DUTCH Plus

What is the DUTCH Plus Test?

The DUTCH Plus™ offers an extensive assessment of sex and adrenal hormones and their metabolites. It also assesses the Cortisol Awakening Response (CAR) and includes the insomnia cortisol sample.

When we wake up, cortisol levels begin to rise by an average of 50%, and even 30 minutes after waking, cortisol levels will still show this sharp increase. 1-hour after waking, cortisol levels have peaked and begin to decline. This “mini stress test” measures the rise and fall of cortisol levels throughout the day.  

The size of this increase correlates with the Hypothalamus-Pituitary-Adrenal Axis function.

Under physical or psychological stress, the hypothalamus induces the pituitary gland to make the adrenocorticotropic hormone (ACTH). ACTH then stimulates the adrenal glands to make cortisol, a stress hormone, and Dehydroepiandrosterone (DHEA) and Dehydroepiandrosterone sulfate (DHEAS). The DUTCH Plus Test has been designed to test these hormones.

Which Patients is the DUTCH Plus Best Used For?

Examples of common conditions related to less severely abnormal cortisol levels include fatigue, depression, insomnia, fibromyalgia, anxiety, inflammation, and more.

The DUTCH Plus test should be considered when patients present the following symptoms and conditions linked to adrenal dysregulation:

• Premenstrual syndrome,
• Peri-menopause symptoms
• Infertility
• Unexplained abdominal weight gain (apple-shaped body)
• IBS – irritable bowel
• Muscle pain or rapid muscle/joint breakdown
• Headaches including migraine
• Heart disease
• High blood pressure
• Blood sugar deregulation
• Anxiety
• Depression
• Fatigue
• Insomnia
• Injuries that are slow to heal
• Hypothyroid symptoms or diagnosis

In addition, a low or blunted Cortisol Awakening Response can result from an under-active HPA Axis. These include:

• Seasonal affective disorder
• Excessive psychological burnout
• PTSD
• Chronic fatigue
• Sleep apnea
• Poor sleep in general
• Chronic pain.
• A decreased CAR has also been associated with systemic hypertension, postpartum depression, functional GI diseases, and autoimmune diseases.

An elevated Cortisol Awakening Response can be a result of an over-reactive HPA Axis. These include:

• Glycemic dysregulation
• Ongoing job-related stress (anticipatory stress for the day)
• Pain
• General depression

What Type of Sample is Needed to Complete the DUTCH Plus Test?

The DUTCH Plus requires four dried urine samples and five saliva samples. These samples should be collected over a day, from waking to bedtime. A quick saturation of saliva swabs upon awakening and at 30 and 60 minutes after waking provide what is required to assess a patient’s CAR.

*The test cannot be ordered for patients under 12 years of age.