Lab result explainedHormonesLast updated November 10, 2026

ACTH blood test: what high and low adrenocorticotropic hormone means

Adrenocorticotropic hormone (ACTH) · Adrenal function (ACTH with a paired cortisol) · reported in pg/mL (SI units pmol/L; 1 pg/mL = 0.22 pmol/L)

Adrenocorticotropic hormone (ACTH, also called corticotropin) is the hormone the pituitary gland releases to tell the adrenal glands to make cortisol. An ACTH blood test measures how much of that signal is in your blood, and it is almost always drawn together with a cortisol level at the same moment, because the two numbers only make sense as a pair. A normal morning ACTH is roughly 7 to 63 pg/mL, with the exact range depending on the laboratory and the assay.

ACTH is ordered when cortisol has already been found to be too high (Cushing's syndrome) or too low (adrenal insufficiency), to work out where the problem sits. If cortisol is high and ACTH is also high or not suppressed, the drive is coming from the pituitary or, less often, from a tumor elsewhere that makes ACTH. If cortisol is high and ACTH is very low, the adrenal gland itself is overproducing. If cortisol is low and ACTH is high, the adrenal glands have failed (Addison's disease); if both are low, the pituitary is not sending the signal, most commonly because steroid medicines have switched it off.

The test is fussy about timing and handling. ACTH peaks between about 6 and 8 am and falls to its lowest around midnight, so a result is only interpretable if you know when it was drawn. The hormone breaks down quickly in a tube at room temperature, so blood is collected in a chilled EDTA (lavender-top) tube, kept on ice and separated within an hour or so. A single number outside the range, drawn at the wrong time or handled slowly, is often repeated before anyone acts on it.

ACTH at a glance

What it is: the pituitary hormone that stimulates cortisol production; measured in picograms per millilitre (pg/mL).
Normal (8 am sample): about 7–63 pg/mL in most US labs; some quote 10–60. Midnight values in healthy people are usually under 10 pg/mL.
Read with cortisol: high cortisol plus ACTH above about 20 pg/mL points to a pituitary or ectopic source; high cortisol with ACTH under 5 pg/mL points to the adrenal gland itself.
Low cortisol with a high ACTH (often above 100 pg/mL) means primary adrenal insufficiency (Addison's disease); low cortisol with low or normal ACTH means a pituitary cause or, most often, steroid medicines.
Stress, illness, pain, a rushed blood draw and a sample left warm all distort the result; a lone abnormal value is usually repeated.
Next step: paired cortisol, then a stimulation or suppression test chosen by your clinician, and imaging of the pituitary or adrenals only once the hormone pattern is clear.

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What ACTH measures

ACTH is cut from a larger pituitary protein called pro-opiomelanocortin (POMC) in response to corticotropin-releasing hormone (CRH) from the hypothalamus. It travels to the adrenal cortex, binds its receptor, and within minutes drives the synthesis of cortisol and, to a lesser degree, adrenal androgens such as DHEA. Cortisol feeds back on the pituitary and hypothalamus to switch ACTH off, which is why the two hormones are read together: the ratio tells you which gland is leading and which is following.

The lab measures ACTH by an immunoassay that uses two antibodies to capture the intact 39-amino-acid hormone. Because ACTH is released in pulses, follows a strong day-night rhythm and is degraded by enzymes in plasma within minutes, pre-analytical handling matters as much as the assay itself. The sample should be drawn at a stated time (usually 8 am, or midnight for a Cushing's work-up), placed on ice, centrifuged in a refrigerated centrifuge and frozen promptly. Hemolysis and delays both falsely lower the result.

Several things raise ACTH that have nothing to do with disease: the stress of venepuncture, acute illness, pain, low blood sugar, intense exercise in the previous hour and heavy alcohol use. Glucocorticoid medicines in any form (tablets, injections, inhalers, nasal sprays, potent skin creams, joint injections) suppress it, sometimes for months after they are stopped, and long-term opioids suppress it as well. Oral estrogen does not change ACTH directly but raises total cortisol by increasing its binding protein, which can confuse the pair.

Normal range for ACTH

Reference ranges vary between labs and by age, sex and pregnancy. Use the range printed on your own report.

Group	Typical range (pg/mL (SI units pmol/L; 1 pg/mL = 0.22 pmol/L))	Notes
Adults, 8 am sample	About 7–63 pg/mL	The most widely quoted US reference interval; some labs use 10–60 or 6–50 pg/mL. Labs differ; use the interval printed on your report.
Adults, midnight sample	Usually below 10 pg/mL	Healthy people lose most of their ACTH and cortisol overnight. A midnight ACTH and cortisol that stay high is one sign of Cushing's syndrome.
High cortisol, ACTH below 5 pg/mL	Suppressed	ACTH-independent Cushing's syndrome: an adrenal adenoma, adrenal carcinoma or bilateral adrenal nodules making cortisol on their own.
High cortisol, ACTH 5–20 pg/mL	Indeterminate	Can be either type; usually needs a CRH or desmopressin stimulation test and a high-dose dexamethasone test to sort out.
High cortisol, ACTH above 20 pg/mL	Not suppressed (ACTH-dependent)	About 80 percent are a pituitary adenoma (Cushing's disease), typically 20–200 pg/mL; the rest are ectopic ACTH from a tumor elsewhere, often but not always above 200 pg/mL.
Low cortisol, ACTH above about 100 pg/mL	High	Primary adrenal insufficiency (Addison's disease). Values of several hundred to over 1,000 pg/mL are common; ACTH more than twice the upper limit with a morning cortisol under 5 µg/dL is close to diagnostic.
Low cortisol, ACTH low or normal	Inappropriately low	Secondary adrenal insufficiency: pituitary disease or, far more often, suppression by steroid medicines or opioids.
Newborns and infants	Higher, up to around 130 pg/mL in the first days	Pediatric intervals differ by age; congenital adrenal hyperplasia produces very high ACTH with high 17-hydroxyprogesterone.

High ACTH

A high ACTH means the pituitary (or, rarely, a tumor elsewhere) is pushing hard on the adrenal glands. What it signifies depends entirely on the cortisol drawn at the same time. If cortisol is low, the adrenal glands are failing and the pituitary is shouting to compensate: this is primary adrenal insufficiency, usually autoimmune Addison's disease in the US, and ACTH is typically in the hundreds. Because ACTH shares its precursor with melanocyte-stimulating hormone, these very high levels darken the skin, which is why a tan that does not fade, dark creases on the palms and dark patches on the gums are classic clues.

If cortisol is high and ACTH is normal or high (above about 20 pg/mL), cortisol is being driven from above. Roughly four in five such cases are a small, benign pituitary adenoma (Cushing's disease), where ACTH is usually only modestly raised or even within the normal range, just not suppressed as it should be. The remainder are ectopic ACTH syndrome, where a tumor outside the pituitary, most often a small-cell lung cancer or a bronchial or pancreatic neuroendocrine tumor, secretes ACTH; levels there are often very high, cortisol is extreme and potassium is low. The two are separated with dexamethasone suppression testing, CRH or desmopressin testing, pituitary MRI and, when needed, sampling blood directly from the veins draining the pituitary.

Modest elevations with a normal cortisol are common and mostly benign: a stressful or painful blood draw, an acute illness, recent hard exercise, depression, heavy drinking, uncontrolled diabetes or simply a sample drawn at 6 am rather than 8. These are repeated under calm, fasting, morning conditions before anything else is done. Rare causes include congenital adrenal hyperplasia, Nelson's syndrome after both adrenal glands have been removed, and interference from heterophile antibodies in the assay.

Common causes

Primary adrenal insufficiency (Addison's disease)
Autoimmune destruction of the adrenal cortex accounts for about 80 percent of US cases; tuberculosis, bleeding into the glands, fungal infection, metastases and certain drugs (ketoconazole, mitotane, immune checkpoint inhibitors) cause the rest. ACTH rises into the hundreds while cortisol and often aldosterone fall.
Cushing's disease (pituitary adenoma)
A small ACTH-producing adenoma keeps making ACTH despite high cortisol. ACTH is usually 20 to 200 pg/mL, which is why a 'normal' ACTH with a high cortisol is still abnormal: it should be suppressed.
Ectopic ACTH syndrome
Small-cell lung cancer, bronchial carcinoid, thymic and pancreatic neuroendocrine tumors, medullary thyroid cancer and pheochromocytoma can secrete ACTH. Levels are often above 200 pg/mL with very high cortisol, low potassium, muscle wasting, high blood sugar and rapid weight loss rather than weight gain.
Congenital adrenal hyperplasia
An inherited block in cortisol synthesis, most often 21-hydroxylase deficiency, lowers cortisol and raises ACTH, which in turn drives excess androgens and 17-hydroxyprogesterone. Diagnosed in infancy or, in milder forms, in adults being investigated for irregular periods or hirsutism.
Stress, acute illness and pain at the time of the draw
ACTH responds within minutes to fear of needles, pain, fever, surgery, trauma and hypoglycaemia. A value drawn in an emergency department or during a difficult venepuncture is not a baseline.
Sampling before 8 am, shift work or jet lag
ACTH peaks between about 6 and 8 am. A 6 am draw reads higher than an 8 am one, and night-shift workers may have their peak in the afternoon. The time of day should be written on the request.
Depression, alcohol use disorder, uncontrolled diabetes and severe obesity (pseudo-Cushing's)
Each activates the stress axis enough to raise ACTH and cortisol and blunt dexamethasone suppression in a substantial minority of people. The abnormality settles when the underlying problem is treated, which is how it is distinguished from true Cushing's.
Nelson's syndrome
After both adrenal glands are surgically removed for Cushing's disease, the loss of cortisol feedback can let the pituitary adenoma enlarge and secrete extreme amounts of ACTH, with marked skin darkening.
Glucocorticoid resistance and assay interference
A rare inherited insensitivity to cortisol raises both ACTH and cortisol without Cushing's features. Heterophile antibodies and biotin supplements can give falsely high or low immunoassay results on some platforms.

Symptoms that can go with it

With Addison's disease: profound fatigue, weight loss, poor appetite, nausea, salt craving, dizziness on standing and darkening of the skin, gums, scars and skin creases
With Cushing's disease or ectopic ACTH: weight gain around the trunk and face, a fat pad between the shoulders, thin skin that bruises easily, wide purple stretch marks, muscle weakness in the thighs, high blood pressure and high blood sugar
Low mood, anxiety, irritability or poor sleep (both high and low cortisol states)
Irregular or absent periods, reduced libido, acne or excess facial hair
Muscle cramps, weakness or palpitations from low potassium, particularly with ectopic ACTH
Often no symptoms at all when the rise is from stress, timing or an acute illness

Low ACTH

A low ACTH is only meaningful alongside cortisol. If cortisol is high and ACTH is suppressed (under 5 pg/mL), the pituitary has done its job and switched off, which means the cortisol is coming from the adrenal gland itself: a benign cortisol-producing adenoma, less often an adrenal carcinoma, or bilateral adrenal nodules. The next step is adrenal imaging rather than pituitary imaging. Mild cortisol excess from an adrenal nodule found by chance on a CT scan (sometimes called mild autonomous cortisol secretion) is far more common than full Cushing's syndrome and produces a low-normal ACTH with a cortisol that fails to suppress on an overnight dexamethasone test.

If cortisol is low and ACTH is also low or just within normal, the pituitary is not producing the signal it should. The commonest reason by far is glucocorticoid medicine: prednisone, dexamethasone, hydrocortisone, injected steroids for joints or back pain, and even high-dose inhaled, intranasal or potent topical steroids can suppress the axis within a few weeks of use, and recovery after stopping can take from weeks to a year. Long-term opioid use is the next most common cause, found in roughly 9 to 29 percent of people on chronic opioids in surveys. Less often, the pituitary itself is damaged by a tumor, surgery, radiation, bleeding, inflammation (hypophysitis, including that caused by immune checkpoint cancer drugs), head injury or postpartum pituitary infarction.

Secondary adrenal insufficiency looks different from Addison's. Aldosterone, which is controlled by the kidney rather than ACTH, is preserved, so salt craving, high potassium and severe dehydration are unusual, and the skin is pale rather than dark. Fatigue, nausea, weight loss, low sodium and low blood sugar are the typical features, and a person can still slip into adrenal crisis under the stress of surgery, infection or injury.

Common causes

Glucocorticoid medicines in any form
Prednisone 5 mg a day or more (or the equivalent) for longer than three weeks suppresses ACTH in most people; inhaled fluticasone, intranasal steroids, potent skin creams, epidural and joint injections and some over-the-counter or herbal products containing hidden steroids do the same. Recovery after stopping typically takes one to twelve months.
Cortisol-producing adrenal adenoma, carcinoma or nodular hyperplasia
The adrenal gland makes cortisol autonomously, which suppresses ACTH to under 5 pg/mL. Most are benign adenomas; carcinoma is suggested by a large tumor, rapid onset and co-secretion of androgens.
Long-term opioid use
Opioids suppress CRH and ACTH release. Opioid-induced adrenal insufficiency is under-recognized and reverses when the dose is reduced or stopped.
Pituitary tumors, surgery and radiation
A non-functioning adenoma, prolactinoma or craniopharyngioma compressing normal pituitary tissue, or treatment of one, reduces ACTH output, usually together with low growth hormone, LH/FSH and TSH.
Hypophysitis and infiltrative disease
Autoimmune inflammation of the pituitary, hypophysitis triggered by immune checkpoint inhibitors (ipilimumab in particular), sarcoidosis, hemochromatosis and histiocytosis can selectively knock out ACTH production.
Sheehan's syndrome and traumatic brain injury
Severe blood loss at delivery can infarct the pituitary, presenting as failure to breastfeed, fatigue and absent periods; moderate to severe head injury causes pituitary dysfunction in a meaningful minority of survivors.
Megestrol, medroxyprogesterone and ketoconazole
High-dose progestins such as megestrol acetate have glucocorticoid activity and suppress ACTH; ketoconazole blocks cortisol synthesis and is used therapeutically but complicates testing.
Sample degradation
A tube left at room temperature or processed slowly loses ACTH, giving a falsely low value in someone whose true level is normal or high.

Symptoms that can go with it

Fatigue, weakness, nausea, poor appetite and weight loss that build over weeks to months
Dizziness or fainting on standing, low blood pressure
Low blood sugar, particularly in children or after missed meals
Low sodium on routine blood tests, with confusion or headache if severe
With an adrenal cause of cortisol excess: central weight gain, round face, easy bruising, muscle weakness, high blood pressure
Pale skin (no darkening, unlike Addison's disease) and loss of pubic and underarm hair in women

Read it alongside

Cortisol (serum, 8 am) — the essential partner; neither ACTH nor cortisol can be interpreted alone, and the pair is drawn from the same needle at the same minute.
Late-night salivary cortisol and 24-hour urinary free cortisol — the first-line tests that establish cortisol excess before ACTH is used to find its source.
Dexamethasone suppression test — an overnight 1 mg test screens for Cushing's; higher-dose testing helps separate pituitary from ectopic ACTH.
ACTH (cosyntropin) stimulation test — a cortisol rise to under about 18 µg/dL (14 to 15 on newer assays) after synthetic ACTH confirms adrenal insufficiency.
Sodium and potassium — low sodium with high potassium suggests Addison's disease; low potassium with very high cortisol suggests ectopic ACTH.
DHEA-S — low in both primary and secondary adrenal insufficiency; very high in adrenal carcinoma.
Renin and aldosterone — high renin with low aldosterone confirms the mineralocorticoid loss of primary adrenal failure.
Glucose and A1C — cortisol excess raises blood sugar; cortisol deficiency lowers it.

What usually happens next

If the ACTH was not drawn with a simultaneous cortisol, or the time of day and sample handling are unknown, expect it to be repeated as a properly timed, chilled, paired sample before any conclusion is drawn.
Tell your clinician about every steroid you use, including inhalers, nasal sprays, creams, joint or spinal injections, and any opioid, because these are the leading explanation for a low ACTH with low cortisol.
For a suspected low-cortisol state, the next test is usually a cosyntropin stimulation test; for a suspected high-cortisol state, two of a late-night salivary cortisol, a 24-hour urine cortisol and an overnight dexamethasone test come first.
Imaging follows the hormone pattern: pituitary MRI when ACTH is not suppressed, adrenal CT when it is. Scanning before the biochemistry is settled finds incidental nodules in up to one in twenty adults and causes confusion.
Ask for an endocrinology referral once an abnormal pattern is confirmed; both Cushing's syndrome and adrenal insufficiency are specialist diagnoses with specific treatments.

Diet, lifestyle and natural levers with evidence

What can move ACTH once the cause is known. Nothing here replaces finding the cause.

Have the test drawn at the right time, rested and fasting

Moderate evidence

ACTH and cortisol at midnight are normally under 10 to 20 percent of the 8 am value, and a draw taken an hour or two off the scheduled time, after a sleepless night or straight after a hard workout can sit outside the range in a healthy person. Shift workers and recent long-haul travellers have a shifted rhythm; tell the lab your usual sleep hours so the sample is timed to your morning, not the clock's. Sit quietly for 15 to 30 minutes before the draw, since the stress of venepuncture itself raises ACTH within minutes.

Review steroid-containing medicines and opioids before testing

Strong evidence

Prednisone at 5 mg a day or more for over three weeks suppresses ACTH in most people, and inhaled fluticasone above about 500 µg a day, intranasal steroids, potent topical steroids, epidural and joint injections and some imported herbal or 'joint pain' products that contain hidden corticosteroids do the same. A meta-analysis of studies in long-term opioid users found adrenal suppression in roughly 9 to 29 percent. These are the commonest reasons for a low ACTH with a low cortisol, and the axis usually recovers over one to twelve months once the drug is tapered.

Never stop a steroid or opioid abruptly to 'clean up' a test; sudden withdrawal after prolonged use can precipitate adrenal crisis. Any change is planned with the prescriber.

Address alcohol, depression, sleep loss and weight (pseudo-Cushing's)

Moderate evidence

Heavy regular alcohol use raises ACTH and cortisol and can blunt dexamethasone suppression; the pattern normalizes within one to four weeks of abstinence, which is why testing is repeated after a dry period. Major depression activates the axis in a substantial minority of people, with cortisol typically 20 to 40 percent higher across the day, and untreated sleep apnea and severe obesity have similar effects. Treating the underlying condition brings the hormones back; nothing about the pituitary or adrenal gland needs fixing in these cases.

Ashwagandha and other 'adaptogens'

Preliminary evidence

Small randomised trials in stressed but otherwise healthy adults report that ashwagandha root extract (240 to 600 mg a day for 8 weeks) lowers morning serum cortisol by around 20 to 30 percent compared with placebo, with a meta-analysis of these trials finding a modest overall reduction. None measured ACTH, none involved people with pituitary or adrenal disease, and no herb or supplement treats Cushing's syndrome or adrenal insufficiency.

Ashwagandha has been linked to rare cases of liver injury, can raise thyroid hormone levels, and should be avoided in pregnancy. It can mask the picture if taken in the weeks before adrenal testing; tell your clinician what you take.

When to see a clinician promptly

Vomiting, severe weakness, confusion, abdominal pain, fever or fainting in anyone with known adrenal insufficiency, on long-term steroids or with a recent low cortisol result: possible adrenal crisis, a medical emergency that needs an injection of hydrocortisone and emergency care the same hour.
A low cortisol with a high ACTH, or any cortisol under 3 to 5 µg/dL in the morning, even without dramatic symptoms: adrenal insufficiency needs treatment started promptly and a steroid emergency card.
High cortisol with a very high ACTH, low potassium, rapid weight loss, muscle wasting or a smoking history: ectopic ACTH syndrome can be caused by a lung or neuroendocrine tumor and is investigated urgently.
New skin darkening with fatigue, salt craving and weight loss, particularly with a personal or family history of autoimmune thyroid disease, type 1 diabetes or vitiligo.
Sudden severe headache with visual change or drowsiness after a known pituitary tumor or a low ACTH: possible pituitary apoplexy, an emergency.
Failure to breastfeed, exhaustion and absent periods after a delivery complicated by heavy bleeding (Sheehan's syndrome).

Frequently asked questions

What is a normal ACTH level?

For a sample drawn at about 8 am, most US laboratories quote roughly 7 to 63 pg/mL (some use 10 to 60 or 6 to 50). Midnight values in healthy people are usually under 10 pg/mL. The number only means something next to a cortisol drawn at the same time: a 'normal' ACTH of 30 pg/mL is appropriate if cortisol is normal, abnormal if cortisol is very high (it should be suppressed) and abnormal if cortisol is very low (it should be much higher).

What does it mean if ACTH is high and cortisol is low?

The adrenal glands are not responding to the pituitary's signal, which is primary adrenal insufficiency, or Addison's disease. ACTH is typically several hundred pg/mL with a morning cortisol under 5 µg/dL. Autoimmune damage is the usual cause in the US. It is confirmed with a cosyntropin stimulation test and treated with lifelong hormone replacement; untreated it can progress to a life-threatening adrenal crisis.

What does high ACTH and high cortisol mean?

Cortisol is being driven from above rather than coming from the adrenal gland on its own. About 80 percent of the time the source is a small benign pituitary tumor (Cushing's disease), where ACTH is often only mildly raised or even in the normal range. The rest are ectopic ACTH from a tumor elsewhere, usually with much higher ACTH, very high cortisol and low potassium. Dexamethasone and CRH or desmopressin testing, pituitary MRI and sometimes sampling of the veins draining the pituitary separate the two.

What does low ACTH and low cortisol mean?

The pituitary is not producing enough ACTH, so the adrenal glands are under-stimulated. Steroid medicines of any kind, including inhalers, nasal sprays, skin creams and injections, are by far the most common cause, and long-term opioids are the next. Pituitary tumors, surgery, radiation, head injury and inflammation of the pituitary account for the rest. Unlike Addison's disease, the skin is pale, salt craving is absent and potassium is normal, but adrenal crisis is still possible under stress.

Can stress raise ACTH?

Yes, quickly. ACTH is the stress hormone's messenger and rises within minutes of pain, fear, a difficult blood draw, acute illness, low blood sugar or hard exercise. Chronic stress, depression and heavy drinking raise the daily average more modestly and can mimic early Cushing's syndrome on screening tests. For a baseline value you should be rested, fasting and seated quietly for 15 to 30 minutes, with the draw at the scheduled time.

How do I prepare for an ACTH blood test?

It is usually drawn first thing in the morning, typically between 7 and 9 am, after an overnight fast and before any morning steroid dose. Avoid strenuous exercise, alcohol and a late night beforehand, and tell the lab about any steroid, opioid, biotin supplement or estrogen you take. The blood goes into a chilled lavender-top tube that is kept on ice, so the draw is often done at a hospital or specialist lab rather than a routine clinic.

Why do steroids and inhalers lower ACTH?

Any glucocorticoid, whether swallowed, inhaled, sprayed, injected or rubbed on, is read by the pituitary as cortisol and switches ACTH off. Prednisone 5 mg a day for three weeks, high-dose inhaled fluticasone, repeated joint or spinal injections and potent skin creams used over large areas can all do it. When the drug stops, the adrenal glands may take weeks to a year to recover, which is why long courses are tapered rather than stopped and why a low ACTH is never interpreted without a medication history.

What is the difference between an ACTH test and an ACTH stimulation test?

An ACTH blood test measures your own hormone level. An ACTH (cosyntropin) stimulation test injects a synthetic form of ACTH and measures how much cortisol the adrenal glands produce in response 30 and 60 minutes later; a peak under about 18 µg/dL (14 to 15 on some newer assays) means the glands cannot respond normally. The blood level tells you where a problem sits; the stimulation test tells you whether the adrenal glands can still do their job.

References

ACTH test. MedlinePlus, US National Library of Medicine (2023)View source
Adrenal insufficiency & Addison's disease. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (2024)View source
Cushing's syndrome. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (2023)
Nieman LK, Biller BM, Findling JW, et al.. The diagnosis of Cushing's syndrome: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism (2008)
Bornstein SR, Allolio B, Arlt W, et al.. Diagnosis and treatment of primary adrenal insufficiency: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism (2016)
Lacroix A, Feelders RA, Stratakis CA, Nieman LK. Cushing's syndrome. The Lancet (2015)
Charmandari E, Nicolaides NC, Chrousos GP. Adrenal insufficiency. The Lancet (2014)
de Vries F, Bruin M, Lobatto DJ, et al.. Opioid-induced adrenal insufficiency: a systematic review and meta-analysis. Journal of Clinical Endocrinology and Metabolism (2020)
Lopresti AL, Smith SJ, Malvi H, Kodgule R. An investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract: a randomized, double-blind, placebo-controlled study. Medicine (Baltimore) (2019)
Cushing syndrome. Merck Manual Professional Version (2024)
Addison disease. Merck Manual Professional Version (2024)
Adrenal insufficiency. Endocrine Society, Patient Resources (2022)

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This page is educational and is not medical advice or a diagnosis. Lab results have to be interpreted together with your history, symptoms and other results by a clinician who knows you. Do not start or stop a supplement to change a lab value before the cause is known.