What's your morning cortisol?

[space8]

Hi there!

Has anyone had their morning cortisol tested? And if so what was the results?

I had one that came back low years ago but it was then retested and came up normal.

The last one came up at 280 (ref range 135 - 540) so I thought it was fine.

I am however right now being evaluated for some type of endocrine disorder (I'm not sure what this will show yet) and started searching for stuff related to that and came across a table for the evaluation of adrenal insufficiency from NHS where I kind of got the idea that 280 might be somewhat low?

It says that:

- 9 a.m. cortisol <100 nmol/L suggests adrenal insufficiency
- 9 a.m. cortisol >400 nmol/L makes adrenal insufficiency unlikely
- For 9 a.m. cortisol of 100-400, consider a short synacthen test

It's unlikely that I have Addison's or anything like that but I know you can have e.g., secondary adrenal insufficiency which isn't as acute.

What's your experience? Should 280 be interpreted as low? Or is it perfectly normal?

 

[Shanti1]

Hi @space8-

Your level certainly looks normal relative to the reference given by your lab. I'm in the US so I'm used to seeing cortisol in ug/dL. Your value of 280nmol/L converts to 10.15ug/dL, which most docs would not bat an eye at. My AM levels are typically 9 on a US test (AM reference range 6.2-19.4 or 171- 535 nmol/L).

Once could argue that, from a functional medicine perspective, a healthy cortisol would be in the top half of the reference range, but this is still far from adrenal insufficiency. Many of us report sub-optimal cortisol levels and studies in people with long-COVID report lower cortisol than healthy controls. When I do a salivary cortisol test, I test much lower. Salivary cortisol measures your free vs bound cortisol levels. Free cortisol is more available for cells to use since it is not bound to a protein.

I'm not sure why the discrepancy with the NHS info, did that page provide any references?

 

[space8]

Hi! Thank you so much for your reply @Shanti1

Yeah, that's what I thought as well. 280 sounded normal (or on the lower side since it's supposed to be the highest in the morning as you say).

I found it here: https://www.ouh.nhs.uk/biochemistry/tests/tests-catalogue/cortisol.aspx and saw the same info/reference ranges posted on a page used by medical professionals in my country.

Perhaps it's not so straight-forward with cortisol? So some people with actual adrenal insufficiency might occasionally test between 100-399 but not above that - or something like that.

Another page (https://gpnotebook.com/simplepage.cfm?ID=-1127219180) wrote that "random measurements have a low sensitivity for Addison's disease due to the pulsatile nature and diurnal variation of cortisol secretion" so I'm not sure if they're only referring to the diurnal variations or also, as said above, that you sometime test in that range even if you do suffer from AI when just taking a random morning sample.

Since you test lower on salivary cortisol have you ever had a doctor investigate it further or tried hydrocortison therapy?

 

[Shanti1]

Since you test lower on salivary cortisol have you ever had a doctor investigate it further or tried hydrocortison therapy?

Yes, I have tried low dose hydrocortisone and adrenal glandular (over the counter desiccated animal adrenal gland). Like so many things, they seem to help initially, but then loose there effectiveness for me over time. However, I still take the adrenal glandular once or twice a week. Many people on this forum feel they are helped by taking low dose hydrocortisone or a glandular.

I found it here: https://www.ouh.nhs.uk/biochemistry/tests/tests-catalogue/cortisol.aspx and saw the same info/reference ranges posted on a page used by medical professionals in my country.

Perhaps it's not so straight-forward with cortisol? So some people with actual adrenal insufficiency might occasionally test between 100-399 but not above that - or something like that.

Merck manual gives morning cortisol < 100nmol/L as confirmatory. However, the diagnostic criteria for adrenal insufficiency as dictated by Up-To-Date provides some rational for the info you are seeing (see below). It looks to be based on a 1998 study. Nonetheless, I don't see many docs doing full workups whenever a cortisol is mid-range of normal, maybe if someone is symptomatic or has other signs or lab work that indicates a problem. Of course, if your docs suspect it, it is important to follow through. That's my take, for what it is worth.

From Up-to-Date:

Morning serum cortisol concentration — In normal subjects, serum cortisol concentrations are higher in the early morning (about 6 AM), ranging from 10 to 20 mcg/dL (275 to 555 nmol/L), than at other times of the day. An early morning low serum cortisol concentration (less than 3 mcg/dL [80 nmol/L]) is strongly suggestive of adrenal insufficiency [12-15].

One report evaluated the utility of basal morning serum cortisol measurements in the diagnosis of adrenal insufficiency [16]. Values below 5 mcg/dL (138 nmol/L) had almost 100 percent specificity, but only 36 percent sensitivity (as defined by a subnormal serum cortisol response to insulin-induced hypoglycemia). Using a higher serum cortisol of 10 mcg/dL (275 nmol/L) as the criterion for adrenal insufficiency increased the sensitivity to 62 percent, but reduced the specificity to 77 percent. Thus, a low morning serum cortisol concentration alone is not a reliable predictor of deficient adrenal function.

Another page (https://gpnotebook.com/simplepage.cfm?ID=-1127219180) wrote that "random measurements have a low sensitivity for Addison's disease due to the pulsatile nature and diurnal variation of cortisol secretion" so I'm not sure if they're only referring to the diurnal variations or also, as said above, that you sometime test in that range even if you do suffer from AI when just taking a random morning sample.

It is both diurnal and pulsatile. Of course it is highest in the morning, but it also is pulsatile in response to exercise, stress, and blood sugar levels.