The Cortisol Profile, Waking marker refers to the pattern of cortisol secretion within the first hour after waking up. Cortisol is a glucocorticoid hormone produced by the adrenal cortex, playing a pivotal role in the human body's response to stress, metabolism regulation, immune response modulation, and maintenance of homeostasis. The waking cortisol profile is characterized by a sharp increase in cortisol levels upon awakening, known as the cortisol awakening response (CAR). This response is a part of the circadian rhythm of cortisol secretion, which generally follows a diurnal pattern, peaking in the early morning hours and gradually declining throughout the day to reach its lowest point at night.

The cortisol profile, specifically the measurement of cortisol levels at waking and again 30 minutes later, is a critical marker in the study of the hypothalamic-pituitary-adrenal (HPA) axis function and its response to stress. Cortisol, a glucocorticoid hormone produced by the adrenal cortex, plays a pivotal role in the body's response to stress, regulating a wide range of processes including metabolism, immune response, and the circadian rhythm. The typical pattern observed in healthy individuals is a peak in cortisol levels within the first 30 to 45 minutes after waking, known as the cortisol awakening response (CAR), followed by a gradual decline throughout the day, reaching its lowest levels at night. This diurnal variation is thought to be a result of the central circadian clock in the suprachiasmatic nucleus (SCN) of the hypothalamus, which modulates the secretion of corticotropin-releasing hormone (CRH) and subsequently adrenocorticotropic hormone (ACTH), leading to cortisol release.

The cortisol profile, particularly the "Cortisol Awakening Response (CAR)" measured at waking and 60 minutes thereafter, represents a critical biomarker in psychoneuroendocrinology, offering insights into the hypothalamic-pituitary-adrenal (HPA) axis functionality. This dynamic measure of cortisol secretion is pivotal for understanding an individual's stress response and adaptability. Upon awakening, cortisol levels sharply increase, peaking within the first 30 to 45 minutes, a phenomenon attributed to the anticipation of the upcoming day's challenges and activities. This surge, quantified by sampling salivary cortisol at waking and again 60 minutes later, encapsulates the reactivity of the HPA axis to natural circadian rhythms and psychosocial stressors.

Cortisol is the main glucocorticoid released from the adrenal gland in response to stress. High levels of cortisol have been reported in cases of Cushing’s disease, malnutrition, early life stress, hypothyroidism, depression, alcoholism, obesity, and critical illness. Additionally, exogenous exposure to glucocorticoids prior to testing may be a source of cortisol elevations.

Cortisol is the main glucocorticoid released from the adrenal gland in response to stress. High levels of cortisol have been reported in cases of Cushing’s disease, malnutrition, early life stress, hypothyroidism, depression, alcoholism, obesity, and critical illness. Additionally, exogenous exposure to glucocorticoids prior to testing may be a source of cortisol elevations.

Cortisol, often referred to as the "stress hormone," is a steroid hormone produced by the adrenal glands in response to signals from the hypothalamic-pituitary-adrenal (HPA) axis. It plays a vital role in regulating metabolism, immune responses, blood pressure, and the body's stress response. Measuring cortisol levels in saliva provides a non-invasive and accurate way to evaluate the body's cortisol production throughout the day.

Cortisol, 30 minutes post-injection is a key measurement taken during the ACTH (Cosyntropin) Stimulation Test to evaluate how well your adrenal glands respond to stimulation. It reflects the level of cortisol in the blood 30 minutes after an injection of synthetic ACTH, which normally prompts the adrenal glands to release cortisol. In healthy individuals, cortisol levels should rise significantly from baseline, typically reaching at least 18 µg/dL or higher. A normal increase suggests proper adrenal function, while a low or blunted response may indicate primary adrenal insufficiency (such as Addison’s disease), secondary adrenal insufficiency due to pituitary dysfunction, or adrenal suppression from corticosteroid use. This serum sample is collected using a standard blood draw 30 minutes after injection and is interpreted alongside baseline and 60-minute cortisol values to determine whether the hypothalamic-pituitary-adrenal (HPA) axis is functioning normally.

Cortisol, 60 minutes post-injection measures the level of cortisol in the blood one hour after an injection of synthetic ACTH (Cosyntropin) during the ACTH stimulation test. This measurement helps evaluate how well the adrenal glands sustain cortisol production in response to hormonal stimulation over time.

A normal cortisol response at 60 minutes is typically defined as a level of 18–20 µg/dL or higher, although exact thresholds may vary depending on the laboratory and the specific assay method used (for example, immunoassay vs. LC-MS/MS). In healthy individuals, cortisol levels often continue to rise between 30 and 60 minutes, with median values generally ranging from 20 to 30 µg/dL.

A cortisol level below 18 µg/dL at 60 minutes may indicate adrenal insufficiency—either primary (due to adrenal gland dysfunction, such as Addison’s disease) or secondary (due to pituitary disorders or recent corticosteroid use). Some individuals may show a delayed but ultimately adequate cortisol response that appears only at the 60-minute mark.

It is important to interpret the 60-minute cortisol value in conjunction with baseline and 30-minute results, as well as the patient’s clinical presentation. This comprehensive approach provides a more accurate assessment of adrenal function and helps guide further diagnostic or treatment decisions.

Cortisol, the main glucocorticoid (representing 75%-95% of the plasma corticoids), plays a critical role in glucose metabolism and in the body's response to stress.

The majority of cortisol circulates bound to corticosteroid-binding globulin (CBG) and albumin. Normally, less than 5% of circulating cortisol is free (unbound). Only free cortisol can access the enzyme transporters in liver, kidney, and other tissues that mediate metabolic and excretory clearance.

Both hypercortisolism (Cushing disease) and hypocortisolism (Addison disease) can cause disease. 

Cortisol is a steroid hormone synthesized from cholesterol by a multienzyme cascade in the adrenal glands. It is the main glucocorticoid in humans and acts as a gene transcription factor influencing a multitude of cellular responses in virtually all tissues. Cortisol plays a critical role in glucose metabolism, maintenance of vascular tone, immune response regulation, and in the body's response to stress. Its production is under hypothalamic-pituitary feedback control

What is cortisol?

Cortisol is a crucial steroid hormone produced by the adrenal glands, involved in various vital functions including the regulation of metabolism, blood sugar levels, anti-inflammatory actions, and the body's response to stress. To gauge an individual's physiological stress levels or diurnal rhythm, saliva is often used as a non-invasive medium for measuring cortisol.

What is LC/MS?

The liquid chromatography-mass spectrometry (LC/MS) method is a preferred analytical technique for these assessments due to its high specificity and sensitivity in detecting and quantifying cortisol in saliva.

What is cortisol?

Cortisol is a crucial steroid hormone produced by the adrenal glands, involved in various vital functions including the regulation of metabolism, blood sugar levels, anti-inflammatory actions, and the body's response to stress. To gauge an individual's physiological stress levels or diurnal rhythm, saliva is often used as a non-invasive medium for measuring cortisol.

What is LC/MS?

The liquid chromatography-mass spectrometry (LC/MS) method is a preferred analytical technique for these assessments due to its high specificity and sensitivity in detecting and quantifying cortisol in saliva.

What is cortisol?

Cortisol is a crucial steroid hormone produced by the adrenal glands, involved in various vital functions including the regulation of metabolism, blood sugar levels, anti-inflammatory actions, and the body's response to stress. To gauge an individual's physiological stress levels or diurnal rhythm, saliva is often used as a non-invasive medium for measuring cortisol.

What is LC/MS?

The liquid chromatography-mass spectrometry (LC/MS) method is a preferred analytical technique for these assessments due to its high specificity and sensitivity in detecting and quantifying cortisol in saliva.

Cortisol is a stress hormone produced by the adrenal glands and is the primary agent used in our body’s flight or fight response to threatening stimuli. Levels naturally peak in the morning and then reach their lowest point at night. A high blood cortisol level at night may indicate a problem with the adrenal glands; however, individuals who work at night and sleep during the day will have an inversed pattern.

Corticosteroid-binding globulin (CBG), also known as transcortin, is a key plasma protein that plays a critical role in the transport and regulation of corticosteroids in the bloodstream. Produced primarily by the liver, CBG binds to glucocorticoids such as cortisol, the body’s primary stress hormone. By binding these hormones, CBG regulates their availability and helps control their biological activity. Around 80-90% of circulating cortisol is bound to CBG, ensuring that only a small fraction is free and biologically active. This intricate regulation is crucial for maintaining hormone balance and responding to stress.

CBG is not only responsible for cortisol transport, but it also acts as a reservoir that releases cortisol in response to changing physiological needs. When the body encounters stress, injury, or inflammation, enzymes like neutrophil elastase can cleave CBG, releasing bound cortisol to target tissues. This enables a rapid response to acute stress, increasing the body’s ability to cope with immediate physiological challenges. Without this mechanism, the body would struggle to meet the hormonal demands necessary to maintain homeostasis in stressful situations.