{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T22:14:27Z","timestamp":1787004867140,"version":"build-2736575974"},"reference-count":22,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Horm Metab Res"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The diagnosis of adrenal insufficiency (AI) is challenging due to nonspecific\n                    symptoms. Measuring 8 AM serum cortisol levels is a common screening test, but\n                    its accuracy in predicting AI remains uncertain. This study aimed to evaluate\n                    the predictive diagnostic value of basal morning cortisol levels in suspected AI\n                    cases and compare them with levels in healthy individuals. We have conducted a\n                    retrospective multicentric cohort study. The study included an epidemiological\n                    cohort (patients with AI suspicion) and a control cohort (healthy volunteers).\n                    In the epidemiological cohort an ACTH-stimulation test was performed to confirm\n                    (AI group) or exclude (non-AI group) the disease. We have included 273\n                    individuals (168 suspected AI cases and 105 controls). Basal cortisol levels\n                    were higher in the control group compared to the AI-suspected group (9.9\u00b13.2\n                    \u03bcg\/dl vs. 7.7\u00b13.3 \u03bcg\/dl, p&lt;0.001), though both were below the 15 \u03bcg\/dl\n                    recommended threshold for excluding AI. Within the epidemiological cohort, even\n                    after a propensity score matching, taking into consideration sex, age and AI\n                    symptoms complaints, no significant difference in basal cortisol levels was\n                    found between patients with and without AI [6.10 (4.43; 8.45) vs. 7.14 (4.68;\n                    12.15), p=0.128]. Logistic regression and ROC curve analyses showed a low\n                    predictive value for basal cortisol, with a positive predictive value of 18.9%\n                    and low specificity. AI patients more frequently experienced hypotension and\n                    nausea, compared with non-AI patients. Morning cortisol levels alone are\n                    unreliable for diagnosing AI. Revising cortisol cutoffs and incorporating\n                    symptom-based criteria may improve diagnostic accuracy.<\/jats:p>","DOI":"10.1055\/a-2509-3766","type":"journal-article","created":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T18:34:53Z","timestamp":1737657293000},"page":"170-176","source":"Crossref","is-referenced-by-count":1,"title":["Reassessing the Role of Morning Cortisol in Adrenal Insufficiency\n                    Diagnosis: Insights from a Multicentric Cohort"],"prefix":"10.1055","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8305-4244","authenticated-orcid":false,"given":"Maria Leonor","family":"Guia Lopes","sequence":"additional","affiliation":[{"name":"Endocrinology, Centro Hospitalar de Lisboa Ocidental\n                    EPE, Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catarina","family":"Regala","sequence":"additional","affiliation":[{"name":"Endocrinology, Instituto Portugu\u00eas de Oncologia de\n                    Lisboa Francisco Gentil EPE, Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clotilde","family":"Limbert","sequence":"additional","affiliation":[{"name":"Endocrinology, Centro Hospitalar de Lisboa Ocidental\n                    EPE, Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiago Nunes","family":"Silva","sequence":"additional","affiliation":[{"name":"Endocrinology, Instituto Portugu\u00eas de Oncologia de\n                    Lisboa Francisco Gentil EPE, Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o","family":"Sequeira Duarte","sequence":"additional","affiliation":[{"name":"Endocrinology, Centro Hospitalar de Lisboa Ocidental\n                    EPE, Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeriano","family":"Leite","sequence":"additional","affiliation":[{"name":"Endocrinology, Instituto Portugu\u00eas de Oncologia de\n                    Lisboa Francisco Gentil EPE, Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susana","family":"Prazeres","sequence":"additional","affiliation":[{"name":"Laboratory of Endocrinology, Pathology Department,\n                    Instituto Portugu\u00eas de Oncologia de Lisboa Francisco Gentil EPE, Lisboa,\n                    Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,1,23]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1210\/jc.2015-1710","article-title":"Diagnosis and treatment of primary adrenal insufficiency: an endocrine society\n                    clinical practice guideline","volume":"101","author":"S R Bornstein","year":"2016","journal-title":"J Clin Endocrinol 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Synacthen test outcome: a\n                    retrospective analysis","author":"R Ravindran","year":"2022","journal-title":"Clin Med Insights Endocrinol Diabetes"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/1472-6823-13-3","article-title":"Predictive factors of adrenal insufficiency in patients admitted to acute\n                    medical wards: a case control study","volume":"13","author":"J B Oboni","year":"2013","journal-title":"BMC Endocr Disord"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1136\/postgradmedj-2020-138514","article-title":"Diagnostic performance of morning serum cortisol as an alternative to short\n                    synacthen test for the assessment of adrenal reserve; a retrospective study","volume":"98","author":"R Kumar","year":"2022","journal-title":"Postgrad Med J"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"G25","DOI":"10.1093\/ejendo\/lvae029","article-title":"European society of endocrinology and endocrine society joint clinical\n                    guideline: diagnosis and therapy of glucocorticoid-induced adrenal\n                    insufficiency","volume":"190","author":"F Beuschlein","year":"2024","journal-title":"Eur J Clin Endocrinol"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1111\/cen.14934","article-title":"\u201cA morning cortisol is the most effective clinical predictor of short synacthen\n                    test outcome\u201d: a tertiary care centre experience","volume":"99","author":"SA D Mathara Diddhenipothage","year":"2023","journal-title":"Clin Endocrinol (Oxf)"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"100180","DOI":"10.1016\/j.endmts.2024.100180","article-title":"Predictive value of different thresholds of morning cortisol in diagnosing\n                    adrenal insufficiency","volume":"16","author":"A A Ghasham","year":"2024","journal-title":"Endocr Metab Sci"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1210\/jc.2005-1131","article-title":"The long-term predictive accuracy of the short synacthen (corticotropin)\n                    stimulation test for assessment of the hypothalamic-pituitary-adrenal axis","volume":"91","author":"A Agha","year":"2006","journal-title":"J Clin Endocrinol Metab"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1530\/eje.0.1390580","article-title":"How reliable is the short synacthen test for the investigation of the\n                    hypothalamic-pituitary-adrenal axis?","volume":"139","author":"V Bangar","year":"1998","journal-title":"Eur J Endocrinol"}],"container-title":["Hormone and Metabolic Research"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2509-3766.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,6]],"date-time":"2025-03-06T19:04:49Z","timestamp":1741287889000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2509-3766"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,23]]},"references-count":22,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2025,3,6]]},"published-print":{"date-parts":[[2025,3]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2509-3766","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0018-5043","1439-4286"],"issn-type":[{"value":"0018-5043","type":"print"},{"value":"1439-4286","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,23]]}}}