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Nutrition Consultations with Val Adrenal Stress TestZRT Lab processes your order completely from beginning to end.

  1. The test kit is sent directly to you along with instructions.
  2. You send completed kit and forms back to ZRT (all shipping is paid).
  3. ZRT will email your results directly to you alone.

The results are clear but should you need help interpreting your test you can schedule an appointment for a consultation. Please click BOOK IT to contact Valerie Robitaille, MS, PhD(c), Holistic Nutritionist

Adrenal Stress Test

Recommended with chronic stress, fatigue, sleep disturbances, allergies and/or lowered immunity; indicator of adrenal imbalance. Tests adrenal hormones DHEA-S and diurnal cortisol (morning, noon, evening, nighttime).

Cortisol is made by the adrenal glands and released into the bloodstream in response to stress signals from the brain. In the bloodstream cortisol is mostly bound by a protein (cortisol binding protein, or CBG), leaving only about 1-3% bioavailable to enter tissues and invoke a response.

Salivary cortisol reflects the amount of cortisol that escapes binding proteins, and enters the tissues throughout the body. As such, saliva is representative of the bioavailability of cortisol to cells, tissues and organs.

Saliva collection at four time points throughout the day (morning, noon, evening, and night) provides a simple and convenient means for assessing not only the bioavailability of cortisol but also its circadian pattern of synthesis (i.e. the diurnal cortisol curve, see below).


To help you decide which hormone test is right for you, download our  Symptoms Checklist:

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Dr. David Zava, ZRT Labs

Additional Information

Adrenal glands that are out of balance can lead to:

High Cortisol

Results in insomnia, anxiety, sugar cravings, feeling tired but wired, increased belly fat & bone loss

Low Cortisol

Causes chronic fatigue, low energy, food and sugar cravings, poor exercise tolerance or recovery & low immune reserves


Out of balance adrenals can lead to high or low DHEA.

The adrenal glands, otherwise known as the “stress glands,” enable our bodies to cope with stress and survive. Shaped like two tiny pyramids, they sit atop the kidneys and from this central location mobilize the response to changes in our environment.

Whether stress comes from outside in the form of a natural disaster, or from within like the anxiety we experience before public speaking, it’s the adrenals’ job to help us adapt to the situation.

They accomplish this by secreting key hormones:

Urine Hormones Page Icon Adrenal Stress Test

The primary stress hormone that fine-tunes our response to the stress of everyday living

Urine Hormones Page Icon Adrenal Stress Test

One of the most abundant hormones in the body, and a precursor to estrogens and testosterone; also balances some of the negative effects of high cortisol

Urine Hormones Page Icon Adrenal Stress Test

Epinephrine / Norepinephrine
Neurotransmitters that mobilize the body’s natural “fight or flight” response in an emergency

Individuls can conduct a saliva cortisol test or a urine cortisol test to assess adrenal hormones. This involves collecting four non-invasive samples over the course of one day, from which ZRT is able to generate results with a diurnal cortisol curve. This four-point graph reveals cortisol levels throughout the day and allows health care providers to pinpoint issues with adrenal gland function.

Diurnal Cortisol Curve Assessment

Thirty minutes after awakening from a good night’s sleep, cortisol levels are at the highest they’ll be all day. Following the morning peak, cortisol levels then fall to less than half that peak level by noon. They continue to drop to very low levels at night where they stay low during the sleep hours. Some individuals have a sharp rise to reach morning levels, others a more gradual incline. Looking at cortisol levels graphed during the day, any abnormal elevation, or depression of levels, or a loss of the expected curve with its characteristic morning peak and swooping decline towards evening may suggest HPA (hypothalamus-pituitary-adrenal) axis dysfunction – which is what we’re most interested in assessing when we’re looking at a diurnal cortisol curve.

Diurnal Cortisol Curves

This curve is derived from taking four daily saliva collections – typically done upon waking, before lunch, before dinner and before bed – and charting them on a 24-hour graph.

The resulting curve – also called a four-point cortisol curve or circadian cortisol pattern – reveals cortisol levels throughout the day, allowing the pinpointing of  issues with adrenal gland function.

adrenal curve normal Adrenal Stress Test



This pattern shows a normal rise in cortisol production within 30 minutes of waking for the day. Cortisol levels then drop throughout the day, reaching their lowest point at bedtime.

Diurnal Cortisol Patterns with Adrenal HPA Axis Dysfunction

Cortisol production is normally at its highest 30 minutes after waking and declines steadily during the day, reaching its lowest point at bedtime. Those with adrenal gland dysfunction generally have irregularities in their diurnal cortisol curves. Some common examples are shown below.

adrenal curve chronic stress Adrenal Stress Test




Overall higher than normal cortisol production throughout the day can result from prolonged stress demands. General symptoms include feeling “tired but wired,” food cravings, insomnia and anxiety.





adrenal curve stress fatigue Adrenal Stress Test




The pattern for chronic fatigue shows an elevated morning cortisol with levels dropping off rapidly during the day. General symptoms include mid-day energy drop, drowsiness and poor exercise recovery.





adrenal curve burnout Adrenal Stress Test




The burnout pattern, also commonly called “adrenal fatigue” is really a reflection of low overall cortisol during the day. General symptoms include day-long fatigue, irritability, food cravings, insomnia and exhaustion.




The Cortisol Awakening Response

Sunlight influences the diurnal rhythm and when it becomes scarce, those rhythms can become dysregulated. The adrenal hormone, cortisol, reacts to stressors in the body like inflammation, illness and low blood sugar; however, outside of its first-response job, it follows a very typical diurnal rhythm. It can be measured upon waking and throughout the day with results in saliva that look a lot like the graph below.

saliva cortisol Adrenal Stress Test

Normally, in the morning as the sun begins its ascent, cortisol charts its course toward the highest level of our 24-hour day. Within 30 minutes of waking up, cortisol should continue to rise by about 50% from the waking level. When the mornings are dark, in susceptible individuals the diurnal rhythm of cortisol flattens out and it becomes difficult to shake off sleep and function normally. Another helpful measure of the HPA axis that captures that 50% rise (or absence of it) is called the cortisol awakening response (CAR) which measures cortisol in response to the “stress” of waking.



Here’s a normal CAR — observe the 2nd black dot in the graph below showing the cortisol level at 30 minutes after the initial waking sample:

saliva cortisol 2 Adrenal Stress Test






Here’s an example of a CAR in someone struggling with SAD:

saliva cortisol 3 Adrenal Stress Test



Notice the morning, noon, evening and night cortisol levels are roughly within normal ranges while the attenuated CAR is the finding of interest. Overall, the defect in cortisol regulation in SAD may be missed if the CAR isn’t assessed along with the diurnal rhythm.

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