The body has two adrenal glands, one located above each kidney. Hormones secreted by these endocrine glands help to regulate many body processes. Measuring blood and urine levels of adrenal hormones, including the following, is often the first step in diagnosing a variety of disorders associated with adrenal gland dysfunction.
Aldosterone controls salt, potassium, and water balance in the body and helps to regulate blood pressure. Overproduction (hyperaldosteronism) or underproduction (hypoaldosteronism) of this hormone may be caused by tumors or other abnormalities within the adrenal glands (primary; e.g., adrenal cancer) or may result from problems outside the adrenals (secondary). Both blood levels and urinary excretion of aldosterone may be measured.
Cortisol is a glucocorticoid hormone that helps to control the metabolism of carbohydrates, proteins, and fats; mediate the body’s response to stress; and regulate the immune system. Oversecretion of cortisol, most often caused by a benign adrenal tumor, results in Cushing’s syndrome. Undersecretion may indicate a form of adrenal insufficiency known as Addison’s disease. Both blood levels and urine levels (known as free cortisol) are usually measured.
18-Hydroxycortisol, a product of cortisol metabolism, is an unusual steroid produced in excessive amounts in patients with primary hyperaldosteronism. Measuring blood levels of this hormone can help to determine whether primary hyperaldosteronism is caused by a tumor called adrenal adenoma, or by overgrowth (hyperplasia) of adrenal tissue; levels are significantly higher in people with an adenoma.
DHEA-S, or dehydroepiandrosterone-sulfate—a sex hormone (androgen) synthesized by the adrenal gland—is a precursor to testosterone. In women, the adrenal glands are the major, and sometimes only, source of androgens. Elevated DHEA-S levels are associated with virilism (male body characteristics), hirsutism (excessive hair growth), amenorrhea (absence of menstruation), and infertility. Adrenal abnormalities such as tumors may lead to abnormally high DHEA-S levels.
Purpose of the Adrenal Hormone Tests
- To evaluate patients with suspected dysfunction of the adrenal glands
- To aid in the diagnosis and evaluation of adrenal abnormalities, such as Cushing’s syndrome, Addison’s disease, adrenal adenoma, or adrenal hyperplasia
- DHEA-S may be measured to determine the cause of hirsutism, amenorrhea, or infertility in women and to evaluate precocious puberty in children
Who Performs Adrenal Hormone Tests
- A doctor, a nurse, or a technician
Special Concerns about Adrenal Hormone Tests
- A nuclear scan performed within the last week may affect the results of adrenal hormone tests, because these hormones are often measured with a laboratory technique that utilizes a radioactive isotope (radioimmunoassay).
- Certain medications and nutritional supplements may alter the results.
- Cortisol and aldosterone levels vary at different times during the day and are also affected by diet, physical activity, and stress.
- Pregnancy can alter the levels of aldosterone, cortisol, and DHEA-S.
- Posture and excessive licorice ingestion can affect aldosterone levels.
- Home kits are now available to monitor cortisol levels through periodic saliva samples (which you send to a laboratory for analysis). They may be useful to selected individuals. Ask your doctor for a recommendation.
Before the Adrenal Hormone Tests
- You may be asked to fast, observe certain dietary restrictions, limit your physical activity, and reduce stress levels for variable periods before these tests.
- Report to your doctor any medications, herbs, or supplements you are taking. You may be advised to discontinue certain of these agents before the test.
- Tell your doctor if you’ve had a recent nuclear scanning procedure.
What You Experience
- A sample of your blood is drawn from a vein, usually from the inside of the elbow or the back of the hand, and sent to a laboratory for analysis.
- To accurately assess urinary excretion of aldosterone, cortisol, and 18-hydroxycortisol, timed urine specimens are collected in a special container over a 24-hour period.
- Once urine collection is complete, label the container with your name, date, and time of completion and return it as instructed by your doctor.
Risks and Complications of Adrenal Hormone Tests
After the Adrenal Hormone Tests
- Immediately after blood is drawn, pressure is applied (with cotton or gauze) to the puncture site.
- Resume your normal diet and any medications that were withheld before the test, according to your doctor’s instructions.
- Blood may collect and clot under the skin (hematoma) at the puncture site; this is harmless and will resolve on its own. For a large hematoma that causes swelling and discomfort, apply ice initially; after 24 hours, use warm, moist compresses to help dissolve the clotted blood.
Adrenal Hormone Test Results
- Your blood and/or urine samples are sent to a laboratory for analysis. The doctor will review the results for evidence of any adrenal hormone disorder.
- In many cases, abnormal results on one or more of the adrenal hormone tests will necessitate additional tests to establish a definitive diagnosis.
- If an abnormality is found and the doctor can make a definitive diagnosis, appropriate treatment will begin.
The Johns Hopkins Consumer Guide to Medical Tests
Simeon Margolis, M.D., Ph.D., Medical Editor
Updated by Remedy Health Media