Synthetic data only. Never enter patient information; nothing is sent or stored. For clinicians. Not FDA cleared.For licensed clinicians. Educational demonstration on synthetic data. Never enter real patient identifiers or protected health information: everything runs in your browser and nothing is sent or stored. Clinical decision support only; not FDA cleared; physician review is required.
CPE-008 · synthetic case ADR-FX-17
Cortisol 14 on an oral contraceptive
Binding globulin raises total cortisol.
Purpose: Binding globulin raises total cortisol.
Inputs the engine received
Cortisol testing
- 8 am total cortisol
- 14 µg/dL
- Estrogen, oral contraceptive or pregnancy
- Yes
Chemistry and vitals
- Age
- 31 years
Symptoms and signs
- Fatigue
- Yes
- Hyperpigmentation (skin, scars, gums, palmar creases)
- Yes
What the engine reports
estrogen, oral contraceptive or pregnancy. Treat the cortisol as provisional and repeat an 8 am cortisol with ACTH after the confounder is addressed, or use an ACTH-stimulation test.
Detected clinical pattern
Indeterminate Morning Cortisol — Stimulation Test Needed
A morning cortisol between 5 and 15 µg/dL does not settle the question.
Why this pattern was identified
- Morning cortisol. 14 µg/dL: indeterminate, an ACTH-stimulation test is needed (Endocrine Society; consensus statement).
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Repeat an 8 am cortisol with ACTH after the confounder is addressed, or use an ACTH-stimulation test.
- 2Perform an ACTH-stimulation test (250 µg cosyntropin) to settle an indeterminate morning cortisol.
Differentials, pitfalls and contradicting signals
- Hyperpigmentation has other causes (sun exposure, other endocrine and dermatologic conditions); it is a clue, not a diagnosis.
Missing information
- ACTH (to separate primary from secondary adrenal insufficiency).
Evidence and rule trace · 4 rules
AI-VAL-01Cortisol result may be unreliable
Inputs: estrogen, oral contraceptive or pregnancy
Total cortisol may mislead; interpretation is provisional.
AI-02Hyperpigmentation
Inputs: hyperpigmentation documented
A strong clue to primary adrenal insufficiency; testing is warranted.
AI-04Morning cortisol band
Inputs: 8 am cortisol 14 µg/dL
Indeterminate (5 to <15 µg/dL): an ACTH-stimulation test is needed.
AI-MISS-01ACTH needed to place the axis
Inputs: low cortisol or insufficient stimulation · ACTH not entered
Primary versus secondary cannot be separated without ACTH.
Evidence
- EV-ES-PAI-2016 · Bornstein SR, Allolio B, Arlt W, et al. Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(2):364-389.
- EV-HUSEBYE-2014 · Husebye ES, Allolio B, Arlt W, et al. Consensus statement on the diagnosis, treatment and follow-up of patients with primary adrenal insufficiency. J Intern Med. 2014;275(2):104-115.
- EV-ES-GCAI-2024 · Beuschlein F, Else T, Bancos I, et al. European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and therapy of glucocorticoid-induced adrenal insufficiency. J Clin Endocrinol Metab. 2024;109(7):1657-1683.
Physician adjudication required. Clinical decision support for physician review. This output identifies laboratory patterns and safety situations. It does not diagnose adrenal insufficiency, name a glucocorticoid dose, or replace emergency treatment. Physician adjudication is required.
Change the values
The same engine, starting from this case. Change any value and watch the pattern and the rule trace react.
Morning cortisol bands
Cortisol testing
- <5 very likely
- 5–14.9 indeterminate
- ≥15 unlikely
46 pg/mL is assumed when empty.
Chemistry and vitals
Symptoms and signs
Exposures, history and context
More adrenal cases
ADR-FX-01
Low sodium, high potassium, weight loss and nausea
A 44-year-old with hyperpigmented scars.
ADR-FX-02
Hyperpigmentation and fatigue
No labs yet.
ADR-FX-03
Salt craving and dizziness on standing
Low sodium.
ADR-FX-04
Cortisol 2.1 with ACTH 180
Low cortisol and high ACTH: a primary pattern.
ADR-FX-05
Morning cortisol 9 µg/dL
Indeterminate.
ADR-FX-06
Morning cortisol 17 µg/dL
Unlikely.
Try Biod in your practice
The Clinical Intelligence Layer — transforming fragmented clinical information into structured intelligence for clinician review and action.