Download Practice -8,9

COLLEGE OF HEALTH SCIENCES – HAIL
Medical laboratory Dept.- Second term
THIRD YEAR – Hormones& Endocrinology
lab 8,9
Cortisol level
A cortisol level is a blood test that measures the amount of cortisol, a steroid hormone
produced by the adrenal cortex.
How the Test is Performed
Blood is typically drawn from a vein, usually from the inside of the elbow or the back of
the hand. The site is cleaned with germ-killing medicine (antiseptic). The health care
provider wraps an elastic band around the upper arm to apply pressure to the area and
make the vein swell with blood.
Next, the health care provider gently inserts a needle into the vein. The blood collects
into an airtight vial or tube attached to the needle. The elastic band is removed from
your arm. Once the blood has been collected, the needle is removed, and the puncture
site is covered to stop any bleeding.
In infants or young children, a sharp tool called a lancet may be used to puncture the
skin and make it bleed. The blood collects into a small glass tube called a pipette, or
onto a slide or test strip. A bandage may be placed over the area if there is any
bleeding.
How to Prepare for the Test
The health care provider may ask you to stop taking drugs that can affect the test.
Drugs that can increase cortisol measurements include:
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Estrogen
Human-made (synthetic) glucocorticoids, such as prednisone and prednisolone
Drugs that can decrease cortisol measurements include:
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Androgens
Phenytoin
How the Test Will Feel
Prepared By Dr. Abdelrahman Elresheid1
When the needle is inserted to draw blood, some people feel moderate pain, while
others feel only a prick or stinging sensation. Afterward, there may be some throbbing.
Why the Test is Performed
The test is done to check for increased or decreased cortisol production. Cortisol is a
steroid hormone released from the adrenal gland in response to ACTH, a hormone from
the pituitary gland in the brain.
Cortisol affects many different body systems. It plays a role in:
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Bone
Circulatory system
Immune system
Metabolism of fats, carbohydrates, and protein
Nervous system
Stress responses
Different diseases, such as Cushing's disease and Addison's disease, can lead to either
too much or too little production of cortisol. Cortisol levels are often measured to help
diagnose these conditions and to evaluate how well the pituitary and adrenal glands are
working.
Normal Results
Normal values for a blood sample taken at 8 in the morning are 6 - 23 micrograms per
deciliter (mcg/dL).
Normal value ranges may vary slightly among different laboratories. Talk to your doctor
about the meaning of your specific test results.
What Abnormal Results Mean
Higher than normal levels may indicate:
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Adrenal tumor
Cushing's syndrome
Ectopic ACTH-producing tumors
Lower than normal levels may indicate:
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Addison's disease
Hypopituitarism
Other conditions under which the test may be performed:
Prepared By Dr. Abdelrahman Elresheid2
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Acute adrenal crisis
Ectopic Cushing's syndrome
Pituitary Cushing's (Cushing's disease)
Risks
Veins and arteries vary in size from one patient to another and from one side of the
body to the other. Obtaining a blood sample from some people may be more difficult
than from others.
Other risks associated with having blood drawn are slight but may include:
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Excessive bleeding
Fainting or feeling light-headed
Hematoma (blood accumulating under the skin)
Infection (a slight risk any time the skin is broken)
Considerations
Normally, cortisol levels rise and fall during the day, repeating on a 24-hour cycle
(diurnal variation). Highest levels are at about 6 - 8 a.m. and lowest levels are at about
midnight.
Physical and emotional stress can increase cortisol levels, because during the normal
stress response, the pituitary gland increases its release of ACTH.
Higher than normal cortisol levels are expected in women who take estrogen or birth
control pills.
Alternative Names
Serum cortisol
Prepared By Dr. Abdelrahman Elresheid3
lab 5
Cortisol - urine
A cortisol urine test measures the amount of the steroid hormone cortisol in the urine.
How the Test is Performed
A 24-hour urine sample is needed. The health care provider will instruct you, if
necessary, to stop taking drugs that may affect the test.
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On day 1, urinate into the toilet when you get up in the morning. Afterwards,
collect all urine in a special container for the next 24 hours. Keep the container in
a cool place during the test period.
On day 2, urinate into the container when you get up in the morning.
Cap the container. Label the container with your name, the date, the time of
completion, and return it as instructed. Keep it in the refrigerator or a cool place
until you return it to the laboratory.
FOR INFANTS
Thoroughly wash the area around the urethra. Open a urine collection bag (a plastic
bag with adhesive paper on one end), and place it on the infant. For boys, the entire
penis can be placed in the bag and the adhesive attached to the skin. For girls, the bag
is placed over the labia. Diaper as usual over the secured bag.
This procedure may take a couple of attempts -- lively infants can displace the bag.
Check the infant frequently and change the bag after the infant has urinated into the
bag. Drain the urine into the container for transport to the laboratory.
Deliver the urine to the laboratory or your health care provider as soon as possible.
How to Prepare for the Test
No special preparation is necessary for this test. If you are taking the collection from an
infant, you may need a couple of extra collection bags.
How the Test Will Feel
The test involves only normal urination, and there is no discomfort.
Prepared By Dr. Abdelrahman Elresheid4
Why the Test is Performed
Cortisol is a steroid hormone released from the adrenal gland in response to ACTH, a
hormone from the anterior pituitary gland in the brain. Cortisol levels rise and fall during
the day. Highest levels occur at about 6 a.m. to 8 a.m. and lowest levels at about
midnight.
Cortisol affects many different body systems. It plays a role in:






Bone
Circulatory system
Immune system
Metabolism of fats, carbohydrates, and protein
Nervous system
Stress responses
The test is done to determine if you have increased or decreased cortisol production.
Different diseases, such as Cushing's disease and Addison's disease, can lead to either
too much or too little production of cortisol. Urine cortisol levels can help to diagnose
these conditions.
Normal Results
Normal range: 10 - 100 micrograms per 24 hours (mcg/24h)
Normal value ranges may vary slightly among different laboratories. Normal results may
sometimes be present in someone with mild Cushing syndrome. Talk to your doctor
about the meaning of your specific test results.
What Abnormal Results Mean
Increased levels of urine cortisol may indicate:
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Cushing syndrome -- pituitary-independent
Cushing's disease -- pituitary-dependent
Pseudo-Cushing's
Severe depression
Tumor that releases ACTH
Decreased levels of urine cortisol may indicate:
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Addison's disease
Hypopituitarism
Congenital adrenal hyperplasia
The test may also be done in cases of exogenous Cushing syndrome.
Prepared By Dr. Abdelrahman Elresheid5
Considerations
Factors that interfere with this test are:
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Medications, including glucocorticoids, lithium, diuretics, ketoconazole, estrogens
and tricyclic antidepressants
Severe emotional or physical stress
Note: Due to these interfering factors, the urine cortisol is often tested on three or more
separate occasions to get a more accurate picture of average cortisol production.
Alternative Names
24-hour urinary free cortisol (UFC)
Prepared By Dr. Abdelrahman Elresheid6