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BASAL MORNING CORTISOL IN PATIENTS REFERRED FOR ACTH STIMULATION TESTING: DIAGNOSTIC PERFORMANCE IN A RETROSPECTIVE
M Erdem1, C Aydin2, B Helvaci3
1Department of Endocrinology and Metabolism, Sincan Training and Research Hospital, Ankara.
Acta Endocrinologica (Bucharest, Romania : 2005)
|August 8, 2026
Summary
Early-morning basal cortisol offers diagnostic insights for adrenal insufficiency (AI) but cannot rule out the condition alone. Dynamic testing remains essential for accurate diagnosis and patient safety.
Area of Science:
- Endocrinology
- Clinical Diagnostics
Background:
- Accurate diagnosis of adrenal insufficiency (AI) is vital to prevent severe complications.
- Early-morning basal serum cortisol is a common initial test, but its effectiveness varies.
Purpose of the Study:
- To assess the diagnostic accuracy of early-morning basal cortisol in patients undergoing ACTH stimulation testing.
- To determine if basal cortisol levels alone can reliably exclude AI.
Main Methods:
- Retrospective cohort study of 404 adult outpatients.
- Analysis of early-morning basal cortisol measurements and ACTH (250 µg) stimulation test results.
- Logistic regression and ROC analyses were used to evaluate diagnostic performance.
Main Results:
- Adrenal insufficiency was diagnosed in 6.7% of patients.
- Basal cortisol showed moderate discriminatory ability (AUC = 0.85) for AI.
- Some patients with clinically relevant basal cortisol levels failed ACTH testing.
Conclusions:
- Early-morning basal cortisol is informative but insufficient to exclude AI.
- Confirmatory dynamic testing is necessary for safe and accurate diagnosis of adrenal insufficiency.
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