Cortisol Free and Cortisone 24‑Hour Urine With Creatinine Biomarker Testing
It measures your 24-hour cortisol and cortisone output and adjusts for urine concentration, with ordering and PocketMD guidance through Vitals Vault.
With Vitals Vault, you have access to a comprehensive range of biomarker tests.
This test measures how much cortisol and cortisone you excrete in your urine over a full 24 hours, and it includes creatinine to help judge whether the collection was complete and how concentrated the urine was.
It is most often used when you and your clinician are trying to confirm or rule out sustained cortisol excess (hypercortisolism) or to investigate symptoms that could be related to altered stress-hormone signaling.
Because cortisol changes hour to hour, a 24-hour urine collection can capture your total daily output in a way that a single blood draw sometimes cannot.
Do I need a Cortisol Free and Cortisone 24 Hour Urine With Creatinine test?
You might consider this test if you have a pattern of symptoms that raises concern for ongoing cortisol excess, such as unexplained weight gain (especially around the trunk), new or worsening high blood pressure, high blood sugar, easy bruising, muscle weakness, or changes in mood and sleep. It can also be part of a workup when you have an adrenal mass found on imaging and your clinician wants to understand whether it is affecting hormone output.
This test can be helpful when your symptoms are persistent but your cortisol results from a single time point feel “all over the place.” A 24-hour collection smooths out the normal daily rhythm and gives a better sense of total cortisol exposure.
You may also be asked to repeat the test if the first collection was incomplete, if your result is borderline, or if you were sick, sleep-deprived, or under unusual stress during the collection window.
Your result should be interpreted with your medical history and other labs. This test supports clinician-directed evaluation and monitoring, but it does not diagnose a condition by itself.
This is a laboratory-developed test performed in a CLIA-certified lab; results are for clinical interpretation and are not a standalone diagnosis.
Lab testing
Order the 24-hour urine cortisol and cortisone test through Vitals Vault.
Schedule online, results typically within about a week
Clear reporting and optional clinician context
HSA/FSA eligible where applicable
Get this test with Vitals Vault
Vitals Vault makes it straightforward to order a 24-hour urine cortisol and cortisone test and complete it on your schedule. After you order, you receive clear collection instructions so you can avoid common pitfalls that make results hard to interpret.
Once your results are back, you can use PocketMD to ask practical questions like whether the collection looks adequate, what a high or low pattern could mean, and which follow-up tests are typically paired with urine cortisol testing.
If you are tracking a known issue or monitoring treatment, Vitals Vault also makes it easy to reorder the same test later so you can compare results over time under similar conditions.
- Order online and complete testing through a national lab network
- PocketMD helps you turn results into next-step questions for your clinician
- Easy re-testing for trend tracking when timing and conditions are consistent
Key benefits of Cortisol Free and Cortisone 24‑hour urine testing
- Estimates your total daily cortisol exposure rather than a single moment in time.
- Adds cortisone to help interpret cortisol metabolism and enzyme activity patterns.
- Includes urine creatinine to assess collection adequacy and urine concentration.
- Supports evaluation for sustained cortisol excess when symptoms suggest hypercortisolism.
- Helps clarify confusing or variable spot cortisol results by using a 24-hour window.
- Provides a baseline you can repeat to monitor changes after medication or treatment adjustments.
- Pairs well with other adrenal tests so you and your clinician can build a more complete picture.
What is Cortisol Free and Cortisone 24 Hour Urine With Creatinine?
Cortisol is a steroid hormone made by your adrenal glands that helps regulate energy use, immune signaling, blood pressure, and your response to physical and psychological stress. Cortisone is a closely related hormone that is generally less active, and your body can convert cortisol to cortisone (and back) in different tissues.
A “24-hour urine” test measures the amount of these hormones your body excretes over an entire day. “Free cortisol” refers to cortisol that is not bound to proteins in the blood and is filtered into urine. Measuring both cortisol and cortisone can provide extra context about how cortisol is being processed.
Creatinine is a breakdown product of muscle metabolism that is excreted in urine at a relatively steady rate. In a 24-hour urine collection, creatinine helps the lab and your clinician judge whether the sample likely represents a complete collection and whether dilution or concentration could be affecting interpretation.
Why 24 hours matters for cortisol
Cortisol normally follows a daily rhythm, with higher levels in the morning and lower levels at night. A single blood or saliva sample can be strongly influenced by collection time, sleep schedule, and acute stress. A 24-hour urine collection is designed to capture total output across the whole day and night.
What the cortisol-to-cortisone relationship can suggest
Your body uses enzymes (including 11β-hydroxysteroid dehydrogenase) to convert cortisol and cortisone depending on the tissue and physiologic needs. When cortisol and cortisone move together, it often supports a “global” change in adrenal output. When they diverge, it can raise questions about metabolism, medication effects, or kidney-related handling—topics your clinician may explore with additional testing.
What do my Cortisol Free and Cortisone 24 Hour Urine With Creatinine results mean?
Low cortisol and/or cortisone (24-hour urine)
Low 24-hour urinary cortisol and cortisone can happen if your adrenal output is reduced, but it can also reflect an incomplete urine collection (for example, missed voids) or unusually low urine volume. Certain medications, especially glucocorticoids (steroids) taken by mouth, inhaler, injection, topical use, or “stress-dose” treatments, can suppress your own cortisol production and lower urinary values. If your result is low and you have symptoms like fatigue, dizziness, or unintentional weight loss, your clinician may confirm with blood testing (often morning serum cortisol) and sometimes ACTH (adrenocorticotropic hormone) or stimulation testing.
In-range (expected) cortisol and cortisone
An in-range result generally suggests your total daily cortisol output is not elevated and is not clearly suppressed at the time of collection. If you still have symptoms, the next step is often to look for other explanations or to use a different cortisol test that targets timing (such as late-night salivary cortisol) when clinically appropriate. Your clinician may also review whether the creatinine and total urine volume support a complete 24-hour collection, because a “normal” value is less reassuring if the collection appears incomplete.
High cortisol and/or cortisone (24-hour urine)
High 24-hour urinary free cortisol can be a sign of sustained cortisol excess, which is why this test is commonly used in evaluation for Cushing syndrome. However, elevations can also occur with severe stress, acute illness, heavy alcohol use, major sleep disruption, depression, intense endurance exercise, or certain medications, so a single high result is usually not the end of the workup. Many clinicians confirm with repeat testing and/or a different screening approach (such as late-night salivary cortisol or an overnight dexamethasone suppression test) before making conclusions.
Factors that influence urine cortisol, cortisone, and creatinine
Collection quality is the biggest factor: missing even one or two urine voids can meaningfully change the 24-hour total, and over-collecting beyond 24 hours can also distort results. Kidney function, hydration status, and muscle mass can affect creatinine and may influence how confidently the lab can assess completeness. Medications matter, including any form of steroid, some anti-seizure medicines, estrogen therapy, and drugs that affect cortisol metabolism; always list what you take on the requisition if possible. Your sleep schedule, shift work, and recent illness or major stress can raise or lower cortisol output, so timing your collection during a “typical” week improves interpretability.
What’s included
- Cortisol, Free, 24 Hour Urine
- Cortisone, 24 Hr Urine
- Creatinine, Urine
Frequently Asked Questions
Do I need to fast for a 24-hour urine cortisol and cortisone test?
Fasting is usually not required for a 24-hour urine collection. What matters more is following the collection instructions exactly and keeping your routine as typical as possible unless your clinician tells you otherwise.
How do I do a 24-hour urine collection correctly?
You typically discard your first morning urine, then collect all urine for the next 24 hours, including the first urine the following morning. Keep the container as instructed (often refrigerated), record start and stop times, and avoid missing any voids. If you miss a collection, contact the lab or your clinician because you may need to restart for an interpretable result.
What is the difference between urine cortisol and salivary cortisol?
A 24-hour urine test estimates total daily cortisol output, while salivary cortisol is often used to check timing—especially late-night cortisol when levels should be low. They answer different questions, and clinicians sometimes use both when evaluating possible cortisol excess.
Why does this test include creatinine?
Creatinine helps assess whether the 24-hour collection is likely complete and whether the urine was unusually dilute or concentrated. That context can prevent over-interpreting a cortisol number that is affected by collection quality.
Can stress or poor sleep make my urine cortisol high?
Yes. Acute illness, major psychological stress, sleep deprivation, shift work, and intense exercise can increase cortisol output and sometimes raise urinary cortisol. If your result is high but the timing was unusual for you, your clinician may recommend repeating the test under more typical conditions.
What medications can affect urine cortisol and cortisone results?
Any form of glucocorticoid (oral, inhaled, injected, topical) can change results, and some medications can alter cortisol metabolism. Estrogen therapy and certain anti-seizure drugs may also influence cortisol testing. Do not stop prescribed medications without medical guidance; instead, list them and ask your clinician whether timing adjustments are needed.
If my result is high, what follow-up tests are commonly ordered?
Follow-up often includes repeating urinary free cortisol, late-night salivary cortisol, and/or an overnight dexamethasone suppression test, plus blood tests such as ACTH to help localize the source. Your clinician may also review blood pressure, glucose, and electrolytes as part of the bigger picture.