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Cortisol, Saliva, 24-Hour Urine Free Cortisol (Total)

Published: August 9, 2026Updated: August 16, 2026

This test measures cortisol levels in your saliva and urine over 24 hours to check for abnormal hormone production, often linked to conditions like Cushing’s syndrome or adrenal dysfunction.

Quick summary

["Helps diagnose hormone imbalances affecting stress response and metabolism."]

Medically reviewed by WellAlly Editorial TeamLast reviewed August 16, 2026Editorial policy

Key facts at a glance

LOINC
58654-5
Short code
Cortis sp1 p chal Sal-sCnc
Synonyms
Cortis sp1 p chal Sal-sCnc
Category
hormone
Sample
serum
Container
Red-top tube (SST)
Units
N/A
Fasting
false
Population
adult
Sex
all
Age range
18–65 years
Specimen volume
5 mL
Stability
Room temperature: 4h, Refrigerated: 24h, Frozen: 7d
Hemolysis max
500
Lipemia max
1000
Icterus max
500
TAT
4–24 hours
Order
routine

Why This Test Is Done

Your doctor may order this test if they suspect conditions like Cushing’s syndrome (too much cortisol), adrenal insufficiency, or other hormonal imbalances. It helps assess how your body handles cortisol over time, which can’t be fully captured by a single blood or saliva sample.

What to Expect Before the Test

For the saliva test: Collect small saliva samples throughout the day (morning to morning) in pre-labeled containers. For the urine test: Provide a 24-hour urine collection in a special container, starting and ending at the same time each day. Follow your doctor’s instructions carefully to ensure accuracy.

How the Test Works

Saliva cortisol reflects recent stress hormone levels, while urine cortisol integrates daily production. Both methods use sensitive lab techniques to measure cortisol concentration, often via immunoassay or similar methods.

What the Results Mean

Results compare your cortisol levels to typical ranges for healthy adults. Elevated levels may indicate overproduction (e.g., from tumors or excess stress), while low levels could signal adrenal problems. Your doctor will interpret results in the context of your symptoms and other tests.

Clinical interpretation

How abnormal results are interpreted and what conditions they suggest.

Abnormal cortisol levels can signal serious conditions like Cushing’s syndrome (excess cortisol), adrenal insufficiency (too little cortisol), or other hormonal disorders. These tests help diagnose and monitor conditions affecting your body’s stress response, metabolism, and immune function.

Short name

Saliva & Urine Cortisol

Frequently asked questions

How long does the saliva collection take?
The saliva collection spans about 24 hours, with samples taken at regular intervals (e.g., every few hours) to capture daily cortisol fluctuations. The urine collection also spans 24 hours, requiring you to collect all urine in a container.
Can I take medications or supplements before the test?
Yes, your doctor will provide specific instructions, but generally, avoid high-stress activities, certain medications (e.g., steroids), or supplements that may affect cortisol levels before testing. Follow their guidance to ensure accurate results.
Will I need to fast for this test?
No fasting is required for either the saliva or urine cortisol test. However, avoid caffeine, alcohol, or strenuous activity for a few hours before collecting samples to minimize stress-related cortisol spikes.
  1. 1
    MedlinePlus — Laboratory TestsSource
  2. 2
    Lab Tests OnlineSource
  3. 3
    Mayo Clinic — Tests & ProceduresSource

Click any link to access the full source. PubMed Central (PMC) links provide free full-text access.

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.

Medical Disclaimer

This content is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you have about a medical condition, and never disregard professional medical advice or delay seeking it because of something you read here.

If you think you may have a medical emergency, call your local emergency number or go to the nearest emergency department immediately.

Medically reviewed by WellAlly Editorial Team Last reviewed August 16, 2026. · Read our editorial policy