Adrenal testing helps healthcare professionals evaluate the function of the adrenal glands, which play an essential role in regulating the body's response to stress, blood pressure, and metabolism. Adrenal testing can be done using different methods, including blood, urine, and saliva tests. Each of these methods has its advantages and disadvantages.
Methods of Evaluating for Adrenal Dysfunction
Blood tests are the most common method of adrenal testing in conventional medicine. They measure the levels of various hormones produced by the adrenal glands, such as cortisol and aldosterone. Cortisol is a hormone that is responsible for regulating the body's stress response, while aldosterone helps regulate blood pressure. Blood tests are usually done in the morning, as cortisol levels are highest in the morning.
While blood tests are widely available and easy to perform, they only measure hormone levels at a single point in time, which means that they do not provide a complete picture of adrenal function, which has a circadian rhythm.
Urine tests, on the other hand, measure the amount of cortisol that is excreted in the urine over a 24-hour period. This test is called a 24-hour urine cortisol test. Urine tests provide a more complete picture of adrenal function than blood tests, as they measure cortisol levels over an extended period.
However, urine tests may be less accurate than blood tests and can be affected by various factors such as fluid intake, medications, and medical conditions, leading to inaccurate results. And while they can measure the total 24-hour cortisol. They don’t give us a picture of the circadian pattern over the 24 hours.
Saliva tests measure the levels of cortisol in the saliva at different times of the day. Saliva tests are typically done four times a day, in the morning, afternoon, evening, and night. Sometimes a 5th specimen is collected in the case of insomnia with middle-of-the-night awakenings.
Saliva tests provide a more complete picture of adrenal function than blood tests, as they measure cortisol levels at different times of the day. Saliva tests can also be done at home, making them more convenient than other methods. However, like urine tests, saliva tests may be less accurate than blood tests and can be affected by factors such as stress, oral hygiene, and medical conditions.
DUTCH (Dried Urine Test for Comprehensive Hormones) testing is a more advanced form of urine testing that provides a more comprehensive assessment of adrenal function. It tests levels in urine at 4-5 points throughout the day. In addition to measuring cortisol, DUTCH testing also measures other hormones such as testosterone, progesterone, and estrogen. It also provides information about the metabolites of these hormones, which can provide insights into how well the body is metabolizing them.
DUTCH testing can also provide information about how the body is responding to stress, which can be crucial in evaluating adrenal function. Like saliva, we see the pattern of cortisol at different points throughout the day. DUTCH also measures some organic acids.
Electrolytes like sodium, potassium, and chloride can also be used to evaluate adrenal function. Electrolytes are minerals that are essential for the proper functioning of the body, and imbalances in electrolyte levels can be a sign of adrenal dysfunction. For example, low sodium levels can be a sign of adrenal insufficiency, while high potassium levels can indicate adrenal excess. Therefore, the evaluation of electrolyte levels can provide valuable information about adrenal function.
Comparison of Methods of Adrenal Testing for Dysfunction
Blood tests
Pros of Blood Tests
- Blood tests are widely available and easy to perform.
- They are generally covered by insurance.
- They can provide accurate results for cortisol and aldosterone levels.
Cons of Blood Tests
- Blood tests do not provide a complete picture of adrenal function as they only measure the hormone levels at a single point in time.
- They require a trip to a lab or doctor’s office to perform
- They can be affected by factors such as stress, medications, and other medical conditions, which can lead to inaccurate results.
Urine tests
Pros of Urine Tests
- Urine tests measure the amount of cortisol that is excreted in the urine over a 24-hour period.
- Urine tests are non-invasive and easy to perform.
- They provide a more complete picture of adrenal function as they measure cortisol levels over a 24-hour period.
Cons of Urine Tests
- They can be affected by factors such as fluid intake, medications, and other medical conditions, which can lead to inaccurate results.
- Urine tests can be less accurate than blood tests.
- They require a 24-hour collection of urine, which can be very inconvenient
Saliva tests
Pros of Saliva Tests
- Saliva tests are non-invasive and easy to perform.
- They provide a more complete picture of adrenal function as they measure cortisol levels at different times of the day.
- Saliva tests can be done at home, making them more convenient than other methods.
Cons of Saliva Tests
- Saliva tests may be less accurate than blood tests.
- They can be affected by factors such as stress, oral hygiene, and other medical conditions, which can lead to inaccurate results.
- Saliva must be collected at set times throughout the day, which makes it easy to get busy and skip.
The DUTCH (Dried Urine Test for Comprehensive Hormones)
Pros of DUTCH Test
- Comprehensive, and tests for estrogen, progesterone, testosterone, and their metabolites as well as cortisol and cortisone
- Provides a detailed picture of hormone levels and their metabolites at set times over a 24-hour period.
- Includes organic acids that suggest functional levels of vitamins B6 and B12, glutathione, Biotin, dopamine and melatonin. It also shows levels of indican, a measure of dysbiosis, and an oxidative stress marker, 8-hydroxy-2′ -deoxyguanosine (8-OHdG)
- Non-invasive and can be done from the comfort of your own home.
- Provides detailed information about hormone levels and metabolites, which can help healthcare providers develop personalized treatment plans based on individual needs.
Cons of DUTCH Test
- Can be more expensive than other hormone testing options, which may make it less accessible for some individuals.
- The DUTCH test requires urine collection at specific times over a 24-hour period, which can be inconvenient for some individuals.
- Some medications, such as diuretics and hormone replacements, may interfere with the accuracy of the DUTCH test results.
There is no perfect method of testing for adrenal dysfunction. Each method, blood, urine, and saliva tests has its pros and cons, and the choice of which test to use depends on the individual's specific needs.
Cortisol Awakening Response
Another method of assessing adrenal function is a test called the cortisol awakening response (CAR). The CAR is a natural surge in cortisol levels that occurs within 30 minutes of waking up in the morning. This surge is thought to be an adaptive response to help the body prepare for the demands of the day.
CAR is a useful tool for evaluating the body's response to stress and can provide insights into a variety of health conditions.
The cortisol awakening response is a sharp increase in cortisol levels that occurs within the first 30 minutes after waking up in the morning. This surge is thought to be a response to the body's preparation for the demands of the day. It has been shown to be independent of the time of day, sleep quality, or duration of sleep.
Saliva testing is the most commonly used method for measuring CAR, because it is non-invasive and can be done easily at home. To measure CAR using saliva testing, samples are typically collected immediately after waking up, and then 30 and 60 minutes later.
CAR can be a useful tool for evaluating a variety of health conditions. One important application of CAR is in the evaluation of stress-related disorders. Stress-related disorders such as depression, anxiety, and post-traumatic stress disorder (PTSD) have been shown to be associated with dysregulation of the HPA (hypothalamic-pituitary-adrenal) axis, which is responsible for the production and regulation of cortisol.
Measuring CAR can provide insights into the functioning of the HPA axis and can help healthcare professionals evaluate the severity of these disorders.
Another important application of CAR is in the evaluation of chronic fatigue syndrome (CFS) and fibromyalgia. Both of these conditions are associated with dysregulation of the HPA axis and have been shown to be associated with abnormalities in CAR. Measuring CAR can provide insights into the severity of these conditions and can help healthcare professionals develop treatment plans.
In addition to evaluating stress-related disorders and chronic fatigue syndrome, CAR can also be used to evaluate other health conditions such as obesity, diabetes, and cardiovascular disease. Studies have shown that dysregulation of the HPA axis, as indicated by abnormalities in CAR, is associated with an increased risk of these conditions.
In conclusion, adrenal testing is a critical process that helps healthcare professionals evaluate the function of the adrenal glands, which play a vital role in regulating the body's response to stress, blood pressure, and metabolism. Different methods can be used for adrenal testing, including blood, urine, and saliva tests, each with its advantages and disadvantages.
DUTCH testing and the measurement of electrolytes can provide more comprehensive information about the adrenal function and should be considered in the evaluation of adrenal health.
For a deeper dive into testing for adrenal dysfunction, listen to the episodes in our Reinvent Healthcare podcast Adrenal theme.
The Nutritional Endocrinology Practitioner Training contains several videos on adrenal health including how they work, what can go wrong, and assessment and management of dysfunction.
Find out more about Nutritional Endocrinology Practitioner resources HERE.

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