High cortisol metabolite levels in a dried urine test, despite low blood cortisol, may indicate high cortisol turnover rather than exhausted adrenal glands.

“let's say that someone there they're showing really low cortisol and they've been told that they have adrenal fatigue but then you run a Dutch panel and you actually see really really high levels of cortisol metabolites meaning the cortisol is just being it's being metabolized very very quickly but it's not as well the adrenal glands aren't actually making cortisol or that the adrenal glands are exhausted or grouped out they just might have you know high cortisol turnover and you know in a case like that sometimes that would be related to something like hyperthyroidism for example”