Test may not be useful in the evaluation of adrenal insufficiency
Special Instructions
A short description of the method used to perform the test
Liquid Chromatography-Tandem Mass Spectrometry
NY State Available Indicates the status of NY State approval and if the test is orderable for NY State clients.
Lists a shorter or abbreviated version of the Published Name for a test
Lists additional common names for a test, as an aid in searching
Cortisol Free Urine
Describes the specimen type validated for testing
Urine
| Urine Volume |
Specimen Required Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Supplies: Urine Tubes, 10-mL
Submission Container/Tube: Plastic, urine tube
Specimen Volume: 5 mL
1. Collect urine for 24 hours.
2. Add 10 g of boric acid as preservative at start of collection.
Urine Preservative Collection Options
Note: The addition of preservative must occur prior to the start of the collection or application of temperature controls must occur during collection.
|
Ambient |
Specimen Minimum Volume Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory
3 mL
How To Prepare For The Test
You may be asked not to do any vigorous exercising the day before the test.
You may also be told to temporarily stop taking medicines that can affect the test, including:
- Anti-seizure drugs
- Human-made glucocorticoids, such as hydrocortisone, prednisone, and prednisolone
- Metabolism of fats, carbohydrates, and protein
- Nervous system function
- Stress response
Different diseases, such as Cushing syndrome and Addison disease, can lead to either too much or too little production of cortisol. Measuring urine cortisol levels can help diagnose these conditions.
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What Is This Test
This test measures the level of the hormone cortisol in your urine. Hormones are chemical messengers that travel through your blood. Cortisol helps your body use proteins, fats and carbohydrates. It helps maintain blood pressure, control blood sugar levels, and regulate the immune system. It’s made and released by the adrenal glands, which sit atop the kidneys.
Another hormone, adrenocorticotropic hormone , controls the release of cortisol. ACTH is made and released by the pituitary gland, which is at the base of your brain.
Cortisol is released at different times during the day, so the best way to measure it is to collect all the urine you produce over a 24-hour period.
Essential Oestrogens With Genomics
Personalise Patient Treatment Protocols with Genomic Testing
We are excited to announce that the addition of select genomic markers to our Essential Oestrogens profile. Assessment of these select genomic markers in conjunction with urine hormone testing, supports broadened clinical insight into women’s and men’s health concerns.
Genomic testing using these SNPs may provide awareness into an array of conditions for which the peri/menopausal and andropausal patient seek support such as anxiety and other mood shifts, cardiovascular disease, cardiometabolic syndrome, bone health and hormone detoxification capacity.
Complete Hormones kit requisitions will now include the option for ordering one or more of the following SNPs:
- MTHFR Methylenetetrahydrofolate Reductase
- Low bone mineral density and/or fracture risk
- Potential risk of all cancers
- Low levels of B vitamins, especially folate
- Risk for cardiovascular disease and stroke
- COMT Catechol-O-Methyltransferase
- Chronic, high levels of stress
- Increased risk for fracture
- High or imbalanced estrogen levels, especially 4-hydroxyestrogn
- VDR Vitamin D Receptor
- Increased risk for cancers in specific populations
- Exposure-specific cancers
Oestrogen imbalance can produce challenging symptoms during the transitional periods of perimenopause/ menopause and andropause including:
- Low sex drive and performance issues
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What Is A Urine Cortisol Test
Definition:A cortisol urine test measures the amount of cortisol in the urine.
Alternative Names: 24-hour urinary free cortisol
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 when you get up in the morning. Afterwards, collect all urine in a special container for the next 24 hours. Keep the container in a cool place during the test period.On day 2, urinate into the container when you get up in the morning.Cap the container. Label the container with your name, the date, the time of completion, and return it as instructed. Keep it in the refrigerator or a cool place until returned to the laboratory.FOR INFANTS
This procedure may take a couple of attempts lively infants can displace the bag. The infant should be checked frequently and the bag changed after the infant has urinated into the bag. The urine is drained into the container for transport to the laboratory.
Deliver it to the laboratory or your health care provider as soon as possible upon completion.
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.
How the test will feel:The test involves only normal urination, and there is no discomfort.
Note: mcg/24 h = micrograms per 24 hours
- ACTH-secreting tumor
Urine Hormones Measured Only In 24
Besides Melatonin, there are several hormones included in Marys 24-hour urine hormone collection that are not available in the dry urine method at this time. They include free T3, free T4, aldosterone, growth hormone, and oxytocin.
Low aldosterone is sometimes associated with age-related hearing loss and supplemental aldosterone has been helpful in some cases in restoring hearing acuity. Marys aldosterone is at a healthy level and she reports no hearing deficits.
24-hour urine free T4 and, especially, free T3 can be sensitive indicators of sub-clinical thyroid hypofunction. The relationship between FT4 and FT3 is also of interest. Significantly more FT4 than FT3 suggests that 5-Deiodinase is being inhibited and the alternative 5-Deiodinase pathway has been activated, leading to higher reverse T3 . This can be a result of stress, high cortisol or heavy metal toxicity. Marys FT4 value of 786 is near the optimal range, but her FT3 , at only 402, is well below optimal. The dual stresses in Marys life of a hostile work environment and the illness and death of her sister are certainly enough to have impacted this pathway. Additional selenium may be helpful here, as may the change in her job circumstances.
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Case Study: Mary Smith
Estriol is considered a protective estrogen because it binds to Estrogen Receptor , which increases differentiation of cells and decreases proliferation of cells. E1 and E2 have important benefits, but also have potentially carcinogenic metabolites. The Estrogen Quotient 7 is calculated by dividing E3 by the total of E1+E2, and should ideally be > 1.5. Some practitioners prefer to see it > 2.0. Marys EQ is lower than optimal. We do not expect the EQ on the 24-hr urine profile and the Dry Urine profile to be identical, but we do expect them to be consistent in what they are telling us, and both EQs are significantly lower than 1.5. Supplemental Iodine may be helpful in improving Marys EQ.
Phase I and Phase II estrogen metabolites also give insight into the health of Marys estrogen metabolism. The Phase I metabolite, 2-Hydroxyestrone , is considered a protective estrogen 4-Hydroxyestrone and to a lesser extent, 16-Hydroxyestrone , are considered carcinogenic. We dont want to see these estrogen metabolites too high, even when staying within the reference range. 16OHE1 serves an important role in maintaining bone density, and when it is too low, women may be at increased risk for osteopenia and osteoporosis. Mary has healthy levels of 2OHE1, at 91% and 92.4% of the reference range median for the 24-hour and the Dry Urine samples, respectively.
How Is The Test Done
For a 24-hour urine collection, all of the urine that you pass over a 24-hour time period must be collected. If you are in the hospital, a healthcare worker will collect your urine. You will receive a special container to collect the sample in if you are doing the collection at home. The following are directions for collecting a 24-hour urine sample while at home: In the morning scheduled to begin the urine collection, urinate in the toilet and flush away the first urine you pass. Write down the date and time. That is the start date and time for the collection. Collect all urine you pass, day and night, for 24 hours. Use the container given to you to collect the urine. Avoid using other containers. The urine sample must include the last urine that you pass 24 hours after starting the collection. Do not allow toilet paper, stool, or anything else to be added to the urine sample. Write down the date and time that the last sample is collected. The urine sample may need to be kept cool during the 24-hour collection period. If so, keep the closed container in a pan on ice. Do not put ice in the container with the urine.
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What Is Normal Protein Range In Urine
For a random urine sample, normal values are 0 to 14 mg/dL. For a 24-hour urine collection, the normal value is less than 80 mg per 24 hours. The examples above are common measurements for results of these tests.
What does a protein level of 30 in urine mean?
A normal amount of albumin in your urine is less than 30 mg/g. Anything above 30 mg/g may mean you have kidney disease, even if your GFR number is above 60.
What is a 24-hour urine protein test?
The 24-hour urine protein test checks how much protein is being spilled into the urine, which can help detect disease or other problems. The test is simple and noninvasive. Urine samples are collected in one or more containers over a period of 24 hours. The containers are kept in a cool environment and then sent to a lab for analysis.
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Agreement Between The Dutch 4
The measurement of reproductive hormones in urine samples collected four times throughout the day were comparable to the gold standard of a 24-h urine collection . As the measures from the 4-spot urine collection are reported in ng/mg-Cr and the 24-h urine measures are reported in ug/d, sex-specific Z-scores were created for direct comparison of the two methodologies. There was excellent consistency for the majority of the analytes and good consistency for the remainder . There was no systematic directionality to the differences between any of the Z-scores . Representative interclass correlations between the analytes are shown in Fig. 3 .
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Phase Ii Estrogen Metabolites
2-Methoxyestrone and 2-methoxyestradiol are considered protective estrogen metabolites. In fact, 2-methoxyestradiol is being used by some clinicians to treat women with a history of or current breast cancer because it increases differentiation of cells and promotes apoptosis.10-12 2-Methoxyestrone has less biological activity and is considered by some to be a reservoir substrate that can be converted to 2-methoxyestradiol. Both of these metabolites are dependent on methyl donors for their formation, and their levels are indicators of the health of the methylation pathways. Carolines phase II metabolites are high, consistent with her other estrogen levels.
Progesterone
The structure of progesterone makes it difficult for it to enter the urine in significant amounts. The progesterone metabolite pregnanediol has been found to be a reliable marker in urine for assessing progesterone levels. Carolines pregnanediol level is low, below even the postmenopausal range. This is especially concerning because of Carolines very high estrogen levels. Progesterone has an important role in opposing estrogen to limit proliferation of breast and endometrial tissue,13 in addition to its role in maintaining bone density.14
Androgens
Carolines testosterone metabolites and DHEA metabolites are low or at the low end of their reference ranges. This confirms that she does not have much to metabolize to begin with.
Adrenal Function
Glucocorticoids
Mineralocorticoids
Growth Hormone
Thyroid
Why The Test Is Performed
The test is done to check for increased or decreased cortisol production. Cortisol is a glucocorticoid hormone released from the adrenal gland in response to adrenocorticotropic hormone . This is a hormone released from the pituitary gland in the brain. Cortisol affects many different body systems. It plays a role in:
- Metabolism of fats, carbohydrates, and protein
- Nervous system function
and Addison disease , can lead to either too much or too little production of cortisol. Measuring urine cortisol level can help diagnose these conditions.
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Why Is The Cortisol 24
The cortisol urine test helps diagnosing Cushing syndrome as well as primary and secondary adrenal insufficiency. It is also used to detect any conditions that may be altering the proper functioning of the pituitary and adrenal glands. The cortisol urine test is performed if you are having symptoms related to rise or fall in the levels of your cortisol.
High cortisol levels are accompanied by symptoms such as increased urination, intensive thirst, noticing fatty tissue deposits and the abdominal section of your body and upper back, gaining weight for no reason, being tired all the time, having a skin that bruises very easily, as well as having pink and purple stretch marks on your skin. Having irregular periods and a lot of facial hair are also experienced in women with high cortisol levels.
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What Are Normal Results For This Test
Laboratory test results may vary depending on your age, gender, health history, the method used for the test, and many other factors. If your results are different from the results suggested below, this may not mean that you have a disease. Contact your healthcare worker if you have any questions. The following are considered to be normal results for this test:
- Radioimmunoassay:
- Low dose dexamethasone suppression test
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How Is A Cortisol Urine Test Performed
A cortisol urine test is a safe, painless procedure that only involves ordinary urination.
Cortisol is measured in a urinary sample collected over a 24-hour period. Your doctor will give you special containers to use for collecting urine samples. Theyll also explain how to collect the urine properly.
On the first day of the urine collection:
On the second day of the urine collection:
If your infant needs to have a cortisol urine test, youll collect their urine in a special bag.
The collection procedure is as follows:
Collect urine samples over a 24-hour period. It will be necessary to check the bag often throughout the collection period.
What Does A 24 Hour Urine Cortisol Test Show
A cortisol test measures the level of the hormone cortisol in a 24-hour sample of urine. The cortisol level may show problems with the adrenal glands or the pituitary gland. Cortisol is made by the adrenal glands. Cortisol levels get higher when the pituitary gland releases adrenocorticotropic hormone .
What does a high 24 hour urine protein mean?
Protein in the urine may signify kidney damage or disease. Protein levels may also rise temporarily due to factors such as infection, stress, or excess exercise. If the protein is caused by kidney damage, the test results will help to determine the extent of that damage.
What are normal results for a 24 hour urine test?
The normal range for 24-hour urine volume is 800 to 2,000 milliliters per day .
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How Does Dutch Compare To Other Hormone Tests
DUTCH vs. Saliva Testing
While the free cortisol pattern in saliva has clinical value, there is a significant missing piece to surveying a patients HPA-Axis function with saliva testing measuring cortisol metabolites. To properly characterize a patients cortisol status, free and metabolized cortisol should be measured to avoid misleading results when cortisol clearance is abnormally high or low. Likewise with sex hormones, measuring estrogen and androgen metabolites gives a fuller picture for more precise clinical diagnosis of hormonal imbalances and HRT monitoring.
DUTCH vs. Serum Testing
While the most universally accepted testing method , serum testing is lacking in some areas. Adrenal hormones cannot be effectively tested in serum because free cortisol cannot be tested throughout the day. There is also a lack of extensive metabolite testing .
DUTCH vs. 24-Hour Urine Testing
There are two primary drawbacks to 24-hour urine testing of hormones. First, the collection is cumbersome, and as many as 40% of those who collect, do so in error . Secondly, dysfunction in the diurnal pattern of cortisol cannot be ascertained from a 24-hour collection. Some providers add saliva for daily free cortisol. DUTCH eliminates the need for two tests.
Do dried samples compromise the analysis? Dried samples are accurate for hormone testing, and values correlate to liquid samples. Samples are stable once they are dried and easier to ship than liquid samples.