My doctor won’t do a 24 hour cortisol test?

[Monster1996x]

I have all the signs of high cortisol (constant bloating, round face, heart palpitations) and I am waking up at 3am every morning.
I requested my cortisol levels to be checked, and my GP issued me with a cortisol blood test that needs to be between 8am and 10am.

I requested a 24 hour test (urine or saliva) because I am most concerned about my cortisol spiking at times when they shouldn’t (3am).
My gp said no because ‘it’s normal for cortisol to fluctuate’??

She then told me that a urine or saliva test is ‘too specialist’ and I’d need to be seen by endocrinology. The waiting list for this is 10 months.

I’m just not seeing what a blood test would achieve if my cortisol isn’t spiking at that specific time.

Is it just me or does this not sound right?…

Just take the test then discuss a referal

I'm not sure about the ins and outs of how valuable it would be but why not do what they are advising and go private for the test you want?

Gp won’t be able to request some of the tests a specialist can. Get the blood test done and then they’ll most likely refer you to endocrinology.

Why would a 24 hour urine output reveal anything though? It'll show your entire cortisol over the 24 hour period, not that you produced x amount at 3am and y amount at 9pm.

What you are asking for is outside the remit of General Practice.

It also would not be done without doing more basic tests first as your GP suggests.

High cortisol levels are actually very rare so why not take your GP's advice?

What can actually be done to lower cortisol levels? I am much like you in symptoms but didn’t realise there was a medical solution.

What you describe are not all the symptoms of high cortisol, and you could have all three of those for completely different reasons. The term ‘High cortisol’ has become more well known through TikTok businesses trying to shill you wellness products. I’d take the test your GP has offered and then discuss any next steps after the results.

Actually high cortisol levels are very very rare and are caused by rare tumours.

Or most commonly by being on high doses of steroids for a long time- but you and your GP would know that applied to you.

Those symptoms are very common so it is much more likely they have nothing to do with high cortisol.

Are you asking for a test for Cushing's syndrome? https://www.nhs.uk/conditions/cushings-syndrome/

It sounds pretty rare unless you have been taking corticosteroids. It also sounds like the test for it is beyond the skills of GPs so you will need a referral
csrf.net/understanding-cushings/diagnostic-testing/#:~:text=The%20diagnostic%20approach%20to%20patients%20with%20suspected%20Cushing%E2%80%99s,24%20hour%20urine%20free%20cortisol%2C%20low-dose%20dexamethasone%20suppression.

You've been instagrammed

Many tests are not available to GPs and HAVE to be requested by a specialist.
Please don't Google and then turn up with a list if tests you (mistakenly) think you need doing. Its massively irritating.

High cortisol is a popular social media video topic with videos suggesting that it’s why people are fat.

GPs don’t have access to all tests. Do this one then ask for a referral to a specialist so they can do further testing if necessary.

Precisely this.

I have been on high doses on steroids for years. I have symptoms of high cortisol. Those ads really annoy me, reminding me of my bloody humpback neck lump and moon face. 😭🤷🏻‍♀️😂

GPS don't have free rein over the tests they can order, some are specialist consultant only, and even if it's something a GP can order they often have to have exhausted other testing first.

My DM was on high dose steroids for years and had all the high cortisol symptoms.

The fat pattern is very distinctive and immediately recognisable to even the most junior doctor- it's a lot more than just bloating and a round face.

Cortisol has a pronounced daily cycle. It is many times higher in the mornings than in the evenings when normal. In fact a midnight cortisol level would be more informative than a morning one as failure to suppress cortisol is the most important abnormality

A 24hr cortisol collection is definitely beyond the expertise of a GP to analyse the results of as are cortisol suppression tests. GPs should not order these as they do not have the ability to analyse or act on them. This is specialist stuff. If they seriously think you have Cushing's syndrome then you do indeed need to see an endocrinologist (although indeed nothing you describe suggests that and it is rare).

Also cortisol spikes in relation to stress are normal and physiological. It's supposed to be high when you are ill and even having a blood test will in itself cause a cortisol spike as it is a stressor. It's actually failure to mount a cortisol response that can be fatal eg in Addisons disease.

I don't know but you've just triggered a memory of the fight a friend had to get her health issues investigated. In the end the NHS dealt with it but only after she went to an overseas specialist who diagnosed her, but the NHS don't accept their diagnosis, they insist on doing all the tests again.

You were given two reasons by your GP as to why she won't do it. Why do you think anyone here knows more than she does. More importantly, why do you think you do?

So how long did you train as a Dr for?

Sure they are not infallible, but they have trained to do the job

A 24 hour urine cortisol test won't show "spikes" (is this the new buzz word or something? People seem obsessed with glucose spikes too).

Speaking from experience you basically piss into a cup for 24hrs and decant into a 5 litre container before delivering to the hospital. It's not a test that would be done by your GP.

Yup! I feel sorry for the GPs.

Tiktok has a lot to answer for.

I take it you are a medical professional qualified to self diagnose?

If not, I’d suggest taking the test your doctor (whose medical qualifications might actually count for something) suggests and go from there

Id strongly suggest combining it with a digital detox - it sound like you need that more than any fancy test you’ve randomly decided on yourself as necessary

Fgs you don't go to the GP requesting serum rhubarb based on some half baked idea and complete ignorance - how about respecting them enough to ask their advice as a professional? What a waste of GP time.

We do a 9 am cortisol. We are looking for low, not high. It does fluctuate!
Think it through - a total 24 hr collection of cortisol will not tell you whether it spiked at a specific time or not anyway!!