Best cortisol tests?

I'm about to get a cortisol test done and my doctor wants to do a urine test, yet an endocrinologist recommended a cortrosyn stimulation test and another doctor doctor recommended a 24 hour swab test.
Seeing as how I've had these symptoms for 5 years, does it change which one I should take? Or should I be safe and get them all?

[darla12345]

Get the saliva test, it will show your cortisol levels at 4 diff times of the day.  Cortisol should be highest in morning and slowly declines all day.  A blood test won't show if your cortisol is normal for the whole day.  Some people in early stages of adrenal fatigue have un-normal fluctuations, especially high cortisol at night, which causes insomnia, and a moderate fatigue.   I am in late stage adrenal exhaustion with extreme fatigue and my cortisol is below normal levels all day.

[darla12345]

Get the saliva test, it will show your cortisol levels at 4 diff times of the day.  Cortisol should be highest in morning and slowly declines all day.  A blood test won't show if your cortisol is normal for the whole day.  Some people in early stages of adrenal fatigue have un-normal fluctuations, especially high cortisol at night, which causes insomnia, and a moderate fatigue.   I am in late stage adrenal exhaustion with extreme fatigue and my cortisol is below normal levels all day.

[siuol11]

Cool, thank you!

[rumpled]

The stim test is the gold standard to diagnose adrenal insufficiency - however that is usually done after a battery of baseline testing which can and should be a number of urine, blood and saliva tests as well as ACTH, antibody and depending on your symptoms, renin/aldosterone and electrolytes.

High cortisol at night is a loss of diurnal rhythm - and is a sign of Cushing's disease, not low cortisol.

[siuol11]

Thanks for the additional info. I've actually had a lot of baseline tests run (T3, T4, etc) and they all came back normal. I have low normal testosterone but everything else seems to be good- except for my symptoms.

[siuol11]

Additionaly, does anyone have info on the cortrosyn stimulation test?

[rumpled]

Those are thyroid tests - so that is baseline thyroid. You need more adrenal testing which is another ball of wax so to speak. Plenty of people just have just thyroid or just adrenal issues - they can happen together but it is not a given.

The stim test should be given in the morning, fasting - they take a baseline draw so they have a number where you started. Some offices may take one or two. They usually put in an IV so there is only one stick. Then at a certain interval, they give you the stim agent, then at a certain time later, they take another draw - and depending on the office again, they may do a several timed tests or just one. Usually people only feel flushed with the test but make sure you have someone with you just in case you get sick - not common but it can happen. They can also give you another stim agent as well to try to determine source - as it can be adrenal or pituitary in source.