Understanding Salivary Four-Point Cortisol Test Results

results of laboratory hormone test from blood spots and saliva samples

By Monica Zatarski, PharmD, RPh

Cortisol is a hormone secreted by the adrenal glands during the normal course of the day, but also in response to stress.  Just like you were meant to rise in the morning and sleep at night, cortisol too follows a daily rhythm and closely follows your energy levels [when optimal].  Cortisol helps us wake up in the morning, hence it should be at it’s highest point right before waking in the morning.  It then follows a dramatic fall between morning and noon and continues a gradual taper through nightfall.  Cortisol should be at its lowest point right before we go to bed so that our minds are calm, our bodies or at peace and we can easily fall into a restorative sleep.

Knowing cortisol shouldn’t be the same consistent level throughout the day, helps one to understand the usefulness of getting multiple levels throughout the day.  A four-point cortisol test obtains a sample first thing in the morning; within the first 30 minutes of waking, then another at noon, 4pm and before bed.

You may have heard cortisol being referred to as the “adrenal stress hormone” and therefore you may think testing cortisol is a great way of assessing adrenal function.  However, our miraculous bodies are not that simple.  No one system can be compartmentalized.  The stress response in its entirely must be evaluated and observed; including the hypothalamus, pituitary gland, and the adrenal gland as a functional unit.  You may have heard this being referred to as the HPA axis (H = Hypothalamus, P = Pituitary, A = Adrenal).  In addition, numerous neurotransmitters act as messengers to accentuate or attenuate the signals between the hypothalamus, pituitary and adrenal.  Therefore, the salivary cortisol test must be understood as a method of identifying stress inducers to determine how the hormones measured are being produced, as well as the metabolism of the body and how this reduces the measured levels of hormones.  In other words, what causes the hormones to rise, and what causes them to fall?

As cortisol patterns are looked at, the real detective work begins to identify the stress inducer and figure out how to modulate it.  In addition, testing cortisol patterns also us to see how that stress is changing function in you, the patient and we can begin to work together to help you adapt.

Such as the stress response is not compartmentalized into one system, so goes it for the endocrine system as a whole.  Therefore, it is recommended when looking at a four-point cortisol test you also include the sex steroid hormone (estradiol, progesterone, testosterone, DHEAS) and melatonin.  There is tremendous utility in the salivary hormone panel to manage stress of all degrees; fatigue, depression, pain, menopause, insomnia, decreased libido, and thyroid.  For each of these, a salivary hormone test, properly interpreted, can be the difference between an average outcome and an outstanding one.