Russian Open Medical Journal · Published 2026-06-30 · DOI 10.15275/rusomj.2026.0205
Ali Alhamza, Abbas Mansour, Nazar Haddad
Background — There is no single test that can definitively diagnose hypothalamic-pituitary-adrenal (HPA) insufficiency (HPAI). The goal of our study was to evaluate the effectiveness of measuring serum cortisol, serum dehydroepiandrosterone sulfate (DHEA-S), and plasma corticotropin (ACTH) levels vs. the short cosyntropin stimulation test (standard dose of 250 μg) for the diagnosis of HPAI. Methods — This cross-sectional study was conducted at Faiha Specialized Diabetes, Endocrine, and Metabolism Center (FDEMC) in Basra, Iraq, from November 2021 through October 2022. All patients with suspected HPAI were assessed at baseline for serum cortisol, serum DHEA-S, and plasma ACTH, and then underwent a formal short cosyntropin stimulation test as the gold standard. Results — A total of 169 patients participated in the study. Of these, 134 (79.3%) were women. Although the overall age of the cohort ranged from 20 to 80 years (mean ± standard error: 38.8 ± 0.94 years), the majority (77.5%) represented the 21-50-year age range. The cutoff value of serum cortisol predicting an abnormal short cosyntropin test result was <5.31 μg/dL, with a maximum sensitivity and specificity of 87.7% and 90.4%, respectively. The serum DHEA-S level of <31.11 μg/dL predicted an abnormal short cosyntropin test result, with a sensitivity of 89.2% and a specificity of 62.7%. The least reliable parameter was the plasma ACTH level, with a cutoff value of <5.30 pg/mL, with the lowest sensitivity and specificity (68.8% and 74.5%, respectively). Conclusion — For excluding HPAI, the serum cortisol level at 9-11 a.m. has the best prognostic value, while DHEA-S has an intermediate value, and plasma ACTH is the least reliable test. The combination of serum cortisol and serum DHEA-S levels provides the best results for diagnosing HPAI.
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Alhamza, A., Mansour, A., Haddad, N. (2026). Use of Serum Cortisol, Plasma Corticotropin, and Serum Dehydroepiandrosterone Sulfate Levels in the Diagnosis of Hypothalamic-Pituitary-Adrenal Insufficiency. Russian Open Medical Journal. https://doi.org/10.15275/rusomj.2026.0205