Use of Serum Cortisol, Plasma Corticotropin, and Serum Dehydroepiandrosterone Sulfate Levels in the Diagnosis of Hypothalamic-Pituitary-Adrenal Insufficiency

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