{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:52:15Z","timestamp":1787017935566,"version":"build-2736575974"},"reference-count":31,"publisher":"S. Karger AG","issue":"12","license":[{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.karger.com\/Services\/SiteLicenses"},{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.karger.com\/Services\/SiteLicenses"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neuroendocrinology"],"published-print":{"date-parts":[[2021]]},"abstract":"<jats:p>&lt;b&gt;&lt;i&gt;Introduction:&lt;\/i&gt;&lt;\/b&gt; According to guidelines, a morning serum cortisol level &amp;#x3c;83 nmol\/L is diagnostic for central adrenal insufficiency (CAI), a value &amp;#x3e;414 nmol\/L excludes CAI, while values between 83 and 414 nmol\/L require stimulation tests. However, there are no currently reliable data on morning serum cortisol for prediction of cortisol response to insulin tolerance test (ITT). &lt;b&gt;&lt;i&gt;Objective:&lt;\/i&gt;&lt;\/b&gt; Using the receiver-operating characteristic curve analysis, the purpose of this study was to detect the morning serum cortisol cutoff with a specificity (SP) or a sensitivity (SE) above 95% that identify those patients who should not be tested with ITT. &lt;b&gt;&lt;i&gt;Methods:&lt;\/i&gt;&lt;\/b&gt; We included 141 adult patients (83 males) aged 42.7 \u00b1 12.3 (mean \u00b1 standard deviation) years old. Based on the serum cortisol response to ITT, patients have been divided into 2 groups: subjects with CAI (peak serum cortisol &amp;#x3c;500 nmol\/L; 65 patients) and subjects with preserved adrenocortical function (peak cortisol &amp;#x3e;500 nmol\/L; 76 patients). &lt;b&gt;&lt;i&gt;Results:&lt;\/i&gt;&lt;\/b&gt; The best morning cortisol cutoff, in terms of SE (87.7%) and SP (46.1%), was \u2264323.3 nmol\/L. The cutoff of morning serum cortisol concentration that best predicted a deficient response to ITT was \u2264126.4 nmol\/L (SE 13.8%, SP 98.7%). The cutoff of morning serum cortisol concentration that best predicted a normal response to ITT was &amp;#x3e;444.7 nmol\/L (SE 96.9%, SP 14.5%). &lt;b&gt;&lt;i&gt;Conclusions:&lt;\/i&gt;&lt;\/b&gt; This is the first study that identifies a morning serum cortisol cutoff that best predict the response to ITT in order to simplify the diagnostic process in patients with suspected CAI. A new diagnostic flow-chart for CAI is proposed.<\/jats:p>","DOI":"10.1159\/000514216","type":"journal-article","created":{"date-parts":[[2021,1,6]],"date-time":"2021-01-06T17:01:25Z","timestamp":1609952485000},"page":"1238-1248","source":"Crossref","is-referenced-by-count":18,"title":["Morning Serum Cortisol Level Predicts Central Adrenal Insufficiency Diagnosed by Insulin Tolerance 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