There are two main ways to measure the diurnal rhythm of the adrenal hormone cortisol, the traditional way is with a saliva hormone test and there is now a more comprehensive test called the  Dutch Hormone Test.

The saliva test measures free cortisol at 4 different periods of the day to measure whether free cortisol levels are high or low, but it does not actually tell us how much cortisol the body is actually making.

The free cortisol is only 1-3% of total cortisol production, and the saliva test does not measure how much total cortisol the body is making, or how quickly it is getting metabolised to cortisone.

This is why most saliva test results will show low cortisol levels - but this can be misleading as it does not show how it is getting metabolised.

DUTCH stands for Dried Urine Test for Comprehensive Hormones and it combines the advantages of the saliva test so it can measure the diurnal rhythm of cortisol, plus it measures the total cortisol production and the cortisol metabolites. This information gives a better overall picture of what is happening with your adrenals, and it makes treatment more specific for your situation.

The DUTCH test also measures DHEA and the DHEA metabolites Etiocholanolone and Androsterone, and melatonin is also measured giving a complete adrenal function picture.​

Symptoms of high cortisol


Muscle weakness

Depression, anxiety and irritability

Loss of emotional control

Cognitive difficulties

New or worsened high blood pressure

Glucose intolerance that may lead to diabetes


Bone loss, leading to fracture over time

Symptoms of low cortisol

Extreme fatigue

Muscle or joint pains

Depression, irritability

Salt craving

Abdominal pain

Low blood pressure, even fainting

Low blood sugar (hypoglycaemia)

Nausea, diarrhea or vomiting

Weight loss and decreased appetite