Adrenocortex Stress Profile with Cortisol Awakening Response

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Turnaround Time: 7 Days
CPT Code:
  • Cortisol - 82530
  • DHEA - 82626
Test Type: Kit Based, Salivary


The Adrenocortex Stress Profile (ASP) provides an assessment of the Hypothalamic-Pituitary-Adrenal (HPA) axis using carefully timed salivary samples of the hormones cortisol and DHEA. Salivary testing is an easy, non-invasive option to measure unbound, biologically active parent hormone levels. The report offers an easy-to-interpret graphic which plots the results of the cortisol awakening response (CAR) and the natural diurnal rhythm.

Adrenocortex Stress Profile (ASP): Four salivary samples measured throughout the day to give insight into the natural circadian diurnal cortisol rhythm, and help clinicians address specific daily stressors.

Cortisol Awakening Response (CAR): Three awakening samples to evaluate CAR with one evening cortisol sample.

CAR is a transient, immediate rise in cortisol upon awakening and is distinct from the diurnal rhythm. CAR reflects a person's ability to cope with anticipated challenges and their perception of control around chronic stress, providing insight into HPA axis resiliency.

The isolated evening cortisol has distinct clinical implications. Elevated evening cortisol is linked to insomnia and associated with various diseases such as diabetes, cardiovascular disease, hormonally driven cancers, and osteoporosis.

DHEA is measured once in the 7:00 AM – 9:00 AM sample and a ratio of DHEA to cortisol is calculated to provide insight into anabolic/catabolic balance.

Daily hassles, chronic pain, blood sugar dysregulation, work stressors, and poor relationship quality can alter the HPA axis. Imbalances in adrenal hormones can have a wide range of negative consequences that can adversely impact a patient's overall quality of life. The symptoms of HPA axis dysfunction can be vague and are highly variable but may include: fatigue, insomnia, weight gain, depression, GI complaints, and chronic pain. HPA axis dysfunction is associated with many conditions including:

  • hypertension
  • cardiovascular disease
  • gastrointestinal and immune dysregulation
  • diabetes and metabolic syndrome
  • depression
  • chronic fatigue
  • persistent pain
  • neurodegenerative disease and cognitive decline

Adrenocortex Stress Profile testing can reveal these HPA axis imbalances and provide direction for clinical intervention with targeted therapeutic treatments such as nutrient support and/or adaptogens, stress management, behavioral modification and lifestyle interventions.

Collection Details:

Patient Preparation:

It is important that you collect saliva during the specified time frame.

If you have difficulty producing enough saliva:

• Rinse your mouth with water and spit out completely

• Press the tip of your tongue to the roof of your mouth against your teeth

• Think of sour foods, such as lemons

• Yawning can also generate saliva

• Do not eat or drink anything except water one hour prior to each collection. Remove all lip balm and lipstick

Collection Instructions:

The sample collection times must be strictly followed to provide your clinician with the most accurate results.

Consider waking at 6am on day of collection.

The following drugs and supplements may influence hormone levels reported in this test: ketoconazole, clomiphene, phenytoin, steroids, and DHEA supplementation. Let your physician know about these and any other medications and supplements you have used in the past 3 months. Do not change or discontinue medications unless instructed to do so by your healthcare provider.