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Related Experiment Video

Updated: Jun 25, 2026

A Modified Trier Social Stress Test for Vulnerable Mexican American Adolescents

A Modified Trier Social Stress Test for Vulnerable Mexican American Adolescents

Published on: July 10, 2017

A subnormal peak cortisol response to stimulation testing does not predict a subnormal cortisol production rate.

A N Paisley¹, S V Rowles, D Brandon

¹Department of Endocrinology, Christie Hospital, Manchester M20 4BX, United Kingdom.

The Journal of Clinical Endocrinology and Metabolism

|February 26, 2009

Summary

A suboptimal peak cortisol response to hypoglycemia does not automatically mean a low cortisol production rate (CPR). These findings suggest that lifelong glucocorticoid replacement therapy should not be initiated solely based on these provocative tests.

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Area of Science:

Endocrinology
Metabolic Disorders
Hormone Replacement Therapy

Background:

Lifelong glucocorticoid replacement therapy decisions often rely on cortisol stimulation tests.
The accuracy of provocative tests in guiding glucocorticoid initiation needs further investigation.

Purpose of the Study:

To investigate the relationship between peak cortisol response during insulin-induced hypoglycemia and daily cortisol production rate (CPR).
To determine if provocative tests accurately indicate the need for lifelong glucocorticoid replacement therapy.

Main Methods:

Ten patients with pituitary disease and suboptimal peak cortisol response underwent CPR measurement using isotope dilution and gas chromatography-mass spectrometry.
24-hour urinary free cortisol (UFC) was also measured.

Main Results:

A strong positive correlation (r = 0.75; P = 0.02) was observed between peak stimulated cortisol and CPR.
All patients had CPR within or above the reference range, despite suboptimal peak cortisol response.
24-hour UFC showed no significant correlation with serum cortisol or CPR.

Conclusions:

This study demonstrates a significant correlation between CPR and peak cortisol during hypoglycemic challenge.
A suboptimal peak cortisol response does not necessarily indicate a low CPR and should not automatically trigger lifelong glucocorticoid replacement.
Urinary free cortisol (UFC) is unhelpful in assessing these patients.