Scott: When somebody has certain conditions, are there tests that can be done to determine hormone levels, cortisol levels, is that, is that basically what you do or what someone should get done first?
Lena D. Edwards: Testing is obviously recommended, but it's not without limitation. And there is no one perfect test really for testing anything. With respect to the hormones and cortisol, in particular, serum testing is probably the least reliable and that's what we typically have been trained to order.
Again, we're trained to look for Cushing's disease, which is too much cortisol, and Addison's disease, which is the complete absence of cortisol. So what we're looking for is the gray zone in between because that's where most people are, somewhere in that gray zone.
Serum or blood tends to overestimate cortisol approximately 75%, so particularly, not particularly reliable. You can do urinary testing, a 24-hour urine collection, but it tends to underestimate true cortisol production by as much as 30%.
Really, what's becoming more and more accepted and actually the World Health Organization approved testing in this manner as early as 1990, is salivary testing. Part of the reason for salivary testing is there's no stress involved in collecting the samples so there's less you know test collection bias. It allows you to see the pattern of cortisol release, which is extremely important.
The pattern of release is probably more important than any one cortisol level that you can measure. The pattern can only be assessed really, through salivary testing.
There are, again, limitations with salivary testing but comparatively speaking, it's probably the most accurate way to truly determine the status of someone's stress response system.