You know whether your patient has high cortisol, normal cortisol, or low cortisol—so what?

Cortisol and DHEA can be high, low or within range and be perfectly appropriate depending on the patient’s physiologic condition. How do these markers change your medical decision-making?

Of course, every lab test must be interpreted only in correlation with the patient’s signs and symptoms, health history, and exam findings. For example, if a patient has a low B12 measurement, is it low because the patient does not intake sufficient B12, or because they cannot absorb sufficient B12? Perhaps they are fighting an illness and have a higher need for B12? Even if the therapy decision includes injectable B12, is there more testing or therapy that should be considered?

In the case of a four-point salivary cortisol test, even before the test is administered, the most important concept to understand is seemingly contradictory: We are not looking at adrenal function in this test. Rather, we are evaluating and observing the patient’s stress response as a system. That system consists of the hypothalamus, pituitary gland, and adrenal gland as a functional unit. It also consists of numerous neurotransmitters that act as messengers to accentuate or attenuate the signals between each. Additionally, the salivary cortisol test must be understood as a method of identifying stress inducers to determine how the hormones measured are 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? Both sides of the equation must be considered when interpreting any test properly, including the salivary hormone profile.

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