Diagnostic Testing for Adrenal Disease

A list of diagnostic tests to measure adrenal function and diagnose adrenal diseases.

8 am Cortisol Blood Lab– Your body’s natural cortisol levels should be the highest in the morning, according to your body’s circadian rhythm. If your AM levels are low, it can indicate an adrenal issue. This test will measure the level of cortisol in your blood.

ACTH Stimulation Test– Measures how well the adrenal glands respond to the release of the adrenocorticotropic hormone (ACTH). When this test is done, your blood is drawn prior to injection of ACTH then at timed intervals to test your adrenal’s response to the ACTH. If your cortisol levels do not rise properly, you are then diagnosed with adrenal insufficiency.

Aldosterone Blood Lab– Blood test which measures the amount of aldosterone (ALD) in your blood. Physicians usually test your levels of renin and aldosterone simultaneously.  (Also known as a plasma renin activity test or an aldosterone-renin ratio)

CRH Stimulation Test- Test which can help evaluate adrenal hormones by differentiating hypercortisolemia associated with Cushing’s syndrome. CRH (corticotropin-releasing hormone) is a naturally-occurring hormone which causes the pituitary gland to secrete the hormone ACTH.  

Dexamethasone Suppression Test– Test which is primarily used to diagnose Cushing’s syndrome by measuring the response of the adrenal glands to ACTH. Cortisol levels should decrease in response to the administration of dexamethasone. This test works to assess the pituitary’s response to glucocorticoid negative feedback inhibition of ACTH secretion.

DHEA Blood Lab– Test which measures the blood level of dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEA-S).

Insulin Tolerance Test (ITT)– A test where insulin is injected into a patient’s vein, after which blood glucose is measured at regular intervals used to assess adrenal function, insulin sensitivity, and pituitary function. This test is considered the standard for diagnosing growth hormone (GH) deficiency and cortisol production in pituitary assessment.

Metyrapone Test– Diagnostic test which is based upon the idea that decreasing serum cortisol concentrations normally produces an increase in ACTH secretion due to a decrease in glucocorticoid negative feedback. The test is performed primarily to detect partial defects in pituitary ACTH secretion. This test is performed when Metyrapone is introduced into the body causing the block of the conversion of 11-deoxycortisol to cortisol by CYP11B1 (11-beta-hydroxylase, P450c11) the final step in the synthesis of cortisol. This causes a decrease of cortisol and increases 11-deoxycortisol. This test is used to evaluate the hypothalamic-pituitary-adrenal axis.

Renin Blood Lab– Test which measures the level of renin in blood. A high level of renin may be indicative that the adrenal glands are not making sufficient hormones. Physicians usually test your levels of renin and aldosterone simultaneously.  (Also known as a plasma renin activity test or an aldosterone-renin ratio)

Saliva Cortisol Test– Test which measures plasma free cortisol concentration in human saliva.

Urine Cortisol Test– Also called a urinary free cortisol (UFC) test. This test measures the total amount of cortisol excreted into urine over 24 hours.

More information on managing adrenal disease can be found on our website and also in the book A patient’s guide to managing adrenal insufficiency.