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The HPA Axis Hormones: 3 Noteworthy Biomarkers

Mindray 2021-01-13


AKA adrenocorticotropic hormone

A hormone produced by pituitary gland

Stimulates the production of cortisol


AKA cortisol

A steroid hormone produced by the adrenal gland

Help regulates metabolism

Suppresses the immune response

Helps to maintain blood pressure


AKA dehydroepiandrosterone sulfate

Mostly secreted by the adrenal gland

Plays a role in developing secondary sexual

Characteristics at puberty in boys

Can be converted into potent androgens and female hormone estrogen

Excess or insufficient CORT may cause symptoms as shown in the picture.

CORT test may be ordered when a person has symptoms suggesting a high or low level of cortisol.

Both ACTH and cortisol levels follow a “diurnal variation”. Commonly, they will be at their highest level in the morning and lowest at night.

Conditions impacting HPA axis could interfere with regulating ACTH and CORT.

Clinical conditions ACTH test result CORT test result
Cushing syndrome (including pituitary tumor caused Cushing disease)
Addison’s disease
Secondary adrenal insufficiency (caused by pituitary dysfunction)
Hypopituitarism or
Adrenal tumors

DHEAS level changes may be seen in the following conditions

Decreased DHEAS level may be seen in:

Adrenal insufficiency

Addison’s disease


Increased DHEAS level may be seen in:

Adrenal cortex tumors

Cushing syndrome

Adrenal hyperplasia

Early puberty in male and virilization in female


Ovarian tumors(rarely)

DHEAS test is also useful in detecting whether the adrenal glands are working properly as well as detecting adrenal tumors (both benign and malignant), congenital adrenal hyperplasia, DHEAS-producing ovarian tumor, cause of masculine physical characteristics.

DHEAS test may be ordered to evaluate adrenal function and suspect androgens overdose

DHEAS test could enhance the sensitivity of evaluating the adrenal function

Adrenal insufficiency - patient may have low DHEAS level in blood

HPA function impairment - patient could have DHEAS secretion impaired too. Recommend DHEAS test to evaluate HPA function

Suspected patient could take DHEAS test to help further detection after a LDC (low dosage corticotrophin) stimulation normal result

Detection sensitivity could be enhanced by DHEAS test

To produce the appropriate amount of hormones, the hypothalamus, pituitary, and adrenal glands must be functioning properly. Mindray provides the 3 biomarkers, ACTH, CORT and DHEAS, to assist in the awareness and management of the illnesses related to HPA AXIS.





2. Kassem LS, et al., J Clin Endocrinol Metab 97: 3655–3662, 2012
3. Al-Aridi R, et al., Endocr Pract. 2011;17:261-270

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