Cortisol Serum: Morning & Evening Samples Test
Short Name: Cortisol Serum (AM/PM)
Also known as: Cortisol AM PM Test, Serum Cortisol Diurnal Variation Test, Cortisol Day Curve Test, Adrenal Cortisol Blood Test
Cortisol Serum: Morning & Evening Samples Test test available at DNA Labs India for ₹1,170. Uses Chemiluminescent Immunoassay on Serum samples. Results in Reports are typically available the same day or within 24 hours after the receipt of both specimens at the laboratory.. Free home collection in 300+ cities across India.
🩺 Medically Reviewed By
Dr Ramarao Paidisetty
Consultant Biochemist · Reg: 21504
Last reviewed: September 7, 2026
Overview
The purpose of the Cortisol Serum: Morning & Evening Samples Test is to evaluate the diurnal variation and absolute levels of cortisol in the blood. This test is ordered to diagnose conditions related to cortisol excess (hypercortisolism) such as Cushing's syndrome, or cortisol deficiency (hypocortisolism) such as Addison's disease and secondary adrenal insufficiency. Measuring cortisol at two time points captures the natural daily rhythm of the hormone, which is critical for distinguishing normal physiological variation from pathological states. The test is also used to monitor patients receiving corticosteroid therapy and to evaluate hypothalamic-pituitary-adrenal (HPA) axis function.
- Test Code
- 363
- Price
- ₹1,170
- Sample Type
- Serum
- Result Time
- Reports are typically available the same day or within 24 hours after the receipt of both specimens at the laboratory.
- Fasting Required
- No
- Method
- Chemiluminescent Immunoassay
Sample Collection
No fasting is required for this test. However, timing is critical: the morning sample must be collected between 7:00 AM and 11:00 AM, and the evening sample between 3:00 PM and 5:00 PM. Inform your doctor about all medications you are currently taking, especially corticosteroids, oral contraceptives, or any hormonal supplements. Avoid strenuous exercise on the day of sample collection. Get adequate sleep the night before the test. Try to remain calm and relaxed during sample collection, as stress can temporarily elevate cortisol levels.
Method: Venipuncture
Laboratory Analysis
A qualified healthcare professional will collect blood from a vein in your arm (venipuncture) using a sterile needle and syringe or vacuum collection system. The blood will be collected into a Serum Separator Tube (SST). The procedure typically takes less than 5 minutes per draw. You will need to visit for two separate collections — one in the morning and one in the evening on the same day. For each specimen, a minimum of 2 mL (1 mL minimum) of blood is drawn. Specify the exact time and date of collection on each sample container and test request form.
Report Delivery
After each blood draw, a cotton ball or gauze pad will be applied to the puncture site. Apply gentle pressure for 3–5 minutes to stop any bleeding. A small bruise may develop at the site, which is normal and will resolve within a few days. You may resume normal activities immediately after each collection. Avoid lifting heavy objects with the arm used for blood draw for a few hours. Your samples will be processed and shipped refrigerated or frozen to maintain specimen integrity.
Timeline: Reports are typically available the same day or within 24 hours after the receipt of both specimens at the laboratory.
Patient Instructions
About This Test
Who Should Get This Test
The purpose of the Cortisol Serum: Morning & Evening Samples Test is to evaluate the diurnal variation and absolute levels of cortisol in the blood. This test is ordered to diagnose conditions related to cortisol excess (hypercortisolism) such as Cushing's syndrome, or cortisol deficiency (hypocortisolism) such as Addison's disease and secondary adrenal insufficiency. Measuring cortisol at two time points captures the natural daily rhythm of the hormone, which is critical for distinguishing normal physiological variation from pathological states. The test is also used to monitor patients receiving corticosteroid therapy and to evaluate hypothalamic-pituitary-adrenal (HPA) axis function.
How to Prepare
- Morning sample must be collected between 7:00 AM and 11:00 AM
- Evening sample must be collected between 3:00 PM and 5:00 PM on the same day
- Each specimen requires a minimum of 2 mL (1 mL minimum) serum collected in a separate SST
- Clearly specify the exact time and date of collection on each sample container and the test request form
- Ship specimens refrigerated or frozen to preserve sample integrity
- Avoid strenuous physical activity before each collection
- Remain seated and relaxed for at least 15–20 minutes before each blood draw
Doctor's Notes
Reviewed by Dr Ramarao Paidisetty — MBBS, MD (Biochemistry) · Reg. No. 21504
"Cortisol assessment with dual-time sampling is essential for evaluating the diurnal rhythm of the hypothalamic-pituitary-adrenal (HPA) axis. A single cortisol measurement can be misleading due to the pulsatile nature of cortisol secretion. Morning and evening sampling provides a more reliable assessment of adrenal function. Patients on corticosteroid therapy or those experiencing significant physiological stress may show altered cortisol patterns. Results should always be correlated with clinical symptoms and may require confirmatory testing such as the low-dose dexamethasone suppression test or ACTH stimulation test before initiating treatment."
Last medically reviewed: September 7, 2026
Test Parameters & Specifications
Sample Stability
- Hemolyzed, lipemic, or icteric samples
- Samples not collected at the recommended timings without documented justification
- Insufficient sample volume (less than 1 mL serum per specimen)
- Unlabeled, mislabeled, or improperly identified sample containers
- Specimens exceeding stability limits at the time of receipt
- Samples collected into incorrect tube type (non-SST)
Understanding Your Results
Normal Morning Cortisol (6.0–18.4 µg/dL) with Normal Evening Decline
Indicates normal adrenal gland function and a healthy diurnal cortisol rhythm
Recommended action: No further testing typically required. Discuss results with your physician.
Elevated Morning Cortisol (>18.4 µg/dL) with Loss of Evening Decline
Suggests hypercortisolism with loss of the normal diurnal rhythm, which is characteristic of Cushing's syndrome
Recommended action: Consult an endocrinologist. Confirmatory tests such as the overnight 1 mg dexamethasone suppression test, 24-hour urinary free cortisol, or late-night salivary cortisol may be recommended.
Low Morning Cortisol (<6.0 µg/dL)
May indicate adrenal insufficiency or dysfunction of the hypothalamic-pituitary-adrenal axis
Recommended action: Consult an endocrinologist urgently. An ACTH stimulation test is typically recommended to confirm adrenal insufficiency.
Normal Morning Cortisol but Abnormally Low Evening Cortisol
An exaggerated decline in cortisol may sometimes be seen in chronic fatigue states or certain hormonal conditions
Recommended action: Correlate with clinical symptoms. Repeat testing or additional hormonal evaluation may be warranted.
Consult an endocrinologist if your cortisol levels are outside the normal reference range, if there is loss of the expected diurnal variation between morning and evening samples, or if your results do not align with your clinical symptoms. Additionally, seek medical attention if you experience persistent fatigue, unexplained weight changes, muscle weakness, dizziness, skin darkening, or mood disturbances. Abnormal cortisol results often require confirmatory testing and clinical correlation before a definitive diagnosis can be made.
Limitations
- ⚠Total serum cortisol measurement includes both bound and free cortisol; in conditions affecting cortisol-binding globulin (CBG), results may not accurately reflect biologically active free cortisol
- ⚠A two-point cortisol profile is a screening assessment; confirmatory tests such as the 24-hour urinary free cortisol, overnight 1 mg dexamethasone suppression test, or ACTH stimulation test may be required for definitive diagnosis
- ⚠Cortisol levels can be influenced by acute illness, pain, or hospitalization, which may lead to misleading results
- ⚠Results should always be interpreted in conjunction with clinical symptoms, medical history, and additional laboratory investigations
- ⚠Reference ranges may vary slightly between laboratories and assay methods
Risks & Considerations
- ●Mild pain or discomfort at the blood draw site
- ●Minor bruising or hematoma at the puncture site
- ●Very rare risk of infection at the venipuncture site
- ●Lightheadedness or dizziness during or after blood collection
- ●Extremely rare vasovagal reaction (fainting)
Interfering Factors
- ●Corticosteroid medications such as prednisone, dexamethasone, or hydrocortisone can significantly alter cortisol levels
- ●Oral contraceptive pills and estrogen therapy may elevate cortisol-binding globulin and total cortisol levels
- ●Acute physical or emotional stress at the time of sample collection can transiently raise cortisol
- ●Pregnancy causes physiological elevation of cortisol levels
- ●Intense physical exercise performed shortly before the test may affect results
- ●Alcohol consumption or substance use may interfere with cortisol metabolism
- ●Shift work or disrupted sleep-wake cycles can alter the normal diurnal cortisol rhythm
Compare With Similar Tests
| Test | Cortisol Serum: Morning & Evening Samples Test | Cortisol Serum (Morning & Evening) | 24-Hour Urinary Free Cortisol | Late-Night Salivary Cortisol | Overnight 1 mg Dexamethasone Suppression Test |
|---|---|---|---|---|---|
| Comparison | Cortisol Serum: Morning & Evening Samples Test |
Frequently Asked Questions
What is the Cortisol Serum: Morning & Evening Samples Test?
Why are two blood samples needed at different times?
Do I need to fast before the cortisol serum test?
What are normal cortisol levels for this test?
What does a high cortisol level mean?
What does a low cortisol level mean?
Can medications affect my cortisol test results?
Is home sample collection available for this test?
How long does it take to get the results?
What is the cost of the Cortisol Serum Morning & Evening Samples Test?
Is the cortisol serum test painful?
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