Adrenal Insufficiency Probability Score

8AM - 9AM Morning Cortisol

Guidelines & Evidence

Verified

Last Review: 2026

When to Use

When to evaluate

Unexplained weight loss, fatigue, malaise, or abdominal pain.

Unexplained hyponatremia, particularly if accompanied by hyperkalemia.

Unexplained hypotension, especially orthostatic refractory to fluids.

Hyperpigmentation of creases and mucous membranes (Primary AI).

Patients with other autoimmune endocrine diseases (Type 1 DM, vitiligo, hypothyroidism).

How it Works

Morning Cortisol Interpretation (drawn 8-9 AM)

Cortisol Level (µg/dL)	Probability	Next Action
< 3 µg/dL (<80 nmol/L)	AI highly probable / confirmed	Treat, then investigate cause
3 – 14.9 µg/dL	Indeterminate	Perform Short Synacthen Test (CST)
≥ 15 µg/dL (415 nmol/L)	AI unlikely (in general population)	Look for other causes

Last Comprehensive Review: 2026

Recent Journal Updates

British J HaematologyJul 22, 2026

Immunoglobulin replacement after chimeric antigen receptor T‐cell therapy in large B‐cell lymphoma with hypogammaglobulinaemia: Secondary Center for International Blood and Marrow Transplant Research analysis

Clinical Context

We think this has broad domain relevance to Adrenal Insufficiency Probability Score.

JAMAJul 21, 2026

PCOS Is Now Called PMOS

Clinical Context

We think this has broad domain relevance to Adrenal Insufficiency Probability Score.

JAMAJul 21, 2026

Correction to Primary Composite Outcome in a Trial of Transfusion Strategy

Clinical Context

We think this has broad domain relevance to Adrenal Insufficiency Probability Score.

Adrenal Insufficiency Probability Score

When to Use

When to evaluate

How it Works

Morning Cortisol Interpretation (drawn 8-9 AM)

Clinical Pearls

CBG Binding

The Acute Patient

Next Steps

Differentiating Primary vs Secondary AI

The Evidence

Guidelines

Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline

Recent Journal Updates

Adrenal Insufficiency Probability Score

When to Use

When to evaluate

How it Works

Morning Cortisol Interpretation (drawn 8-9 AM)

Clinical Pearls

CBG Binding

The Acute Patient

Next Steps

Differentiating Primary vs Secondary AI

The Evidence

Guidelines

Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline

Recent Journal Updates