The Adrenal Stress Profile by ZRT Laboratory is a lab test designed to assess the functioning of the adrenal glands through the analysis of saliva samples. This test specifically measures salivary levels of diurnal cortisol and morning dehydroepiandrosterone sulfate (DHEAS), two critical hormones produced by the adrenal cortex that play essential roles in the body's response to stress, metabolism, and overall physiological balance.
Cortisol is widely recognized as the body's primary stress hormone, playing a key role in the "fight or flight" response. It facilitates various bodily functions to respond to stress by increasing blood sugar levels, enhancing the brain's use of glucose, and limiting nonessential or harmful processes in a crisis, such as the immune response, digestion, and reproduction.
Cortisol's production follows a diurnal rhythm, with levels peaking in the early morning and gradually tapering off throughout the day, reaching their lowest at night. This pattern helps regulate various bodily functions, including sleep-wake cycles and energy management.
Because of its many roles in physiological functions including the stress response, metabolism, digestion, circadian rhythms and immune regulation, chronically elevated levels of cortisol may have many implications on human health. [10.]
DHEA-S is the sulfated version of dehydroepiandrosterone (DHEA), another adrenal hormone that serves as a precursor to sex hormones such as estrogen and testosterone. DHEA-S is the most abundant steroid hormone in the human body and is involved in a myriad of physiological processes including immune function, energy metabolism, stress response, and the maintenance of muscle and bone mass. DHEA-S levels typically decrease with age. [9.]
Unlike cortisol, DHEA-S levels do not fluctuate significantly throughout the day, making them a reliable marker for long-term adrenal function.
Both cortisol and DHEA-S are essential for health and well-being, with each hormone playing distinct roles in the body's response to stress and in maintaining physiological equilibrium. The balance between these hormones is critical, as imbalances can lead to a range of health issues. Ongoing research continues to uncover the complexities of these hormones and their implications for health and disease management. [1.]
Ideal candidates for the Adrenal Stress Profile by ZRT Laboratory are individuals who may be experiencing symptoms indicative of adrenal imbalance or dysfunction, often as a result of prolonged exposure to stress. This test is particularly suited for those who have been unable to find relief through general medical care or who suspect that their symptoms may be related to adrenal gland issues. Key groups of people who might benefit from this test include:
Individuals Under Continuous Stress: Those who face chronic emotional stressors such as marital, financial, or occupational challenges, as well as physical stressors like sleep deprivation, excessive caffeine intake, pain, or rigorous exercise routines. [11.]
Patients with Symptoms of Adrenal Imbalance: Symptoms can range widely and include immune dysfunction, persistent fatigue, allergies, sleep disturbances, unexplained muscle loss, and other signs of hormone imbalance. [8.]
People with Chronic Fatigue Syndrome (CFS) or Fibromyalgia: Since these conditions are often linked with hormonal imbalances and stress, the test can help in understanding the role of adrenal function in their symptomatology. [8., 11.]
Individuals with Difficulty Managing Weight: As cortisol plays a significant role in metabolism and fat storage, those struggling with weight issues without clear dietary or physical activity-related causes might find the test insightful. [5.]
Patients with Anxiety or Depression: Since adrenal hormones can impact mood and stress responses, individuals with psychological conditions such as anxiety or depression may benefit from assessing their adrenal function. [3.]
Those Experiencing Sleep Disorders: Given cortisol's influence on sleep-wake cycles, people with insomnia or disturbed sleep patterns may undergo this test to evaluate if adrenal hormones contribute to their condition. [6.]
Women with Reproductive Health Issues: Since DHEAS is a precursor to sex hormones, women facing infertility, menstrual irregularities, or menopause-related symptoms might find the test useful in uncovering underlying hormonal imbalances. [GLEICHER] Additionally, chronically elevated cortisol levels have also been associated with infertility. [7.]
Individuals Looking to Optimize Health and Well-being: Even in the absence of specific symptoms, people interested in a comprehensive approach to health and wellness might use this test to ensure their adrenal glands function optimally, especially in today's fast-paced, high-stress environments.
By identifying specific hormonal imbalances, the Adrenal Stress Profile allows healthcare providers to develop targeted treatment plans. These can include lifestyle modifications, dietary changes, supplementation, and other therapies tailored to address the unique needs of each individual, thereby offering a pathway to improved health and quality of life.
The decision between ordering a saliva test versus a blood serum test for assessing adrenal function, specifically cortisol levels, depends on several factors including the clinical context, the specific information the practitioner is seeking, and the convenience and accuracy of the test in reflecting adrenal activity. Here’s a breakdown of considerations for choosing one test over the other:
Advantages:
Diurnal Variation: Saliva testing can easily capture the diurnal variation of cortisol levels, which is essential for assessing adrenal rhythm. Saliva samples can be collected multiple times throughout the day from a patient’s home or work, reflecting the natural fluctuation of cortisol levels in their daily environment.
Convenience: Non-invasive testing done at home makes it easier for patients to collect samples at the correct times (e.g., immediately upon waking, before bedtime) to accurately assess cortisol's diurnal rhythm.
Free Cortisol Measurement: Saliva testing measures the “free” fraction of cortisol, which is biologically active and not bound to proteins, potentially offering a more accurate understanding of the hormone's actions in the body. Saliva testing is often used in research studies as an accurate measure of free or available cortisol. [2.]
Disadvantages:
Limited Scope: Saliva measures cortisol levels and may not provide additional markers that blood tests can offer, such as levels of ACTH or aldosterone.
Advantages:
Comprehensive Testing: Blood tests can include additional markers including ACTH (adrenocorticotropic hormone), aldosterone, and DHEAS, potentially providing a broader view of adrenal function.
Standardization: Serum cortisol testing procedures and reference ranges are well-established, making comparisons and interpretations widely understood among healthcare providers.
Disadvantages:
Diurnal Variation Challenge: Capturing the diurnal variation of cortisol requires multiple blood draws throughout the day, which can be inconvenient and less feasible for patients.
Bound vs. Free Cortisol: Blood tests measure total cortisol, which includes both cortisol bound to carrier proteins and the smaller fraction that is "free" or bioavailable. This may not always reflect the functional level of cortisol affecting the body's tissues and may be misleading. [2.]
Clinical Objective: If assessing cortisol's diurnal rhythm is crucial, saliva tests are preferred. For a broader hormonal assessment including ACTH and aldosterone, blood tests may be more appropriate.
Patient Convenience: For patients who may have difficulty visiting a lab multiple times a day or who are significantly stressed by blood draws, saliva testing offers a less invasive option.
Specific Conditions: Certain conditions, such as suspected Cushing's syndrome or Addison's disease, might require blood tests for a comprehensive evaluation, including ACTH levels.
Ultimately, the choice between saliva and blood serum tests for an adrenal stress profile should be tailored to the individual patient’s clinical presentation, the specific diagnostic question at hand, and the logistical considerations of test administration. In some cases, practitioners might use both types of tests to obtain the most comprehensive assessment of adrenal function.
Normal ranges for cortisol levels in saliva tests vary depending on the laboratory and the specific timing of the sample collection, reflecting the body's diurnal rhythm. Salivary cortisol levels are measured in picograms per milliliter (pg/mL) or nanomoles per liter (nmol/L). It's important to note that because cortisol levels fluctuate throughout the day, most labs will provide reference ranges for different times, such as morning (upon waking), noon, evening, and nighttime.
Here are general reference ranges for salivary cortisol at different times of the day:
Morning (upon waking): The normal range is typically between about 3.7-9.5 nmol/L (133-344 pg/mL), though this can vary slightly by lab. This reflects the peak (or near-peak) level of cortisol, as it is highest in the early morning.
Noon: By midday, cortisol levels usually drop, with normal ranges being approximately 1.2-3.0 nmol/L (43-108 pg/mL).
Evening: In the evening, cortisol levels decrease further, with normal ranges often cited as 0.6-1.9 nmol/L (22-69 pg/mL).
Nighttime: Before bedtime, the normal range can be very low, typically around 0.4-1.0 nmol/L (14-36 pg/mL), reflecting the lowest point of the diurnal cycle.
These ranges are general guidelines, and the specific normal ranges provided by the lab conducting the test should always be consulted, as methodologies and reference standards can vary. The interpretation of cortisol levels must consider the individual's health status, symptoms, and the exact timing of the sample collection relative to the individual's sleep-wake cycle and personal stressors.
It's also important for healthcare providers to consider both the absolute value of cortisol levels and the pattern of secretion throughout the day when assessing adrenal function and diagnosing conditions related to cortisol imbalances.
Collecting a saliva sample for a laboratory test is a straightforward process that requires careful preparation to ensure the accuracy of test results. This non-invasive method is particularly useful for assessing various hormone levels, such as cortisol and DHEA, offering valuable insights into an individual's hormonal balance and overall health.
Saliva sample collection is straightforward but requires careful preparation for accuracy. For three days prior to testing, avoid anti-aging creams. Avoid taking other hormone replacement therapy including DHEA-S and 7-Keto DHEA for at least 24 hours before testing. Patients taking cortisol should consult their doctor before making any changes to their cortisol dosing schedule.
Refrain from eating, drinking (except water), or brushing teeth two hours before collection.
Immediately before collecting your sample, wash your hands and dry them with a clean towel or paper towel. Collect the first sample immediately upon waking, followed by samples before lunch, dinner, and bedtime. Utilize the provided tube and label it clearly with your name, date, and time of collection.
To facilitate saliva production, you can think about food, yawn, or gently press the tip of your tongue against your teeth. Collect the saliva in the large tube provided in your kit, filling it at least half full, excluding any bubbles. This step may take between 15 to 30 minutes. After capping the tube, clearly label it with your name, the date, and the time of collection
Once all samples are collected, place them in the provided bag and then into the test kit box along with the completed requisition form. Bring this to the appropriate shipping facility.
If unable to ship within 24 hours, freeze the samples to preserve integrity. Utilize the prepaid return envelope for shipping and ensure proper packing, especially if samples are frozen, to maintain their condition during transit. Keep track of the tracking number for monitoring.
Results from the saliva test are typically available within 3-5 business days after the lab receives the samples. However, processing times may vary. Your healthcare provider will contact you to schedule a follow-up appointment to review the results together, discuss their implications, and recommend any necessary actions based on the findings. This personalized feedback is crucial for understanding your hormonal health and making informed decisions about your health management strategy.
[1.] Di Luigi, L., Guidetti, L., Baldari, C. et al. Cortisol, dehydroepiandrosterone sulphate and dehydroepiandrosterone sulphate/cortisol ratio responses to physical stress in males are influenced by pubertal development. J Endocrinol Invest 29, 796–804 (2006). https://doi.org/10.1007/BF03347373
[2.] El-Farhan N, Rees DA, Evans C. Measuring cortisol in serum, urine and saliva - are our assays good enough? Ann Clin Biochem. 2017 May;54(3):308-322. doi: 10.1177/0004563216687335. Epub 2017 Mar 16. PMID: 28068807.
[3.] Fiksdal A, Hanlin L, Kuras Y, Gianferante D, Chen X, Thoma MV, Rohleder N. Associations between symptoms of depression and anxiety and cortisol responses to and recovery from acute stress. Psychoneuroendocrinology. 2019 Apr;102:44-52. doi: 10.1016/j.psyneuen.2018.11.035. Epub 2018 Nov 24. PMID: 30513499; PMCID: PMC6420396.
[4.] Gleicher N, Barad DH. Dehydroepiandrosterone (DHEA) supplementation in diminished ovarian reserve (DOR). Reprod Biol Endocrinol. 2011 May 17;9:67. doi: 10.1186/1477-7827-9-67. PMID: 21586137; PMCID: PMC3112409.
[5.] Hewagalamulage SD, Lee TK, Clarke IJ, Henry BA. Stress, cortisol, and obesity: a role for cortisol responsiveness in identifying individuals prone to obesity. Domest Anim Endocrinol. 2016 Jul;56 Suppl:S112-20. doi: 10.1016/j.domaniend.2016.03.004. Epub 2016 Mar 31. PMID: 27345309.
[6.] Hirotsu C, Tufik S, Andersen ML. Interactions between sleep, stress, and metabolism: From physiological to pathological conditions. Sleep Sci. 2015 Nov;8(3):143-52. doi: 10.1016/j.slsci.2015.09.002. Epub 2015 Sep 28. PMID: 26779321; PMCID: PMC4688585.
[7.] Karunyam BV, Abdul Karim AK, Naina Mohamed I, Ugusman A, Mohamed WMY, Faizal AM, Abu MA, Kumar J. Infertility and cortisol: a systematic review. Front Endocrinol (Lausanne). 2023 Jun 29;14:1147306. doi: 10.3389/fendo.2023.1147306. PMID: 37455908; PMCID: PMC10344356.
[8.] Klimas NG, Broderick G, Fletcher MA. Biomarkers for chronic fatigue. Brain Behav Immun. 2012 Nov;26(8):1202-10. doi: 10.1016/j.bbi.2012.06.006. Epub 2012 Jun 23. PMID: 22732129; PMCID: PMC5373648.
[9.] Neunzig J, Bernhardt R. Dehydroepiandrosterone sulfate (DHEAS) stimulates the first step in the biosynthesis of steroid hormones. PLoS One. 2014 Feb 21;9(2):e89727. doi: 10.1371/journal.pone.0089727. PMID: 24586990; PMCID: PMC3931814.
[10.] Rohleder N. Stress and inflammation - The need to address the gap in the transition between acute and chronic stress effects. Psychoneuroendocrinology. 2019 Jul;105:164-171. doi: 10.1016/j.psyneuen.2019.02.021. Epub 2019 Feb 20. PMID: 30826163.
[11.] Tomas C, Newton J, Watson S. A review of hypothalamic-pituitary-adrenal axis function in chronic fatigue syndrome. ISRN Neurosci. 2013 Sep 30;2013:784520. doi: 10.1155/2013/784520. PMID: 24959566; PMCID: PMC4045534.
The Adrenal Stress Profile measures DHEA-S and diurnal cortisol to assess the effects of stress on adrenal hormone balance.
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