She did not have diabetes or hypertension. In preparation, her bloods were collected and a random cortisol was requested, which came back at 763 nmol/L. Salivary cortisol has better specificity for diagnosis of Cushing’s syndrome than urinary cortisol and is easier to collect if this test is available, it is increasingly preferred to urinary free cortisolĪ 67 year old woman with no significant medical history required urgent orthopaedic surgery after a fall. If high clinical suspicion for hypercortisolaemia, patients should be referred to specialist care for testing and interpretation of resultsĭynamic testing is often required to confirm cortisol deficiency or excess given the pulsatile nature of cortisol secretion and the influence of diurnal variation, feedback control and stress. Random, untimed cortisol levels are of limited clinical valueĬortisol measured at around 8-9 am (when the level is expected to be highest) is the preferred initial screening test for cortisol deficiency
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