Cortisol, AM, baseline

This test measures your cortisol level in the morning, when it is naturally at its highest, to check whether your adrenal glands are producing the right amount of this important stress hormone. Results outside the normal range may need follow-up testing to understand the cause.

When elevated: Persistently elevated AM cortisol may indicate endogenous hypercortisolism (Cushing syndrome or disease), chronic physiological stress, or HPA axis dysregulation, and is associated with increased risks of metabolic syndrome, hypertension, osteoporosis, immune suppression, and mood disorders. Elevated values in the context of clinical features of Cushing syndrome should prompt confirmatory testing such as 24-hour urinary free cortisol, late-night salivary cortisol, or low-dose dexamethasone suppression testing. Transient elevations are common with acute illness, pain, or psychological stress and do not necessarily indicate pathology. When low: A low AM cortisol (generally below 3–5 µg/dL) raises concern for primary adrenal insufficiency (Addison disease), secondary adrenal insufficiency due to pituitary or hypothalamic dysfunction, or suppression from exogenous glucocorticoid use. Adrenal insufficiency is a potentially life-threatening condition, particularly during physiological stress, and warrants prompt clinical evaluation including ACTH stimulation testing and measurement of plasma ACTH. Symptoms such as fatigue, orthostatic hypotension, hyponatremia, and hyperpigmentation (in primary insufficiency) should heighten clinical suspicion.

Morning cortisol reflects your body's stress-recovery balance and is particularly relevant to athletes managing training load and overtraining risk. Chronically elevated baseline cortisol may indicate inadequate recovery, poor sleep quality, or accumulated training stress, while consistently low levels can signal overreaching or adrenal fatigue; tracking trends helps optimize periodization and detect when recovery interventions are needed.