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Normal values for blood and urinary steroid hormone levels (unstimulated)

Normal values for blood and urinary steroid hormone levels (unstimulated)
Test Representative normal values (may vary among laboratories)*
(micrograms/dL)		 Comments
Serum or plasma cortisol (by LC-MS/MS)
Premature infants (day 4) 26 to 28 weeks 1 to 11
  • Basal serum cortisol should be drawn between 6:00 and 8:00 AM, the time of the normal circadian peak
    • If the result is low, adrenal insufficiency is likely
    • If the result is indeterminant (low-normal), then an ACTH stimulation test is advisable to make a definitive diagnosis
    • Sampling serum cortisol later in the day is not informative, because it is normally low
  • Stresses such as hypoglycemia, fever, trauma, pain, or anxiety increase cortisol secretion
    • If early morning cortisol is low during one of these stimuli, adrenal insufficiency is likely, but a borderline low result is inconclusive
    • If the level is high-normal or elevated during one of these stimuli, adrenal insufficiency is unlikely
  • Medications such as glucocorticoids or megestrol acetate (megace) suppress endogenous cortisol production
31 to 35 weeks 2.5 to 9.1
Full-term infants 3 days 1.7 to 14
7 days 2 to 11
31 days to 11 months 2.8 to 23
Children 12 months to 15 years (8:00 AM) 3 to 21
Adults 8:00 AM 8 to 19
4:00 PM 4 to 11
Salivary cortisol (by LC-MS/MS)
Children and adults 8:00 AM 0.025 to 0.600
  • Salivary cortisol is sometimes used to screen for adrenal insufficiency in adults
  • Salivary cortisol is not established to screen for adrenal insufficiency in children, although it may be used as a screen for glucocorticoid excess (as occurs in Cushing syndrome)
Results should be interpreted using age-specific reference ranges provided by the clinical laboratory. The reference range may vary depending on the assay technique used in a given commercial laboratory. Values should also be interpreted with an understanding of the factors that affect the results (refer to comments column). Ideally, an ACTH stimulation test is included to make a definitive diagnosis of adrenal insufficiency.
LC-MS/MS: liquid chromatography-tandem mass spectrometry; ACTH: adrenocorticotropic hormone.
* Normal ranges are based on reference ranges using high-pressure LC-MS/MS from Esoterix Laboratories, Calabasas Hills, California and are used with permission.
Graphic 51607 Version 5.0

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