What is 24hr Free Cortisol? High and low values | Lab results explained

In the DUTCH test the 24hr Free Cortisol biomarker is the sum of the Waking, Morning, Afternoon and Night cortisol levels.

24hr Free Cortisol high low meaning treatment dutch dried urine functional

Cortisol is a stress hormone produced by the adrenal glands and is the primary agent used in our body’s flight or fight response to threatening stimuli. Levels naturally peak in the morning and then reach their lowest point at night. A high blood cortisol level at night may indicate a problem with the adrenal glands; however, individuals who work at night and sleep during the day will have an inverted pattern.

Lower levels:

Can be due to:

  • Addison’s disease (where the adrenal glands are not responding to the ACTH released by the pituitary gland and are not producing enough cortisol)
  • Hypothyroidism
  • Medications – opioids, corticosteroids, Accutane
  • HPA-axis dysfunction
  • Head trauma affecting the HPA axis

Higher levels:

Can be due to:

  • Cushing’s disease (where the pituitary gland releases too much ACTH, stimulating the adrenals to release too much cortisol)
  • High levels of stress (including mental stress)
  • Insulin resistance
  • Hyperthroidism
  • HPA axis dysfunction

Possible treatment options:

  • Evaluate DUTCH correctly to help pinpoint and address the root cause
  • Reduce stress levels
  • Improve sleep quality (and quantity if needed)
  • Meditation
  • Massage
  • Support the HPA axis


The information on is NOT intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice.

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