Do Adrenaliv supplements affect cortisol test results?

Adrenaliv Supplements and Cortisol Testing Interference

Adrenaliv supplements can interfere with cortisol testing results and should be discontinued at least 1-2 weeks prior to any cortisol testing to ensure accurate results. 1

Mechanism of Interference

Adrenaliv supplements typically contain ingredients that can directly affect the hypothalamic-pituitary-adrenal (HPA) axis or contain compounds that may cross-react with cortisol assays:

• Many contain adrenal extracts or precursors that can alter endogenous cortisol production
• Some ingredients may cross-react with antibodies used in immunoassays for cortisol
• Supplements may contain actual steroid compounds that affect laboratory measurements

Types of Cortisol Tests Affected

Different cortisol testing methods have varying susceptibility to interference:

Serum/Plasma Cortisol Tests

• Morning cortisol measurements (8-9 AM) can be falsely elevated or suppressed 1
• ACTH stimulation tests (250-μg) may show blunted or exaggerated responses 1
• Both total and free cortisol measurements can be affected 1

Salivary Cortisol Tests

• Particularly vulnerable to interference due to direct oral contamination 1
• Late-night salivary cortisol tests used for Cushing's syndrome diagnosis may be unreliable 1

Urinary Free Cortisol (UFC)

• 24-hour urinary collections may show altered cortisol excretion patterns 1

Recommendations for Accurate Testing

To ensure accurate cortisol testing results:

1. Discontinue Adrenaliv supplements at least 1-2 weeks before testing 2
2. Inform healthcare providers about all supplements being taken
3. For critical diagnostic decisions, consider using more specific testing methods:
   • Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is less susceptible to supplement interference 3
   • High-dose (250-μg) ACTH stimulation test is preferred over low-dose testing 1

Special Considerations

For Cushing's Syndrome Diagnosis

• Multiple test modalities may be needed to confirm diagnosis when supplement use is suspected 1
• Consider using the combination of UFC, late-night salivary cortisol, and dexamethasone suppression test 1

For Adrenal Insufficiency Diagnosis

• Morning cortisol levels <5 μg/dL strongly suggest adrenal insufficiency regardless of supplement use 4
• Levels between 5-10 μg/dL require confirmatory ACTH stimulation testing 4
• Supplement use may mask true adrenal insufficiency by artificially elevating cortisol levels 2

Clinical Implications

Inaccurate cortisol test results due to supplement interference can lead to:

• Missed diagnoses of adrenal insufficiency, potentially resulting in life-threatening adrenal crisis
• False diagnosis of Cushing's syndrome leading to unnecessary treatment
• Inappropriate glucocorticoid replacement dosing in treated patients

Common Pitfalls to Avoid

• Assuming that "natural" supplements don't affect laboratory testing
• Failing to inquire specifically about supplement use when ordering cortisol tests
• Interpreting borderline cortisol results without considering supplement interference
• Relying solely on a single cortisol test when supplement use is suspected

For patients currently taking Adrenaliv supplements who require cortisol testing, the most reliable approach is to temporarily discontinue the supplement and use multiple testing modalities when possible to ensure accurate diagnosis and appropriate treatment decisions.