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Thyroid UK
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Which Genova adrenal test to do?

I'm not sure which test to choose;there are 3.cortisol awakening response(just cortisol),adrenal stress profile(cortisol/DHEA),and conprehensive adrenal stress profile(cortisol/DHEA/SlgA).i am tginking the second one(as third one is mire expensive).

13 Replies

Hi My Endo says that none of them are any use. She is fine about private Labs as I use blue Horizon. However, she says that the only reliable test for Adrenals is a 24 hour urine collection, a cortisone tablet ( script) at midnight and a blood test at 9 am.This of course, would mean having it done through a doctor, unless Blue Horizon can do it through Spire, I do not know but I do know Spire charge a lot and I do not use them.

Sorry not more help.

Best wishes,



Bit confused there Jackie - what do you mean 'she is fine about private Labs' - isn't Genova Diagnostics a private lab?


Hi sorry only just found your reply. If you click on "reply to this" under the post we are notified. She is happy about private tests in general but not the ones some Labs do for Adrenals as considers them unreliable.



No problem. I did click on "reply to this" under the post which is why it is indented. I have noticed that the notifications come into my mail box days after, they are never immediate - perhaps this is what is happening.

Regards the adrenal saliva test, I have read that this test (i.e. saliva) is far better than the urine test - so I am very confused about it all.


Hi You are right, just appeared! The urine test on its own is no good either. It must be the test as I have prescribed it.with the cortisone at midnight and a blood test at 9am. She has specifically said to me and others that the other tests for adrenals are not suitable.urine test on its own would not be suitable either.

Best wishes,



I did the genova saliva test - i found it useful. However, so not expect the nhs to take notice of your results.

More recently i had a long synacthen test on the nhs - it was gruelling and an utter waste of time: despite a previous very low morning cortisol, this 24 hour test was - according to the NHS - within normal range...........................only, the print out shows "no normal ranges established for this test".

What a cop out.


Hi what does the long synacthen test involve? My short synacthen showed morning cortisol 217, then 317 after. I'm feeling rough and would like more tests. Any suggestions? F x


It is very gruelling if you already feel below par. It involves getting to the hospital for 8.30am on day 1 so that your blood is drawn by 9.30. About an hour later you get synacthen injected IM, then your blood is taken at intervals throughout the day till about 5pm. You sit there all day and UK NHS hospitals don't cater for coeliacs (but they dont tell you this in advance!) so you need to take your own meals.

Day 2 you need to be back for 8 ish to have your blood drawn again by 9.30am

As i said, total waste of time - due to there being no reference ranges, you will always be told your results are normal.


My current endo has been known to make negative noises about saliva based adrenal testing too Jackie - on the basis that it can be hard to differentiate between (given the sort of elevation of cortisol often picked up, and the lack of clear diagnostic criteria) short term circumstantial causes and disease processes.

I'm no expert, and this is only one ad-hoc perspective - but i'm inclined to feel that in this (as is often the case) the conservative medical view by focusing on illness misses the reality.

That this is likely another case (much like happens when the stock blood tests for hypothyroidism return supposedly 'normal' results time after time in obviously ill people) where by setting the reference values far too wide medicine misses a very common cause of suffering and chronic illness.

From my own experience:

1. Medicine and endos seem mostly to diagnose disease when cortisol and other adrenal hormone levels are greatly and consistently raised, or are in the basement. e.g. stuff like Cushings or Addisons diseases. They seem (?) to ignore more or less anything else.

I've ended up in hospital several times with dangerously high blood pressure - which its (belatedly) become pretty clear was caused by hypothyroidism and especially by high cortisol. To the point on one occasion where they spent several weeks looking for a pheochromocytoma (a hormone releasing adrenal tumour). Despite an initial 24 hr urinary catecholamine test suggesting an issue in this regard (they as a precaution put me on a nasty suppressive drug), they backed off when my levels had dropped below threshold by a third test - and decided there was no need for any form of treatment beyond blood pressure medication.

Which in retrospect missed what was going on, and what was causing my blood pressure. As did the four or so other consultant physicians who from the mid 1990s onwards worked me up during hospital stays in attempts to find the cause too....

2. Saliva based stress profiling (e.g. the Genova adrenal stress profile) looks at cortisol and DHEA levels at four points during the day, and seems to be set up to detect much lower (but still abnormally high) levels of hormone - the sort of thing that results from e.g. physically and/or mentally stressful situations, glucose intolerance or panic and anxiety situations - as well as illness.

It (and other similar tests) may highlight raised levels of cortisol that an endo might not regard as 'disease' per se - on the basis that it's within a range that's possible as a response to life situations.

One positive result may not in isolation mean that much, but if there's reason to think when looking at the situation holistically that it's your 'normal' (i.e. you were not abnormally stressed when tested) then it may be highly significant. i.e. it does require some interpretation/repeat tests may be required to reach certainty/it's not the magic bullet one shot definitive diagnosis of a specific illness beloved of conservative/bureaucratic medicine - but it's far from useless.

It also by looking at levels at different times of the day provides the time based information needed to treat high cortisol using adaptogens. (the Seriphos and the like that i've described using in other threads)

I tested as having raised cortisol levels on the Genova adrenal stress test, and have recently obtained great health benefits from treating it. I've no doubt that at least in my own case that chronically high cortisol levels have been a long standing health problem. It seems likely that I have a learned/programmed tendency to chronic stress - possibly with its origins in a stressful childhood, and it likely cost me my thyroid and lots more.

Despite what seems to be the conservative endo view, these more moderate and often brain programmed chronically raised levels of cortisol seem to have have major longer term implications for health and well being. Not just for metabolic health, but also the many other chronic illnesses characteristic of modern life involving hypothyroidism, autoimmune disturbances, gut problems, nutritional deficiencies etc

Most holistic/naturopathic doctors will for example finger chronically raised cortisol of this sort as commonly being the basis of chronic fatigue and the associated thyroid illness. There's lots of books out there on the topic of cortisol and chronic stress, how they feed into chronic fatigue and other illnesses, and how they are treated. e.g amazon.com/Chronic-Fatigue-... (see the list of related books by other authors on this page too)

Personal experience suggests that this line of thought (and treatment) can deliver results...


PS it seems that chronically raised cortisol caused by chronic stress eventually (with the onset of adrenal exhaustion) progresses on into low or intermittently low levels. The 24 hr total cathecholamines test can't detect intermittent variations...

While high cortisol and the associated reduced effect of thyroid hormone produces fatigue, many don't really address the problem until this point is reached. When the resulting fatigue and likely secondary illnesses (auto immune stuff and the like) have become such that they can't be ignored.

Recovery (or partial recovery) seemingly retraces this trajectory, with the result that any underlying mental programming towards chronic stress (or an overly optimistic return to a habitually stressful life situation) could result in a return to raised cortisol. Or in a bouncing between high and low adrenal output when the recently recovered adrenals become exhausted again go off line again. (this can it seems even happen at intervals during the day)

i.e. it's seemingly important to address the lifestyle/post traumatic/conditioned causes of chronic stress as well as adrenal recovery in any treatment programme.

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ACTH STIM: The ACTH Stimulation test, also called the Cosyntropin test, measures the ability of your adrenals to be stimulated by the ACTH, a pituitary hormone, and is used to diagnose Addison’s or Cushings disease, as well as hypopituitary. Usually done in an out-patient setting and takes only a few hours. A synthetic ACTH is injected into your arm and the response of your plasma cortisol levels are measured. You’ll need to fast, and the test is usually done in the morning. You cannot be on any cortisol medications or supplements. An ACTH plasma test is often done at the same time ot measure the amount of ACTH being secreted by the pituitary gland. Your cortisol levels will double if your adrenals are not diseased. The ACTH has not been found to be a good test for the kind of adrenal fatigue manifested by thyroid patients, which is sluggishness, not disease.


I had the cortisol injections twice in my shoulder joint because yhe pain in my shoulers arms and hands were unbeatable. I now have no pain for the first time for 8 years and i can use my right arm again without severe pain.


wtf? that was a CORTISONE INJECTION not CORTISOL ! a completely different stuff... switch on your brain before writing these stupidity please


i am wha nting the price of cortisol test to identify adrenal issues


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