Cortisone is the inactive form of cortisol. Cortisone shows minimal biological activity per se, reflecting negligible affinity for the glucocorticoid and aldosterone receptors. The kidney, colon and saliva gland have lots of activity for changing cortisol to cortisone (active to inactive) to keep cortisol off the aldosterone receptor. Cortisone is converted back in the liver, fat, etc. (inactive to active).
Why are we looking at cortisone in addition to cortisol on the DUTCH test?
- It can help to confirm the diurnal pattern of cortisol
- It does NOT necessarily tell you if cortisol or cortisone is preferred overall (look to the metabolites THE and THF for this)
- It helps you identify if there is potential cortisol (hydrocortisone) contamination. Ex. Somebody puts cortisol cream on their knees at bedtime. In this situation the evening cortisol levels could be inflated and it would then make more sense to look at the cortisone levels. If cortisone levels go with it (also elevated at night) then we have real physiological production of cortisol. If, on the other hand, the cortisone is much lower at night it is likely that the cortisol cream (hydro-cortisone = cortisol) the cortisol levels were “contaminated”. This is a rare case, but when it does happen the cortisone levels become your best representation of your cortisol pattern throughout the day.
- What you see in urine (or saliva) as free cortisone actually reflects free cortisol that enters the kidney and is converted to cortisone locally before excretion. This makes free cortisone a secondary, confirmatory marker for the up-and-down pattern of free cortisol.
- When free cortisol is high and cortisone is NOT, free cortisol levels may not be quite as high as the cortisol levels themselves imply…OR free cortisol could be elevated due to a metabolic preference (away from cortisone) more so than increased production.
- The relationship between free cortisol and free cortisone tells us some information about how sharply the kidney is deactivating cortisol. But it doesn’t tell us SYSTEMICALLY which one is predominating (use the ratio of the metabolites for that).
24hr Free Cortisone
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