The cortisol urine test measures the level of cortisol in the urine. Cortisol is a steroid (glucocorticoid) hormone produced by the adrenal gland.
Cortisol can also be measured using a blood or saliva test.
How the Test is Performed
A 24-hour urine sample is needed. You will need to collect your urine over 24 hours in a container provided by the laboratory. Your health care provider will tell you how to do this. Follow instructions exactly so that the results are accurate.
Because cortisol level rises and falls throughout the day, the test may need to be done three or more separate times to get a more accurate picture of average cortisol production.
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 (synthetic) glucocorticoids, such as hydrocortisone, prednisone and prednisolone
How the Test will Feel
The test involves only normal urination. There is no discomfort.
Why the Test is Performed
The test is done to check for increased or decreased cortisol production. Cortisol is a glucocorticoid (steroid) hormone released from the adrenal gland in response to adrenocorticotropic hormone (ACTH). This is a hormone released from the pituitary gland in the brain. Cortisol affects many different body systems. It plays a role in:
- Bone growth
- Blood pressure control
- Immune system function
- Metabolism of fats, carbohydrates, and protein
- Nervous system function
- Stress response
Normal range is 4 to 40 mcg per 24 hours.
Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or may test different specimens. Talk to your doctor about the meaning of your specific test results.
What Abnormal Results Mean
A higher than normal level may indicate:
- Cushing disease, in which the pituitary gland makes too much ACTH because of excess growth of the pituitary gland or a tumor in the pituitary gland
- Ectopic Cushing syndrome, in which a tumor outside the pituitary or adrenal glands makes too much ACTH
- Severe depression
- Tumor of the adrenal gland that is producing too much cortisol
A lower than normal level may indicate:
- Addison disease in which the adrenal glands do not produce enough cortisol
- Hypopituitarism in which the pituitary gland does not signal the adrenal gland to produce enough cortisol
- Suppression of normal pituitary or adrenal function by glucocorticoid medicines including pills, skin creams, eyedrops, inhalers, joint injections, chemotherapy
There are no risks with this test.
24-hour urinary free cortisol (UFC)
Chernecky CC, Berger BJ. Cortisol - urine. In: Chernecky CC, Berger BJ. Laboratory Tests and Diagnostic Procedures. 6th ed. Philadelphia, PA: Elsevier Saunders; 2013:389-390.
Stewart PM, Newell-Price JDC. The adrenal cortex. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 15.
Update Date 10/28/2015
Updated by: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.