Adrenal Insufficiency Community
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Saliva testing Cortisol

My a.m. cortisol has been low, but in range in my last few blood tests. I found that a hospital near me does saliva cortisol testing so I asked my doctor (MD) if we can test mine through saliva. He said that saliva testing was better for high cortisol, but gave me a lab slip anyway, but the lab just gives you one tube that you spit in one time between 11pm and 12 am.

Is that right?

Does he have to request several tubes and I spit in them at different times or is a 24 hour saliva cortisol test a completely different test?

I have Hashi/Hypo if that makes a difference.
9 Responses
Avatar universal
Cortisol should vary during the day and it has a normal rhythm which is called a circadian or diurnal rhythm. You reach a peak in the morning and fall throughout the day and that is a normal rhythm. If you suspect Cushing's, one tests usually serum at 8am and saliva at 11pm or 12am to see if there is a loss of the diurnal rhythm.

There are some labs or doctors that do the round the clock testing - but the standard is the late night to see if the rhythm is reversed.

High cortisol can suppress TSH. Hashimoto's is an independent auto-immune disease. I also had Cushing's and the thyroid issues.
Avatar universal
My TSH is .06 with T4, T3 combo. My doctor doesn't want to see it that low and would like to change my dose. However, even on this dose I still have some (hypo?) and recently diarrhea also.

He never mentioned Cushing's. He may have said Adrenal Insufficiency/Addison's, but in passing.

Cortisol (8:57am)     8.4           am range 7.7-22.6

Is a 24 hour saliva test that you can order on line different than what a lab in a hospital does?

Is the 24 hour saliva cortisol usually ordered by a ND for adrenal fatigue?

And that's why he didn't think it would be a good way to test my cortisol. Because at the lab in the hospital they don't do 24 hour tests?

This wasn't clear to me because the hospital said do it at what ever time your doctor says to do it, "if he wants several tubes, we'll give you several tubes", but maybe what's inside the tubes for 24 hour saliva cortisol test is different in each tube.

Sorry if I'm not being clear. I'm confused about it.
Avatar universal
I have low (not high) am cortisol.
Avatar universal
Sorry I was confused since that test is typically for high cortisol - but it can work for low as well.
After all, you are looking to see if your cortisol is off if you are high or low and you need to test several times and you need to have a stim test to finalize a diagnosis if you are low.

The adrenal fatigue test is usually not accepted by most MDs - the lab is not deemed as reputable (I have no idea) and not sure about the accredation, but they will typically not accept the results on the order yourself tests...

I personally am not a proponent of the AF idea.

It is very confusing. You have to test many times - one test does not tell you enough since cortisol varies and to test several times over a period of time is prudent.
Avatar universal
Hi rumpled,

Thanks for your reply. I'm going to find all my cortisol test results and post them here for you to look at. Is that okay?

I'll also post sodium and potassium since I've read they're relevant.

So, the 24 hour saliva test and the saliva test ordered by my MD are different. Thanks for clearing that up for me.

I don't know if I have many of the symptoms of Addison's. My symptoms are no sex drive what's so ever, tired, easily stressed, inability to handle stress. Maybe it's depression and not low cortisol? I don't know?

Thanks for your help
Avatar universal
Sodium and potassium are relevant as well. Sure I can look but I am only a layman and the docs differ from what us patients think and find.

You have symptoms and being treated will help resolve some of them. Low and high cortisol ironically have many of the same symptoms!
Avatar universal
I know you're a layman, but I think you know more than I do about it and I appreciate your help.

I can't find a symptoms list that includes my symptoms listed above except on a thyroid website that my doctor wouldn't appreciate as my source.

If you've seen those symptoms on a peer reviewed type site. Can you email me the link?

Avatar universal
There are links in the health pages and I will look and see if I find anything else quickly.
798555 tn?1292787551
Yes the 24 hr saliva test is different. 4 tubes , for four different times of the day. MD's will not look at it. NP Docs will. Or you can order one online or from a chiro, and treat yourself with supplements.

This is a 'gray' area, some will say it helped them though, when standard blood testing showed nothing.
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