Timed Urine Specimens (2-Hour, 4-Hour, 24-Hour)

For many urine chemistry procedures the specimen of choice is 24-hour urine. A 24-hour urine
collection is performed by collecting a person’s urine in a special container over a 24-hour
period. It always begins with an empty bladder so that the urine collected is not “left over” from
previous hours. This specimen shows the total amounts of wastes the kidneys are eliminating
and the amount of each.
Purpose
A 24-hour urine collection is noninvasive (the skin is not pierced). It is used to
assess kidney (renal) function and detects disease.
Example: Begin collecting the 24-hour urine specimen by voiding at 7:00 am and discarding the
urine. Collect all urine voided during the next 24 hours. At 7:00 am the next morning, void and
add the urine to the collection container. Keep the collection container refrigerated until delivery
to the laboratory.
Cortisol urine test
The cortisol urine test measures the level of cortisol in the urine. Cortisol is
a glucocorticoid (steroid) hormone produced by the adrenal gland.
Cortisol can also be measured using a blood or saliva test.
How the Test is Performed
A 24-hour urine sample is needed. You will need to collect your urine over 24 hours in a
container provided by the laboratory. Your health care provider will tell you how to do this.
Follow instructions exactly.
Because cortisol production by the adrenal gland can vary, the test may need to be done three
or more separate times to get a more accurate picture of average cortisol production.

Special considerations
Factors that interfere with this test are:
 Medications, including glucocorticoids, lithium, diuretics, ketoconazole, estrogens, and
tricyclic antidepressants
 Severe emotional or physical stress
Note: Due to these interfering factors, the urine cortisol may be tested on three or more
separate occasions to get a more accurate picture of average cortisol production.
Nursing considerations:
- Ask patient if she is able to void independently or needs assistance

References

DEXAMETHASONE SUPPRESSION TEST

A dexamethasone suppression test is primarily used to help diagnose Cushing syndrome.
Cushing syndrome indicates that you have an abnormally high level of cortisol. Cortisol is a
steroid hormone produced by the body during high levels of stress. (Abnormally low cortisol
levels can be a sign of Addison’s disease, which is not diagnosed by this test.)

Dexamethasone, which is like cortisol, lowers the amount of ACTH released by the pituitary
gland. This in turn lowers the amount of cortisol released by the adrenal glands. After a dose
of dexamethasone, cortisol levels often stay very high in people who have Cushing's
syndrome
What the test addresses

A dexamethasone suppression test measures how your cortisol levels are affected by
taking dexamethasone. Dexamethasone is a manmade corticosteroid similar to one produced
naturally by your adrenal glands. It’s prescribed to replace the natural chemical if your body isn’t
producing enough of it. It may also be prescribed as an anti-inflammatory agent that’s used to
treat arthritis and various blood, kidney, and eye disorders.
Your adrenal glands are located on top of your kidneys. In addition to producing cortisol, they
produce steroid hormones such as:

 androgens, which are male sex hormones

 cortisol
 epinephrine

 The test is also used to determine how well the adrenal glands respond to
adrenocorticotropic hormone (ACTH). ACTH is a hormone produced by the brain’s
pituitary gland. It has a number of functions, including the production of corticosteroids.
Too much ACTH can cause Cushing syndrome. In a healthy person, as the pituitary
glands make less ACTH, the adrenal glands make less cortisol. Dexamethasone should
decrease the amount of ACTH, which should then cause the amount of cortisol to
decrease.
 If you’re currently taking the corticosteroid medicine dexamethasone, your doctor may
recommend a dexamethasone suppression test to determine how it’s affecting cortisol
levels in your blood.
 Dexamethasone relieves inflammation related to arthritis and severe allergies, among
other conditions. When you take dexamethasone, which is very similar to cortisol, it
should decrease the amount of ACTH released into your blood. If your cortisol level is
high after taking a dose of dexamethasone, this is a sign of an abnormal condition.

Dexamethasone is classified as a corticosteroid (more precisely a glucocorticosteroid), and

has many uses in the treatment of cancer. One way that it works is to decrease inflammation
(swelling).

LATE-NIGHT SALIVARY CORTISOL TEST

A saliva cortisol test is done to measure the level of cortisol, a hormone in saliva. Cortisol is
made by the adrenal gland and has many functions. It helps the body use sugar (glucose) and
fat for energy (metabolism). It also helps the body manage stress.
Complete and return this form with your specimen.
Specimens received without this information may be rejected.
Instructions for the Patient
• Do not brush teeth before collecting specimen. •
Do not eat or drink for 15 minutes prior to specimen collection.
• Collect specimen between 11 pm and midnight.*
• Record the exact collection date and time on BOTH the container label on the swab tube and
in the yellow box on this form.
Collection Date (mm-dd-yyyy) _____________________ Time (hh:mm) _____________ am
pm
To Use the Salivette
1. Remove top cap of the tube to expose the swab.
2. Place swab directly into the mouth by tipping the tube so the swab falls into the mouth. Do
not let fingers touch the swab.
3. Keep the swab in the mouth for approximately 2 minutes. Roll the swab in the mouth. Do not
chew the swab.
4. Spit the swab back into the tube. Do not let fingers touch the swab.
5. Replace the cap. Make sure cap is pushed on tightly.
6. Record the exact collection date and time on barcode label and on this form.
7. Return the tube (with swab) and this sheet to your healthcare provider within 24 to 48 hours.
Be sure to write the collection date and time on this form. *Note: The doctor may require a
different collection time. Specimens may also be collected from 7 to 9 am or 3 to 5 pm,
depending

1. Advice patient to resume usual activity and food intake.

2.

Medications to control excessive production of cortisol at the adrenal gland include

ketoconazole, mitotane (Lysodren) and metyrapone (Metopirone). Mifepristone (Korlym,
Mifeprex) is approved for people with Cushing syndrome who have type 2 diabetes or glucose
intolerance.

KETOCONAZOLE
Ketoconazole is effective for long term control of hypercortisolism of either pituitary or adrenal
origin. Its effect appears to be mediated by inhibition of adrenal 11 beta-hydroxylase and 17,20-
lyase, and it, in some unknown way, prevents the expected rise in ACTH secretion in patients
with Cushing's disease.
Ketoconazole caused rapid normalisation of cortisol and ACTH that persists over 10 years on
treatment, while adrenals show no change in shape or
size. Ketoconazole decreases cortisol in patients with Cushing's syndrome, and may prevent
adrenal overgrowth.
Some of the more common side effects of ketoconazole include:
 nausea.
 headache.
 diarrhea.
 stomach pain.
 abnormal liver function test results.
MITOTANE
- Mitotane is a cytotoxic agent used for the treatment of adrenocortical carcinoma, but it is
also of value in controlling hypercortisolemia in benign causes of Cushing's
syndrome. Mitotane reduces cortisol production by blocking cholesterol side-chain
cleavage and 11 β-hydroxylase.

AMINOGLUTETHIMIDE (AG)
 - Aminoglutethimide is an adrenal steroid inhibitor, which means it interferes with the
hormones produced by the adrenal gland.
- sold under the brand names Elipten, Cytadren, and Orimeten among others, is a
medication which has been used in the treatment of seizures, Cushing's syndrome,
Cytadren (aminoglutethimide) is indicated for the suppression of adrenal function
in selected patients with Cushing's syndrome. Morning levels of plasma cortisol
in patients with adrenal carcinoma and ectopic ACTH-producing tumors were
reduced on the average to about one half of the pretreatment levels, and in
patients with adrenal hyperplasia to about two thirds of the pretreatment levels,
during 1-3 months of therapy with Cytadren (aminoglutethimide) . Data available
from the few patients with adrenal adenoma suggest similar reductions in plasma
cortisol levels. Measurements of plasma cortisol showed reductions to at least
50% of baseline or to normal levels in one third or more of the patients studied,
depending on diagnostic groups and time of measurement.
PASIREOTIDE
- Pasireotide injected twice daily during up to 12 months to control cortisol excess in
patients with residual or persistent Cushing's disease was found to reduce the size of
pituitary tumors in a high proportion of the 53 patients in which residual tumor was still
visible at initiation of this medical therapy,” Andre
Corticosteroid medications used to treat asthma, arthritis, certain cancers, and other
conditions can also cause high cortisol levels when taken in high doses or for a long period of
time. Commonly prescribed corticosteroids include: prednisone (Deltasone, Prednicot,
Rayos) cortisone (Cortone Acetate)Apr 17, 2017

Ang Kasinatian sa mga Pilipino nga Nagpuyo sa

Cebu Nag-edad 35-75 nga adunay Type 2
Diabetes Mellitus
Kabalo ko nga kining panuhid kay adunay mga sikolohikal nga risko tungod kay mahimo kong
makahinumdom sa akong mga kasinatian nga sensitibo. Busa, ipaubos sa mga imbestigador ang kini nga
mga risgo pinaagi sa pagtugot kanako nga makaistorya ug dili mangutana ug bisan unsang mga
pangutana nga mahimong makaapekto kanako sa dili mayo nga pamaagi. Pwede ko nga mangayo ug
tambag kung tugotan ko o dili ang akong kaugalingon nga muapil ani nga panuhid. Paghuman, hiposon
pag-ayo sa mga imbestigador ang datos nga nakolekta aron malikayan ang potensyal nga mapagawas
ang kompidensyal nga mga datos. Nakahimatngon ko nga direkta akong makabenipisyo ani nga panuhid
pinaagi sa pagkuha ug dugang nga kahibalo bahin sa akong kondisyon nga type 2 diabetes mellitus ug
ang mga epekto niini sa kinabuhi sa mga tawo nga adunay parehas nga sakit sa ako. Gawas kanako,
mahimo usab nga makabenipisyo ang ubang tawo sa kini nga pagtuon pinaagi sa pagkabalo kung giunsa
kini pag-atubang sa mga tawo, labi na ang mga nagtrabaho sa ospital, mga pamilya sa adunay type 2
diabetes mellitus, ug mga umaabot nga imbestigador.
Makadawat ako ug Php 100.00 gikan sa mga imbestigador ingon insentibo alang sa pag-apil nako sa ilang
panuhid. Nakahimatngon ko nga maprotektahan sa mga imbestigador ang akong pribado nga mga
imppormasyon sa tanan nga mga oras.
Boluntaryo ang akong pag-apil ug dili ko hatagan sa mga imbestigador ug silot o walaon ang mga
benepisyo kung mudesisyon ko nga dili moapil. Aduna ako’y katungod nga muatras o pag-ngan ang mga
impormasyon nga akong ihatag bisan kanus-a. Aduna usab ko’y karapatan nga makabalo kung unsa ang
resulta sa panuhid labi na kung kini nahuman na. Akong ipahibalo kini sa nanguna na imbestigador.

Kung aduna pa ko’y gusto nga pagahisgutan sa mga imbestigador, mga paglaraw, mga kabalaka bahin sa
akong pag-apil nga gusto nakong isulti, pahibal-on sila sa bisan unsang mga problema, kung gusto ko
muhawa sa pagtuon, makontak ko sila pinaagi sa mga mosunod:

Nanguna na Imbestigador: Achilleus Kyle Fernandez

Email Address:  achilleuskylejosephfernandez@gmail.com
Contact Number:  09196340906

If I want to obtain more information about the study, ask questions, discuss any concerns about the
study, report problems, leave the study before it is finished; please contact through the following: 
Lead Investigator: Vanessa R. Bullecer
Email address: vanessarbullecer@gmail.com 
Phone: 09183021523

I am aware that Velez College Ethics Review Committee (VCERC) has approved the study, and may reach
through the following contact information regarding the rights of study participants, including
grievances and complaints: 

Name: Mrs.Kachiri Salibio-Mercadal, RN, MN, MA(c) 

Address: 41 F. Ramos St., Cebu City 
Email: velezrc@gmail.com 
Tel: 253-7388 

Akong nabasa ug nasabtan ang mga butang nga giistorya sa kin inga porma sa pagtugot.
Natubag sad ang akong mga pangutana ug wala na akoy gikabalak-an. Adunay usa ka kopya niining
akong gipirmahan nga porma sa pagtugot nga akong madawat.

___________________________  ___________________________ 
Pirma sa Impormante Petsa
___________________________  ___________________________ 
Pirma sa Nagsaksi  Petsa 
___________________________  ___________________________ 
Pirma sa Imbestigador  Petsa
___________________________  ___________________________ 
Pirma sa Imbestigador Petsa
___________________________  ___________________________ 
Pirma sa Imbestigador  Petsa
___________________________  ___________________________ 
Pirma sa Imbestigador Petsa
Nasayod ako nga naaprubahan na sa Velez College Ethics Review Committee (VCERC) ang
kini nga pagtuon. Bahin sa akong katungod isip isa ka partisipante, apil na ang mga reklamo ug
kabalaka, pwede nakong ikontak ang naa sa ubos nga impormasyon: