Quick Facts
- Sample: 24-hour urine collection
- Fasting: Not required
- Turn-around: 4–6 business days. May take longer based on weather, holiday or lab delays. At this time, the lab is experiencing delays, which could add 5-7 business days to the normal turnaround time for results.
Benefits
- Comprehensive assessment - captures daily cortisol fluctuations over 24 hours
- High accuracy testing - uses advanced LC-MS/MS technology for precise results
- Convenient home collection - no painful procedures or clinic visits required
- Early detection capability - identifies adrenal disorders before severe complications
- Private and confidential - secure results delivery without physician referral
- Fast results - get answers within 4-6 days
Who Is This Test For?
- Individuals experiencing unexplained weight changes or persistent fatigue
- People with chronic stress symptoms or high blood pressure
- Those with family history of adrenal disorders
- Patients monitoring treatment for Cushing syndrome or Addison disease
- Anyone seeking proactive endocrine health screening
How It Works – Just 3 Steps
- Order online - purchase your test kit and receive collection instructions
- Collect at home - save all urine for 24 hours in provided container
- Get results - receive secure, confidential results within 4-6 days
FAQ
What does this test measure? Free cortisol levels in your urine over a 24-hour period to assess adrenal gland function.
Is the collection process difficult? No, it simply involves collecting all urine for 24 hours - no pain or discomfort involved.
When should I take this test? If you have symptoms like unexplained fatigue, weight changes, or are monitoring adrenal disorders.
Can I take medications during collection? Consult your healthcare provider about pausing certain medications like steroids before testing.
How accurate are the results? Very accurate - this test shows >95% sensitivity for detecting Cushing syndrome (Labcorp).
Do I need to fast? No fasting is required, but avoid strenuous exercise the day before collection.
More Details
What is the purpose of this test?
This test measures free cortisol excreted in your urine over 24 hours to help diagnose adrenal gland disorders. Cortisol, known as the "stress hormone," is produced by your adrenal glands and plays a vital role in metabolism, immune response, and stress adaptation. The 24-hour collection provides an integrated assessment of your cortisol production, capturing daily fluctuations that single-point tests might miss (Mayo Clinic 2020).
Who would benefit from this test?
This test is particularly valuable for individuals experiencing symptoms of abnormal cortisol production. Those with unexplained weight changes, chronic fatigue, muscle weakness, or high blood pressure should consider testing. It's also essential for patients with suspected Cushing syndrome (excess cortisol) or Addison disease (insufficient cortisol). People under chronic stress or those monitoring adrenal disorder treatments will benefit from this comprehensive assessment (Mount Sinai 2023).
When should I order this test?
Order this test if you're experiencing persistent symptoms linked to abnormal cortisol levels. Symptoms of excess cortisol include unexplained weight gain, thin arms and legs, a fuller face, easy bruising, muscle weakness, and high blood pressure. Symptoms of insufficient cortisol include chronic fatigue, muscle weakness, loss of appetite, weight loss, and abdominal pain. Healthcare providers often recommend this as a first-line screening tool for suspected adrenal disorders (Quest Diagnostics 2025).
How do I interpret the results?
Normal range
- Cortisol level: Women: <45 mcg/24h, Men: <60 mcg/24h
- What it means: Healthy adrenal function
- Typical action: Continue routine monitoring
Elevated
- Cortisol level: >60–100 mcg/24h
- What it means: Possible Cushing syndrome or chronic stress
- Typical action: Consult endocrinologist for further testing
Very high
- Cortisol level: >100 mcg/24h
- What it means: Likely Cushing syndrome or adrenal tumor
- Typical action: Immediate specialist referral required
Low
- Cortisol level: <20 mcg/24h
- What it means: Possible Addison disease or pituitary dysfunction
- Typical action: Additional testing and specialist consultation
Cushing syndrome affects approximately 40-70 people per million annually, with many cases remaining undiagnosed due to subtle early symptoms.
Disclaimer: Reference ranges may vary by laboratory. Listed ranges are general guidelines and may differ from those used by the performing lab. Always consult your healthcare provider for interpretation.
Pre-test preparation
Avoid strenuous exercise the day before urine collection as this can affect cortisol levels. Consult your healthcare provider about temporarily stopping certain medications, including glucocorticoids, estrogens, and androgens, as these can interfere with results. Keep the collection container refrigerated during the 24-hour period. No fasting is required, and you can maintain your normal diet and daily activities (ARUP Laboratories 2025).
How often should I get tested?
- Initial screening with symptoms: Once; may repeat if results are borderline
- Monitoring Cushing syndrome treatment: Every 3–6 months during treatment
- Monitoring Addison disease treatment: Every 6–12 months or as directed
- High-risk individuals with family history: Annually or when symptoms develop
- Chronic stress management: Every 6–12 months or as directed
Why early detection matters
Early detection of adrenal disorders significantly improves treatment outcomes and prevents life-threatening complications. Untreated Cushing syndrome can lead to diabetes, heart disease, and bone fractures, while untreated Addison disease can result in adrenal crisis - a medical emergency. Timely diagnosis enables appropriate treatment, reduces healthcare costs, and prevents the progression to severe complications. The 24-hour urine test provides a reliable screening method that can detect these conditions before they become critical (Medical News Today 2024).
Related tests you may consider
ACTH Test - Measures adrenocorticotropic hormone to determine if cortisol abnormalities stem from pituitary or adrenal disorders.
DHEA-S (Dehydroepiandrosterone Sulfate) Test- Provides broader insight into adrenal function and hormone balance.
Cortisol Blood Test - Provides a single time-point measurement of blood cortisol levels for comparison or acute assessment. These complementary tests help create a complete picture of your adrenal health and guide appropriate treatment decisions.
