Cortisol Awakening Response

Why Is the Cortisol Awakening Response Important?

The Cortisol Awakening Response (CAR) can be added to several of the HPA Stress Profiles.  The CAR is the predictable rise and fall in cortisol within the first hour of awakening and is essential in evaluating the overall dynamic function of the HPA axis. There are two events that contribute to this dynamic rise in morning cortisol. The first is in response to ACTH output from the pituitary as a part of the normal circadian activities of the HPA axis. The second occurs in response to exposure to daylight with the activation of the suprachiasmatic nucleus in the brain which occurs within 30-45 minutes after awakening and can increase cortisol by 50% from the waking value. These events occur in a timed and metered fashion allowing for a rise and fall of cortisol over a one-hour period.

Check out the Related Links below right for critical information on these advancements, as well as papers demonstrating how saliva continues to be the most valid and reliable specimen.

Combining a CAR with an HPA Stress Profile allows us to see the momentum of the rising cortisol as stimulated by a healthy HPA axis. Within the first hour of awakening, the cortisol should rise and fall in a predictable manner peaking within 30-40 minutes after waking then showing a predictable decline at the 60-minute mark.  The results of the CAR can also help us to more accurately interpret the HPA Stress Profile as the diurnal values may be a direct effect of the cortisol awakening response. Evaluating both tests together gives a much broader picture of what is occurring in the entire system and, more specifically, provides insight into a patient’s internalization of stress which is a major contributor to poor health.

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The CAR allows us to determine how robust the HPA axis is and relate those results to an individual’s history. Barring serious adrenal disease, in most cases, the adrenals are able to produce their respective hormones in response to stimulation. It is the HPA axis that demonstrates dysfunction in response to stressors when adrenal hormones are low or high.

We can measure the response to HPA stimulation by measuring the output of endpoint hormones like cortisol and DHEA-S, however, we cannot assume that the dysfunction resides within the adrenal gland if cortisol or DHEA-S are low or high.  Utilizing a Cortisol Awakening Response test gives us deeper insight into where the dysfunction is occurring and guides us in developing a prognosis and program for recovery.

Who Should Do This Test?

Maybe the question should be “Who shouldn’t do this test?” The answer would be, “Those without stress on any level.” Chances are, if these people exist, they’re not in your office seeking your help. An HPA Stress Profile with CAR (perhaps combined with other hormones and secretory IgA) is going to be appropriate for most of your patients and provides an easy assessment of their ability to deal with stressors and is also reflective of how well they have dealt with stressors in the past.

Basic HPA Stress Profiles

Cortisol x 4, DHEA-S

Cortisol x 5 (with optional waking sample), DHEA-S

Cortisol x 4

Cortisol x 4, DHEA-S, Estradiol, Estriol, Melatonin, Progesterone, Testosterone

Cortisol x 4, DHEA-S, Estradiol, Estriol, Estrone, Melatonin, Progesterone, Testosterone

HPA Stress Profiles with Cortisol Awakening Response (CAR)

Cortisol x 6 (Cortisol Awakening Response), DHEA-S

Cortisol x 6 (Cortisol Awakening Response), DHEA-S, Estradiol, Estriol, Melatonin, Progesterone, Testosterone

Cortisol x 6 (Cortisol Awakening Response), DHEA-S, Estradiol, Estriol, Estrone, Melatonin, Progesterone, Testosterone

HPA Stress Profiles with CAR and SIgA

Cortisol x 6 (Cortisol Awakening Response), DHEA-S, Secretory IgA

Cortisol x 6 (Cortisol Awakening Response), DHEA-S, Estradiol, Estriol, Melatonin, Progesterone, Testosterone, Secretory IgA

Cortisol x 6 (Cortisol Awakening Response), DHEA-S, Estradiol, Estriol, Estrone, Melatonin, Progesterone, Testosterone, Secretory IgA

HPA Stress Profiles with Secretory IgA (SIgA)

Cortisol x 4 , DHEA-S, Secretory IgA

Cortisol x 4, DHEA-S, Estradiol, Estriol, Melatonin, Progesterone, Testosterone, Secretory IgA

Cortisol x 4, DHEA-S, Estradiol, Estriol, Estrone, Melatonin, Progesterone, Testosterone, Secretory IgA