What do high cortisol test results mean?

Question

Hi doctor,

I have undergone a number of cortisol tests over the past few years and have had some confusing results. Initially, when the doctor first tested my cortisol levels, there was a suggestion that I may have Cushing's syndrome. After a few salivary cortisol tests, she decided to do free urine test. They came back as normal. Therefore, she told me it was not Cushing's syndrome. Since then, I have continued to have issues and did the test again last year and just a few weeks ago. The test I did last year came back with high cortisol levels, and the recent test conducted a few weeks ago showed low cortisol levels. My belief is that it might be cyclical cushings or adrenal fatigue, but I cannot get a straight answer and have been told it was normal.

Kindly help.

Answer 1

Hi,

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If the result of the test is normal, then you do not have Cushing's disease. Cortisol levels show cyclical changes within a day. So, measuring hormone levels would not suffice.

Screening tests for Cushing syndrome are:

Midnight serum or salivary cortisol.
24-hour urine-free cortisol.
Low-dose Dexamethasone suppression test (Liddle test).

Any of the above tests combined with an adrenocorticotropic hormone (ACTH) level obtained at the same time as cortisol. You should start considering an alternative diagnosis for your symptoms, like pseudo-cushing syndrome. A pseudo-Cushing state is defined as having some of the clinical features and biochemical evidence of Cushing syndrome.

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What do high cortisol test results mean?

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