Evaluation of morning cortisol in diagnosis and management of adrenal insufficiency in a tertiary hospital in Central Pahang
https://doi.org/10.15605/jafes.041.S1
- Author:
Saravanaa Nalliah
1
;
See Chee Keong
1
Author Information
1. Hospital Raub, Hospital Sultan Haji Ahmad Shah
- Publication Type:Journal Article
- MeSH:
Hydrocortisone;
Adrenal Insufficiency;
Tertiary Care Centers
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):19-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Adrenal insufficiency (AI) is a life-threatening condition
that frequently presents with non-specific symptoms,
complicating early diagnosis. Morning serum cortisol
serves as an effective initial screening tool for assessing
the hypothalamic-pituitary-adrenal (HPA) axis, potentially
reducing the necessity for dynamic investigations such as
the Short Synacthen Test (SST). This study aims to assess
the clinical indications for morning cortisol testing and
evaluate institutional compliance with guideline-based
cortisol cut-offs, the initiation of hydrocortisone therapy,
and the provision of “sick day” education.
Methodology:A retrospective cross-sectional study was conducted
among inpatients at a tertiary hospital in Central Pahang
who underwent morning cortisol evaluation between
March and August 2025. Data regarding demographics,
indications, biochemical results, and clinical management
were analyzed using SPSS version 26.0.
Results:Among the 111 patients included (mean age: 54.96 ±
15.88 years), the primary indications for testing were
hyponatremia (54.1%), hypotension (27.9%), and a history
of traditional medication use (26.1%). Based on Endocrine
Society guidelines: <150 nmol/L (AI likely): 16.2%, 150–300
nmol/L (Borderline): 26.1%, and >300 nmol/L (AI unlikely):
57.7%. Notably, only 10 of the 18 patients with cortisol
levels <150 nmol/L were formally diagnosed and initiated
on appropriate therapy. In the borderline group, only two
patients underwent an SST. Although 12 patients overall
were treated for AI, only eight received documented “sick
day” education. Low cortisol levels were significantly
associated with hyponatremia, hypotension, and traditional
medication use, and demonstrated a negative correlation
with serum sodium and albumin levels.
Conclusion:Morning serum cortisol is a valuable screening tool for
AI, particularly in patients presenting with hyponatremia
or hypotension. However, significant gaps persist in
follow-up management, confirmatory testing, and patient
education. Implementing standardized protocols and
enhancing clinician education are essential to optimize care.
- Full text:2026072811133457397EP_A002.pdf
